Cambio sees the UK as the biggest potential area of growth for its electronic patient record business and is investing heavily to make this a reality.

But Gordon Lorimer, the company’s new managing director for the UK and Ireland, believes its future role will be working on the more challenging trust sites.

He says the market picked up in the early days of 2016, with some large and specialist trusts going to tender; such as Great Ormond Street Hospital and Papworth Hospital.

A number of others are also coming forward and looking for EPR systems with flexibility; as they have systems in place that they want to integrate.

Lorimer says this means they want to work with a supplier that is willing to modify its product to include the intellectual property that they want to carry forward. Which is where, he says, Cambio comes in.

“Looking at the market going forward, I don’t think we will be doing the easy straight-forward EPR implementations; but we are the right company to do more of the challenging ones,” he says.

“Whether [those are] specialist hospitals or trusts in trouble that need a lot of constant, close attention from their EPR supplier; that’s where I see our differentiation in the market. It’s our capability to develop and the fact we will get around a table and work with people.”

A foot in the UK market

Cambio got its foot in the UK market when Princess Alexandra Hospital NHS Trust signed a ten year contract with the Swedish supplier in April 2013.

Wrightington, Wigan and Leigh NHS Foundation Trust had been slated to be the first UK trust to deploy the company’s IT system, but that contract was cancelled in July 2012.

A joint statement from the trust and Cambio at the time said they had completed the assessment and specification stage of the project, but had “mutually agreed not to progress with the implementation phase.”

Princess Alexandra Hospital, which runs a 490-bed district general hospital in the new town of Harlow, Essex, went live with the Cosmic EPR in July 2014.

Digital Health News has reported on issues at the trust since go-live. These are by no means all IT related. The trust has yet to secure foundation status (which all trusts were meant to have achieved by April 2014) and was subject to a Care Quality Commission investigation last November that concluded it ‘requires improvement.’

Like other DGHs in new towns near London, the trust appears to be facing a huge influx of elderly and A&E patients, while struggling to recruit and retain staff.

The CQC noted that this was leading to administrative problems, poor time-keeping in clinics, and admitted patients being sent to the next available bed (although it also noted that the staff working in these conditions remained “exceptionally caring”).

A ‘fantastic reference site’

Having said all that, the trust has also had problems with its IT. For a start, it has had to pay a fine of around £1.8 million for multiple breaches of the 52-week target for treating patients.

In papers for its July 2015 board meeting, the trust said these not due to a failure to treat patients in time, but to “ongoing issues relating to technical faults in Cambio”; specifically that “some patient records are ‘locked’ and we cannot open them to check dates and hence treat.”

Both the company and the trust said at the time that they were working together and that the use of Cosmic at the hospital was improving. Lorimer acknowledges that the trust has had many issues, but still feels it is a “fantastic reference site."

“The transfer from the previous system [McKesson’s legacy patient administration system, TotalCare, which was at the end of its life and at the end of a support contract negotiated by the Department of Health during the National Programme for IT era] was done in something of a rush,” he says. 

“There were a number of data quality issues that we inherited and we have been working on those. We are talking about hundreds of issues and we are working through those very well. We have an excellent relationship with Princess Alexandra Hospital.”

He argues that the fact that the trust is dealing with issues so common to so many NHS organisations (including a financial deficit, which stood at around £38 million for the financial year just ended) makes it an “even better reference site” for Cambio.

“They didn’t realise a number of things when they let the contract. When they started the project they didn’t know they had such data quality issues, for example. So they had to come to the supplier and say: ‘can you adjust to cope with these issues?’

“We are very flexible – particularly in the UK, we have got to be flexible because we need to have a great reference site – so we are investing a lot of money in the UK and continue to do so.”

It’s about resources

Last year, Cambio delivered eight full releases of code to Princess Alexandra Hospital, including a substantial degree of tailoring to meet the trust’s requirements and to sort out issues with Referral to Treatment Time coding.

It was able to do this because it has 250 developers based in Sri Lanka and a UK team of 25. “Cambio sees the UK as the biggest area of expansion and we are building a team here in anticipation of greater business being won,” Lorimer says.

“So when Princess Alexandra Hospital come to us with an issue, we don’t say: ‘We want more money,’ but: ‘Let’s understand the issue and work through it’.”

Lorimer has substantial experience of working with the NHS on its healthcare IT issues. He did a short stint as commercial director for iSoft in the mid-years of the national programme, and then went on to work for BT, NCR Healthcare and, for a much longer period of six years, Intouch with Health.

He joined Cambio last June, and says that when he arrived he asked Princess Alexandra Hospital to come up with an exhaustive list of the issues it had with the Cosmic system. It came up with a list of 37 items, and the Cambio team expanded that out to 87 items.

This was then divided into issues that needed action by the trust or by the company; more than 90% needed action by the trust to proceed. “We got around a table and agreed a process to resolve every one of them,” he explains.

An integrated experience

Cambio’s experience as the market leader in Sweden means it has unique experience of working in a very joined-up healthcare system.

The hospitals there are organised into 20 regions, of which Cambio is the supplier for ten. In each region, the company supplies systems to the acute, mental health, community, GP and social care providers.

While the development of better integrated systems is the ultimate aim for the NHS and social care in the UK, Lorimer says the company is not expecting to be providing systems to all areas of the market.

Instead, he anticipates working closely with other providers within an ecosystem to make sure its systems are joined up. England’s GPs, for example, have sophisticated, proven clinical systems and are not going to be switching to Cosmic.

“The model will be slightly different, but we are very open from a technical point of view; for instance in terms of handling HL7 messaging, connecting and building on OpenEHR,” says Lorimer.

“It’s going to be a hybrid working with a variety of providers. Where organisations prefer to stick with specific elements we will have to link with GP players and take out the primary care part of Cosmic and insert another GP solution. It means we know all about them and how to connect between these two settings.”