Morecambe Bay plans Lorenzo revamp despite lack of clinician buy in

The first ever “Lorenzo” trust is pushing ahead with a major upgrade, despite reporting “significant and fundamental issues” with the system nearly a decade after it was deployed.

The University Hospitals of Morecambe Bay NHS Foundation Trust’s January board papers revealed that among staff there was “not widespread acceptance and appreciation” of CSC’s Lorenzo electronic patient system.

“It does exist but in small pockets of enthusiasts rather than across the board.”

Morecambe Bay was the first trust to install the EPR in 2008, which is now used by 18 trusts.

The trust’s EPR programme report said there were “significant and fundamental issues for users”, many of which were related to “old hardware.”

This included the system going offline after software upgrades, forcing staff had to revert to paper and pens.

Staff also reported frustration with the “spinning wheel of doom” within Lorenzo, where the record would “take a while” to refresh.

To address these issues, there trust has embarked on an “EPR Optimisation Programme”, moving its Lorenzo 2.10 to a new hardware platform on 26 February.

This will give the trust its “own Lorenzo Instance” with the CSC data centre that it currently shares with 17 other Lorenzo trusts, the papers said.

“This is still within the CSC Data Centre but will be ‘UHMB Only’ and no longer shared with any other Trusts”.

A CSC spokeswoman said that the company was “working closely” with the trust to provide “both the functionality and performance required”.

“As part of this, their Lorenzo system will be moved to a new hardware platform…They will continue to use the same version of Lorenzo (currently 2.10).”

The exact timing of the transition would be confirmed with the trust, she said.

“In the interim, they continue to use the existing Lorenzo “instance””.

Morecambe Bay and Lorenzo have a long and convoluted history.

The trust was the acute ‘early adopter’ for Lorenzo developed by iSoft, which was later bought by CSC.

The company developed Lorenzo to be rolled out across the North, Midlands and East of England as part of the National Programme for IT (NPfIT). However, after development and deployment delays, Lorenzo went live in only a handful of trusts under NPfIT.

Other trusts has since picked the EPR, most of them as part of a post-NPfIT deal struck between CSC and the Department of Health.

Morecambe Bay gave an early version of Lorenzo a “soft landing” in 2008, with Lorenzo going live in one ward. It became a key reference site for Lorenzo Release 1.9.

With that national contract due to expire in July last year, the trust went out to tender for a new EPR in 2014. After a competitive tender, trust eventually decided to stick with Lorenzo.

The January board papers said in the next 18 months new functionality would be EPR rolled out. These would include e-prescribing and drugs administration, digital dictation, new integrated theatre scheduling and records system and an electronic link between ECG machines and Lorenzo.

The move to a new infrastructure has been delayed by six to eight weeks because of “technical issues identified by CSC”, the papers said.

The papers also identified a “significant issue” that any software issues identified within the new system could not be rectified in the live Lorenzo instance until October this year.

Morecambe Bay covers 1,000 square miles with three main hospitals in Barrow, Kendal and Lancaster.

On Thursday the Care Quality Commission upgraded its rating of the trust from “requires improvement” to “good”. Mike Richards, CQC chief inspector of hospitals, described it in a statement as a “remarkable turnaround for a trust that has faced very significant difficulties”.

The trust did not respond to questions before publication.

Digital Health Intelligence maintains a database of the administrative and clinical systems in use at trusts, and uses this to calculate a clinical digital maturity index score for them (log-in required). University Hospitals Of Morecambe Bay NHS Foundation Trust has a score of 87 and is ranked 19 (out of 153 acute trusts).