The selection of InterSystems’ TrakCare by three trusts in the South of England marks a major shift in the supplier landscape for electronic patient records.

Gloucestershire Hospitals NHS Foundation Trust, Northern Devon Healthcare NHS Trust, and Yeovil District Hospital NHD Foundation Trust, known as the SmartCare consortium, will replace their legacy EDS Swift systems with an integrated, remotely-hosted clinical information system from the company.

The win is the second for InterSystems in a few weeks. In February, it was announced that North Tees and Hartlepool NHS Foundation trust had signed a contract for TrakCare, which it described as a new patient administration and electronic patient record system and a replacement for its 26 year-old iExpress PAS.   

The two wins inject some much needed, additional choice into the hospital supplier landscape, which has been moribund in the South since the wheels came of the National Programme for IT with Fujitsu’s exit as local service provider in 2008, and which is still dominated by the remains of the CSC LSP deal in the North, Midlands and East.

They also make InterSystems one of the leading, new market entrant EPR suppliers in the English NHS market, joining a pack that includes Oasis, Silverlink, IMS Maxims, Cambio, Meditech, Allscripts and Epic in aiming to challenge the current market leaders CSC, Cerner and McKesson.

These companies all have rather different systems and approaches. But another feature of InterSystems’ TrakCare is that it is billed as having significant potential to deliver integrated care records across local and regional health communities.

This is an idea that is receiving a new focus from policy makers, with the tech fund’s promotion of integrated digital care records, and the Department of Health’s call for integrated care pioneers.

But any new suppliers entering the market – challenging incumbents, forcing them to sharpen up on their products, service and price – are a key component of any meaningful market refresh, so this should be good news for the wider NHS.

From portals to EPRs, via Scotland  

InterSystems is a long-standing supplier of database, integration and portal technology to the NHS. Its TrakCare system is used by the States of Guernsey Health and Social Services Department, which recently extended its use to 900 social care workers, and the Royal National Hospital for Rheumatic Diseases NHS Foundation Trust.

For the past four years, the company has also been rolling out the product across five Scottish health boards, under a deal won in 2010.

The scale of the roll-out, particularly in NHS Lanarkshire, which covers Glasgow, has made this quite possibly the biggest roll-out of an administration and clinical system anywhere in the UK. More than two thirds of Scotland’s population of just over 5m people is now covered by TrakCare.

The core functions being delivered in Scotland include general hospital patient administration – including mental health patient administration – complex scheduling and order communications. Optional modules include A&E, community, pharmacy management, maternity, radiology and theatres.

InterSystems has made the shortlist in several recent procurements, including at Cambridge in 2012, before it decided to use Epic for its marquee eHospital programme which, courtesy of the Tech Fund, has just been extended to cover Papworth Hospital as well.

But assuming contracts are awarded and implementation goes well – two very, very big assumptions – North Tees and Hartlepool and the SmartCare consortium will provide the first, big English reference sites.

North Tees is further ahead, since it has already picked a contracting partner, Insight, “to design a contract that fully reflects the trust’s needs”, and worked out the phasing of the implementation.

In a statement issued by InterSystems this week, Lynne Hodgson, the trust’s director of finance, information and ICT, said the first phase would include “PAS and EPR, as well as maternity, emergency department and theatre management,” while the second phase would take in more clinical functionality.

This will include “electronic prescribing, medicine administration and decision support.” All of the systems will run over a new server and storage infrastructure from Cisco and EMC.

SmartCare has only just made its supplier announcement. In a statement to EHI, a spokesperson for Gloucestershire Hospitals NHS Foundation Trust, which has been leading the procurement, said trusts would now prepare individual business cases that would be consolidated and submitted for approval to the Department of Health and the Treasury.

But its tender indicates that the trusts in the consortium have big ambitions. The tender included a requirement for: a patient administration system; order communications; e-prescribing; clinical decision support; A&E; theatres; pathology; pharmacy and stock control; and clinical documentation, with the deal worth between £35m and £60m in total. 

Trusts with big ideas

The other suppliers in the bidding for the North Tees contract are not known. But InterSystems pipped Epic and Meditech to the SmartCare deal, where pricing is rumoured to have been keen.

Epic is currently working with Royal Devon and Exeter NHS Foundation Trust, which recently picked the US company as its preferred supplier of an electronic patient record system, and is said to have hopes in London.

Meditech has seen The Rotherham NHS Foundation Trust struggle with its V6.0 deployment, but has had considerable success at other trusts in the NME, including Sunderland, which has just won tech fund money to extend its roll-out.

Both companies are likely to have seen the £60m SmartCare tender as the plumb prize, since it is the first and most valuable of six Southern consortia, covering 21 acute trusts that received nothing from NPfIT, but which will now get some central funding, to select a supplier.

The next most attractive joint southern procurement is the £40m EPR procurement by East Kent Hospitals University NHS Foundation Trust and Maidstone and Tunbridge Wells NHS Trust, which is due to reach preferred bidder stage by mid-2014.

The four remaining collaborative procurements are for more discrete areas including e-prescribing and medicines management, electronic document management and clinical portals.

All will provide indications of where trusts are heading with their EPR deployments, and which companies are likely to do well as they make their choices. But it’s clear that InterSystems has announced itself as a player to watch.


More consortia out to tender: The other five collaborative procurements in the South, backed by central funding, are:

Salisbury, Poole Hospital and Royal Bournemouth and Christchurch Hospitals NHS foundation trusts, and Portsmouth Hospitals NHS Trust, which are tendering for an e-prescribing and medicines administration system worth £5m-£7m.

Western Sussex Hospitals NHS Foundation Trust, East Sussex Healthcare NHS Trust and Queen Victoria NHS Foundation Trust, which have tendered as the SAcP Sussex Collaborative Programme for an electronic document management system and a clinical portal.

South Devon Healthcare, Torbay and South Devon Care Trust, South West Ambulance Service Trust, Rowcroft Hospice and Southern Devon GP practices (via commissioners),which want an e-prescribing system.

East Kent Hospitals University NHS Foundation Trust and Maidstone and Tunbridge Wells NHS Trust, which are jointly procuring an electronic patient record system in a contract worth £10m – £40m.

Frimley Park Hospital NHS Foundation Trust, Ashford and St Peter’s Hospitals NHS Trust and Heatherwood and Wexham Park Hospitals NHS Foundation Trust, which are tendering for an electronic document management system under a ten-year contract worth £5m-£10m.