Ongoing delays in implementations of Release 0 of the Cerner Millennium Care Record Service (CRS) in the south of England are having a knock effect, pushing back deployment dates for trusts awaiting Release 1 of the software.

As a result several hospital trusts in the South currently have no firm implementation date for implementation, while others are taking a wait and see approach before committing to the Cerner software.

Three southern trusts have told EHI they don’t currently have implementation dates, including Royal West Sussex NHS Trust which says it will need confidence in 17 separate areas before it can commit to taking the software.

To date Fujitsu, the LSP for the South of England, has deployed the Release 0 version of Millennium to eight trusts. The Release 0 version of Millennium is based on the software installed by Cerner at Newham and Homerton prior to the beginning of the NHS IT programme, though this has since undergone modifications.

Problems are still being reported with adapting this initial software to enable trusts to meet NHS reporting requirements including basic common data set (CDS) reporting due to software not yet able to capture all the data required.

One well-placed source told EHI: "The basic problem is that Millennium doesn’t yet capture all the information trusts need for reporting." The impact of this problem was felt most severely at Nuffield Orthopaedic Trust (NOC) – which was marked down last year by the Healthcare Commission for breaching wait targets.

Eighteen months on, NOC is still experiencing problems and has recently purchased a separate information management reporting system from Infoflex to help meet statutory reporting requirements. The trust told EHI that CRS was just one of many systems it uses to deliver day-to-day operations.

Other outstanding issues include unfamiliar workflow and integration with the national Choose and Book system. The NOC has confirmed to EHI that it has yet to integrate Millennium with the Choose and Book system – a service run by Atos Origin using Millennium-based software supplied by Cerner.

The first full version of Millennium tailored to the NHS IT Programme requirements is Release 1, which had been due this month but is now not expected until the autumn and possibly not until 2008. Further development work is now understood to be required in areas ranging from mental health to 18-week wait recording and reporting.

There is now a question mark over whether the R1 software will be ready meet the December deadline the DH has set for trusts to record and report on 18-week waits. One industry source told EHI. "They won’t meet the 18 week wait date and the Choose and Book problems are still not resolved."

A senior NHS source in the south, however, told E-Health Insider last week that work is almost complete on R1 and the specification of the subsequent R2 is on the verge of being closed. They explained that it had been necessary to re-open the work on R1 to make the software compliant with changes in the Mental Health Act.

With the roll out of release 0 running late and the NHS IT Programme version of the Millennium software now not due until 2008 trusts are once again facing delays. Some are sitting tight as they receive mixed messages about the success of implementations so far, ranging from very positive at Winchester to fairly negative at Milton Keynes – where last month 79 staff signed a letter highlighting failings of the system.

Trust reaction to Release 0 also appears to heavily influenced by how sophisticated the patient administration system they had prior to Millennium, together with how careful the data cleansing and migration process was.

A board paper from South East Coast Strategic Health Authority, spells out the latest position: "The further work refining the deployment process for Cerner Release 0, and the detailed design and build work for Release 1 – particularly in the area of mental health – have resulted in the feasible go live dates for trusts becoming later than originally envisaged, and with trusts working to a range of dates, rather than a formally agreed plan."

Another board paper from the South Downs Health NHS Trust, part of the Surrey and Sussex health community, say that a new system will now not be delivered until spring 2008, seven months later than previously anticipated: “As reported in February, the original implementation date for the new system within Central Sussex slipped because of delays in earlier implementations. The earliest possible go-live date is March 2008.”

The paper from South Downs says slippages in implementations mean that ‘resources supporting these projects cannot be released’ to other trusts elsewhere and ‘the go-live sequence between deployment families has to be agreed across the patch.’

Last July, Fujitsu the local service provider for the South of England said it would implement Millennium R0 into 12 trusts by the end of October

Ten months on, and official Connecting for Health deployment stats show that they have now implemented eight acute patient administration systems, the latest one being Surrey and Sussex NHS Trust in April, with several more due in the next few months.

Despite some real progress stubborn problems remain with aspects of the Release 0 systems, which experts attribute to the challenge of adapting a system built for the US to the UK. One expert told EHI that a root cause of problems have been the consistently unrealistic deadlines demanded centrally that have left little time for tailoring to meet NHS requirements. Simultaneous implementations have also left little opportunity for lessons to be learned and shared between sites.

To try and overcome these problems the Southern cluster is adopting a new strategy which will establish champion adoption sites for acute, community and mental, with improved mechanisms to spread implementation lessons. Winchester is to be the ‘champion’ for acute implementations.

In a significant development last month, BT the LSP for London said that it would not use the same version of the Millennium software being used in the South but would instead develop its own version, with changes in both configuration and code.

One source in the South told EHI said that this development had understandably resulted in a dilution in Cerner’s "undivided attention" on development in the South.

While development is clearly underway and steps are being taken to improve future implementations currently some trusts in the south are feeling their way in the dark. Of the seven still awaiting systems meant to have been deployed by now several say they currently have no set implementation date.

Worthing and Southlands Hospitals NHS Trust, told EHI that they had no definite date for deployment of R0. A spokesperson for Kent and Medway NHS Trust meanwhile said that dates for the implementations of R0 look likely to go on to autumn at least.

Royal West Sussex NHS Trust, says that its plans to replace its SemaHelix current patient administration system with Cerner Millennium – a project due this summer – will be kept under review, and will only proceed if 17 criteria are met.

A recent trust paper says: "Contrasting messages from the two recent implementations in February 2007, Winchester reported that everything went as expected and was a “safe” system whereas at Milton Keynes 79 clinicians and admin staff wrote an open letter stating that the new system is "not fit for purpose", we are obviously taking great interest in the lessons to be learned from these projects."

The Royal West Sussex board paper concludes: "As a result, we have identified 17 key areas in which we need confidence before we can launch the implementation phase of the local NPfIT project 3 months before go-live. This phase will include training all staff that will use the new Millennium system, rolling out all new IT equipment, migrating data and changing our operational processes where necessary. At the end of this phase a final “go/no go” decision will be taken by the trust."



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