Challenges with booking and reporting patient activity following the implementation of Lorenzo at Sheffield Teaching Hospitals NHS Foundation Trust are contributing to major activity under-performance, which has cost the organisation £12 million to date.

Sheffield Teaching Hospitals went live with CSC’s electronic patient record in September last year.

An integrated performance report, dated February 2016, says the trust's major activity under-performance has continued to grow over recent months and now stands at £11.9m.  

This is largely due to elective activity, out-patients, critical care and a larger than expected deduction for emergency readmissions within 30 days; and the report indicates that at least some of this is because of problems with technology.

“There are still data issues following the implementation of the new Lorenzo (patient administration system) towards the end of September which are creating challenges in reporting complete and accurate income figures,” the report says.

“However, it is clear that the bigger issue is the operational impact of the new system on booking and scheduling processes, particularly in outpatient services.”

The report says that some administrative tasks around outpatient booking have been more time consuming on the new EPR and that Lorenzo experts are visiting outpatient areas to “assess the issues and recommend changes to processes where appropriate."

Resolving the issues following the Lorenzo implementation and getting activity back to normal levels is critical to the trust, it adds.

The report also talks about a rise in ‘did not attend’ rates for outpatient appointments, which the trust has experienced since deploying the new EPR, and says that in some cases, patients had not received an appointment letter.

“An analysis of the issues has shown that for some patients the DNA status was recorded incorrectly,” the paper says.

Some patients had contacted the hospital via the text reminder service, but this had not been actioned; while other patients were inpatients at the time of their outpatient appointment.

The use of Lorenzo has also “meant delays to administrative processes affecting pathway management”, which is impacting on cancer wait times.

Medical director at the trust, Dr David Throssell, said in a statement to Digital Health News that the new system needs time to embed and confirmed that tasks are taking longer to complete in the “initial phases."

“We have implemented one of the biggest and most complex changes in terms of both the technology and business processes that the trust has seen for many years.

"We have now had a few months to use the system in real time and we are able to see where the system needs refinements to fit the way we work,” he said.

“A particular area of focus is the way the system supports administrative tasks around outpatient booking along with simplifying how some data is collected so that it better fits our operational and reporting requirements. This is being worked on as a priority with our technology partners.”

The trust has also experienced issues with reporting national data since implementation.

January board papers say that four months on from implementation, Sheffield was “still not in a position to report data nationally on the A&E four hour wait target as a consequence of the changeover to Lorenzo”. However, it was close to being able to recommence reporting.

The data on patients whose discharge from hospital was delayed for non-clinical reasons was also unavailable, but expected in the near future.

A statement from CSC said Sheffield has embarked on a major change programme.

“As with any initiative of this scale, there will be things that need refining and improving as the programme rolls out. We have been working closely with the Sheffield team since the go-live of Lorenzo to ensure the system fits their needs.”

Sheffield decided to take Lorenzo in October 2014 and board papers have revealed that the full cost of deploying and running the system over ten years will be around £33 million.

To support the purchase of the system from CSC, Sheffield is making use of central funding from the Department of Health, which is available to trusts in the North, Midlands and East of England that are able to provide a business case for the implementation of Lorenzo.