North Bristol NHS Trust went live with Cerner Millennium before the outpatient or theatre builds were complete, sparking a “crisis” that took five months and £4.6m to resolve, a report reveals.

Following an independent review of the implementation, the trust will create an independent programme management office that will “rigorously challenge the management of all our projects”, chief executive Marie-Noelle Orzel has said.

North Bristol went live with Millennium in December last year, triggering a series of issues in outpatients and theatres, including patients being booked into non-existent appointment slots and appointment letters not being sent.

The trust commissioned PricewaterhouseCoopers to do an independent review of the deployment.

The final report says the trust failed to identify the implementation as a change programme. It also details issues with the software and data migration, staff training and operational go-live planning.

North Bristol was the last of the three ‘greenfield’ sites in the South of England to go-live with Millennium as part of a contract with BT to support trusts that had implemented the Cerner system with ex-local service provider Fujitsu and extend its use.

The trust went live in December 2011, following go-lives at Royal United Hospital Bath and Oxford University Hospitals NHS Trust.

However, the consultants’ report says the trust board and the Cerner programme board – made up of trust executives and representatives from Cerner, BT and NHS Connecting for Health – “did not plan to have, and did not receive, independent assurance that the state of the programme supported a decision to go-live.”

The Cerner programme board was “ineffective”, the internal Cerner project team was under-resourced, and significant issues relating to the theatre and outpatient builds were not escalated to the trust board, it adds.

While complex IT implementations are never without risks and issues, the scale of the issues in this implementation were “not properly understood by those with responsibility.” As a result, “they were not in a position to make sound decisions,” the report concludes.

Problems with the go-live were reported as early as January, with clinicians expressing concern about disruption to patient care to the BBC, which claimed staff were “on the verge of meltdown.”

At the time, the trust said the problems were unexpected and related not to the software but “implementation and data migration difficulties in some clinics.”

The PwC report puts more detail on these issues. It ways that because the outpatient and theatre builds were not complete before go live, the new and old systems did not mirror each other; but there were no controls in place to detect this.

Fake clinics with abnormal timings – such as 12:30am – were used in the old patient administration system for testing, but were not separated from real clinics before go-live. As a result, patients were sent appointment bookings for them.

On migration, the weeks from the PAS and Cerner systems were also misaligned, so the dates for clinics and theatres were incorrect.

“This created huge confusion as patient notes did not agree to Cerner Millennium,” it says. “This also affected information in letters, with patients advised to attend their appointment on the wrong date.”

Additionally, in theatres, the trust did not map old procedure codes to new, meaning that it had to run a parallel manual process to ensure patients received the correct procedures.

The report says data migration was a serious issue as old and out of date data was not cleared from the legacy PAS, and so went live in Millennium.

The report also outlines problems with training and preparation. It says training was inadequate as staff were not trained on the system implemented.

The report says North Bristol should have learned from the experience of the other two greenfield sites.

“There were not dissimilar Cerner implementations within the greenfield programme, running a few months before the North Bristol implementation,” the report says.

“Similar difficulties were experienced there, but they were more successfully addressed.”

Orzel said the trust accepts the findings and that patient safety was not compromised during the implementation.

Software and resource brought in to rectify the problems cost an additional £4.6m, which came from the trust’s contingency fund.

“The electronic patient record system is now working correctly and we are confident that it will better equip us to meet future challenges,” she said.

The report adds that although the implementation in A&E and the wards went well, there is now an issue with ward staff engaging and using the system as intended.

EHealth Insider reported last week that the trust’s IM&T director, Martin Bell, is leaving next month.