Financial pressures could cause Humber NHS Foundation Trust to move to a ‘best of breed’ approach with its clinical IT systems when its national contract for the Lorenzo electronic patient record system expires, according to the trust’s board of directors.

The trust, which provides mental health and community services to the populations in Hull and the East Riding, currently uses CSC’s Lorenzo patient administration system as well as TPP’s SystmOne for community health with contracts signed under the National Programme for IT.

Humber’s current, centrally funded contract with CSC is set to expire in July 2016 – the same time as the end of the trust’s contract for SystmOne.

In April last year, Humber said it was looking at potential alternatives for Lorenzo ahead of the contracts’ expiry dates.

According to a board update on the trust’s informatics strategy last month, financial pressures will be among the biggest drivers in determining how Humber will replace its clinical systems.

“The cost and resources to procure a single system may not be affordable in the trust’s current financial position,” the papers say.

Humber estimates that the cost of implementing a new trust-wide system could run to £8.1 million over the next five years.

The report says the trust is developing “alternative plans that allow the trust to continue with multiple clinical systems but maximise the potential with those systems and a focus on improving user interphases [sic]”.

According to the board papers, Humber’s overall IT strategy is also being affected by budget concerns. The report says that while the delivery of the informatics strategy is “broadly on plan”, there must be “significant investment” in the next financial year to ensure it is a success.

“A failure to increase the investment in FY15/16 will make it very difficult to deliver the strategy.”

Humber has contracted consultancy firm Deloitte to assess the trust’s strategy in light of the financial concerns. There are also plans for a board workshop dedicated to the issue in April or May.

In the risk log for its informatics strategy, Humber says that if there is no clinical system in place by the time the contract ends, there is a “fall back plan” in the form of Lorenzo’s perpetual licence which can be transferred to the trust and used to provide the core clinical system.

Lee Rickles, Humber’s head of programmes and informatics, told EHI News that Humber is using the NHS Shared Business Services framework to help progress with its plan for a new IT system as it is the most cost-effective option available.

“Lot of trusts looking to exit the national contract are going that way,” he said.

Rickles said the trust “anticipates being on a local contract” by the time its NPfIT contracts expire in July 2016.

He told EHI News that if Humber was on the new contract for Lorenzo it “would be a different discussion” but that was “the challenge of being an early adopter”.

Humber was one of the first trusts to implement Lorenzo as part of NPfIT, taking over from the Pennine Care NHS Foundation Trust as an ‘early adopter’ for mental health when Pennine pulled out in spring 2011.

The trust went live with the system in May 2012 and expanded its functionality later that year after a successful implementation, while it also worked with Hull and East Yorkshire Hospitals NHS Trust on plans to create a unified Lorenzo EPR across both trusts.

The original local service provider agreement between the government and CSC was for the Lorenzo PAS to be deployed across all trusts in North, Midlands and East of England. However, troubles with the system led to a renegotiation of the LSP contract.

This removed the CSC’s exclusive rights to provide IT systems to trusts in the NME region, but made DH funding available to purchase Lorenzo for trusts that still wanted to go with the system.

However, as an early adopter Humber missed out on the chance for extra DH funding to cover its use of Lorenzo.

With the recent news that Warrington is set to deploy Lorenzo, there are now six trusts planning to deploy the system, while 13 have gone live since 2010.

Humber is still committed to Lorenzo for the time being. In its board papers, the trust reports that it has received £500,000 from the second round of NHS England’s nursing technology fund to provide tablets running Lorenzo to its mental health teams.