Barts and the London NHS Trust projects a £3m shortfall in income this year due to serious data, reporting and technical problems with its new Cerner Millennium Care Records System.
The new CRS system, installed by BT in April, has left the London trust unable to accurately report on inpatient and activity. As a result it has been unable to accurately record or bill for activity for the first three months of the year. It says the problems look set to continue.
A July BLT board paper states: “There remain significant data quality issues with the trust’s activity and patient treatment activity and income information due to the implementation of CRS. The trust is working with BT/Cerner to correct these issues in time to ensure that Quarter 1 income can be accurately invoiced.”
As a result the trust says it now faces “a very significant underperformance against the trust’s income budgets”.
The trust has already had to set aside £1.5m contingency from reserves to cover the “high risk around income” in the first quarter and is budgeting a £3m total contingency for the full year. The risk is such that it now threatens the trust’s financial recovery plans.
Although the trust says it is working with BT and Cerner to resolve the known problems it recognises that this may not be possible within the timescales it needs to report to its commissioners within. Figures for June were needed by the middle of August. “The trust has therefore provided £1.5m against income to date to reflect the ongoing risk.”
Because the data quality issues are ongoing BLT says that a “continuation of some of these errors may means there is a risk of income loss in future quarters”. As a result the trust now forecasts “an underperformance on income of £3m for the year”.
The report also states that April activity “was reduced due to implementation issues with CRS”, with issues with bookings resulting in some clinics and operating theatres not running at their capacity. “It is therefore possible that even when the known data quality issues have resolved the trust will have underperformed against its activity plan in April.”
The problems are not even confined to reduced activity, inability to accurately report and consequent reduction in budgeted income. Problems are also reported with data veracity and the technical operation of the system, with data recorded on the CRS system not appearing in the data warehouse.
“There are known system errors where data which has been entered into CRS has not been reflected in the data warehouse…” The report adds: “These issues have caused significant understatement of both inpatient and outpatient activity and income”.
The Cerner CRS problem is reported to be leading to a series of operational problems, with staff finding the system difficult to use. Because staff find the workflow for admitting elective patients too complex to use, the trust has recorded a “significant shift to non elective activity”, again affecting contracted income. The trust says the problem appears to be “ongoing”.
Similar problems with staff not following complex workflow mean “There are significant numbers of outpatient attendees which have not been checked out (signed off)…”
Because some staff found the system difficult to use a significant backlog of clinical coding rapidly built up, having a detrimental impact on the trust’s ability to report activity. Working through this clinical coding backlog pre and post go live has resulted in extra costs.
In addition to the £3m provision the latest trust board papers also reveal the trust had to spend an extra £930,000 on additional unplanned temporary staff costs “relating to the implementation and subsequent validation of CRS”.
The BLT board paper also says it has been “reluctant” to take action under or over performance until it has accurate activity data.