Royal Berkshire NHS Foundation Trust has spent nearly £30m on implementing its Cerner Millennium electronic patient record system.
EHealth Insider requested a copy of the trust’s EPR governance committee meeting minutes going back a year via the Freedom of Information Act.
In July 2012, the committee noted that "expenditure to date was approximately £26m and had been extended as expected at the rate of approximately £1m per month." The November 2011 minutes highlight overspending on contractors.
“It was noted that a significant proportion of the overspend related to the hiring of external contractors within the trust’s EPR team. Decisions to keep the team at full strength had been based in part on the assumption that the go live date would have been sooner."
The overspend was also discussed at the trust board’s July meeting where members were told the original business case had, “assumed that administrative costs following implementation would be lower.”
The chief executive said the level of administrative support required was high and there were 24 additional staff still on board. He was discussing potential reimbursement for this cost with Cerner.
The impact of the go-live on patient experience was discussed and issues included; patients attending for clinics that did not exist; receiving multiple requests to attend clinics; and not receiving follow-up appointments.
The system also had a “considerable” impact on the trust’s ability to deliver performance standards.
“In particular, it had been necessary to undertake high volumes of manual data validation to assure accurate reporting,” the minutes say.
Despite these challenges, “the ‘go-live’ at the trust had been more successful than in other Cerner Millennium sites."
Royal Berkshire quit the National Programme for IT in the NHS in 2008. In mid-2009, the trust signed with University of Pittsburgh Medical Centre to deliver Millennium; however, Cerner was represented on the EPR committee and UPMC was not.
The trust had planned to go live with Millennium in March this year, but this was pushed back to May and it went live on 17 June.
The cause of the delays are not detailed in the notes, which have a significant number of paragraphs redacted, but the last report prior to the May go-live date says that all priority one and two issues had been resolved.
A source close to the project told EHI in March that the “showstopping” reason for the delay to the project was a problem with the Cerner hosting contract the trust signed with CSC in early 2010.
In 2011, the trust also signed a a separate, seven-year outsourcing deal with CSC, including helpdesk support, worth up to £50m.
Despite the trust and CSC saying support contracts had nothing to do with the delay, two new contract award notices were published in June awarding Cerner £16.5m for the remote hosting of Millennium, a helpdesk and support for the system.
The issue of hosting is not mentioned in minutes passed to EHI, however the committee does discuss helpdesk support as a “remaining key issue”. In June, it is reported that CSC helpdesks would be in place for go-live.
“The chief executive requested that the order placed and exactly the service to be provided be set out from him in a letter to CSC to avoid any confusion. Similarly, letters should be drafted to Cerner and UPMC as well as CfH setting out the precise position,” the minutes say.
On 14 June, the committee reported that: “The trust’s contractors had been written to setting out the requirements on them with the exception of UPMC where it was felt this may not be necessary. Cerner had already responded positively. The CSC response was awaited.”