NHS trusts in the South of England using Cerner Millennium Release 0 are not yet able to electronically capture 18 week referral to treatment (RTT) data, one of the government’s key objectives for the NHS.
Trusts have been required to report on RTT times since January, with the target to be achieved for all 18-week waits by the end of 2008. Documents seen by E-Health Insider from the local service provider in the south, Fujitsu, say that Cerner Millennium R0 cannot measure RTT as it was specified before the policy was introduced.
Two of the trusts who had the Millennium patient administration system delivered by Fujitsu before April have confirmed to EHI that getting 18 weeks pathways data from R0 is still a challenge for them and they are now looking at other ways of obtaining this information.
One trust, the Winchester and Eastleigh Healthcare NHS Trust, said that they currently rely on the manual collection of data for their reporting of RTT times, as their new Millennium system does not enable them to collect and report of the necessary data.
In national figures released last week, the trust was identified as having only achieved 22% of their referrals within the 18 week timescale, making the trust one of the poorer performing trusts in the country.
In a statement, the trust’s acting chief executive, Juliet Beal, said: "We have the first stage of NHS Care Records Service (Release 0) which does not yet have the capacity to monitor the new 18 week target. As a pilot site, we will be at the forefront of making this happen.
"Our old computer system could not be upgraded to enable us to monitor the new 18 week target. We will have both the software and the procedures for accurate performance monitoring in place by December 2007 at the latest – a full 12 months before the new national target comes into force."
She added: "This trust is confident that it can build on its success in cutting waiting times to meet the 18 week target from referral to treatment."
The Nuffield Orthopaedic Centre (NOC), the first site to receive R0 from Fujitsu, was named as the joint worst trust for waiting times in the country, completing just 5% of their referrals within the 18 weeks target.
As EHI reported last month, the NOC are still experiencing problems with the system 18 months after going live and have recently purchased a separate information management reporting system from Infoflex to help meet statutory reporting requirements, including 18-week waits.
An NOC trust spokesperson told EHI: "Infoflex is an information management tool that will help the NOC with Department of Health targets, but also delivers other useful functionality that is not part of the scope of the NHS CRS project."
The software has been successfully used by the neighbouring Oxford Radcliffe Hospitals Trust, who achieved 60% of patient referrals within 18 weeks using the technology to keep track of appointments.
Sarah Pennington, Oxford’s 18-week programme manager, said: "We’re working with every department to take out the bottlenecks and improve and sustain the changes we have made. Being able to integrate the many patient IT systems that we have across the trust will enable us to manage all patients’ pathways and improve the care that patients receive as a consequence."
The NOC say they are confident that the new tool will help them increase their performance in a similar way. Sara Randall, NOC’s acting director of operations, said: "We have robust plans in place and are fully confident that we will achieve the December 2008 target date."
Connecting for Health said they are working with both BT, local service provider to London, and Fujitsu, to ensure that Millennium is able to capture the necessary data in the future. Existing systems suppliers are also working to ensure their systems support 18 weeks.
Documents seen by EHI indicate that Fujitsu has since January been pursuing a ‘tactical solution’ – based on data extracted from Cerner Millennium R0 that will measure RTT times across the majority, but not all, elective care pathways, requiring trusts to manually record excluded pathways. The system is for instance unable to handle "transfers between providers".
In a statement Cerner said: "A solution to support the 18 week wait target is currently available and Cerner is working closely with all parties to integrate appropriate changes for those trusts that require it. Depending on their specific needs and implementation timelines, Trusts can choose to implement the current solution as it is or wait for additional features to be available."
A spokesperson told EHI: "Currently Cerner Millennium Release 0 does not support the new 18 week target as trusts would require. We are working hard to ensure that the appropriate changes are put in place for those trusts operating Cerner Millennium so that they can hit the January 2008 deadline.
In London three trusts will be going live on Cerner Millennium before the end of the year, of these Barts and the London NHS Trust is working with BT to adapt the system to meet specific requirements and it is envisaged that this will be delivered in the appropriate timescales. The remaining two trusts are content to work with Cerner Millennium in its current form.
In the South, six trusts have deployed Cerner Millennium. We are currently in negotiations with Fujitsu regarding making changes to the system to enable monitoring of the 18 week target, in addition to looking at alternative options that would be delivered in the timescales."
Marc Warburton, chief executive of CIMS, developers of InfoFlex said that while trusts waited, the InfoFlex toolset would allow them to approach 18 Week Pathway projects in different ways according to the quality of the data sources available.
"InfoFlex can build the 18 week pathway from data collected on disparate systems either though the use of unique identifiers or through the definition of locally defined data rules.
The flexibility of the toolset allows the system to expand and change as the users increase the systems scope and capability."
Nearly half of all patients are currently being treated within 18 weeks, a year and a half ahead of schedule, according to the Department of Health figures.
Links
InfoFlex http://www.infoflex-cims.co.uk/indexflash.htm