NHS patient records: Key trust drops flagship scheme

Another blow for upgrades to patient record systems...

The rollout of the Lorenzo electronic patient record system has been subjected to repeated delaysPhoto: Shutterstock

A multibillion pound project to install a patient record system across the NHS has been dealt another blow after a key health trust decided to abandon the system.

Pennine Care NHS Foundation Trust has decided it no longer wants Computer Sciences Corporation (CSC) to implement the Lorenzo electronic patient record system.

The mental health trust was one of four NHS trusts chosen to be early adopters of Lorenzo. The system was to go live at these early-adopter sites before CSC rolled it out to trusts across the Midlands and the north and east of England.

The project to implement Lorenzo at Pennine was more than a year behind schedule, with the system first due to go live at the trust in November 2009.

A joint statement issued by the Department of Health and the Pennine trust on Friday said the DoH "will continue ongoing discussions with CSC" about the Lorenzo rollout, which is being delivered under CSC's Local Service Provider (LSP) contract with the DoH.

CSC said it was disappointed with Pennine's decision to withdraw from the Lorenzo early-adopter programme. "We remain in ongoing discussions with the DoH regarding Lorenzo and how completion of this phase of Lorenzo's mental health functionality can be achieved, including the identification of a suitable alternative trust," CSC said in a statement.

CSC has repeatedly missed targets, known as milestones, for the rollout of the Lorenzo system to the early-adopter sites, and by March this year had missed 67 milestones set under its LSP contract.

The LSP contract is worth just over £3bn but the DoH has said it expects negotiations with CSC will reduce the contract's value by about £500m.

The Pennine-DoH joint statement said "the delays of the mental health functionality within Lorenzo are very regrettable" and that Pennine had withdrawn from the early-adopter programme after "long and careful consideration by the trust".

According to the statement, Pennine "will now consider other options available in the wider market" for an electronic patient records system.

While the DoH has not spelled out the impact of Pennine's withdrawal on the wider rollout of the Lorenzo system, last year in a press briefing about NHS IT projects, DoH CIO Christine Connelly said CSC had to deploy Lorenzo at all the early-adopter sites under the terms of the LSP contract.

"We are clear on what the contract says success looks like, and that means essentially the trust signing off and saying the deployment has been successful," she said.

Connelly provided further insight into the contract earlier this year, this time into how the DoH might be able to end its commitment to take the Lorenzo system from CSC.

Under the terms of the LSP contract, which is being renegotiated, the DoH is required to pay CSC to implement Lorenzo at a minimum number of NHS trusts.

But, in a letter to MP Richard Bacon, Connelly indicated that...

...under extenuating circumstances the DoH could withdraw from its commitment to CSC that a minimum number of trusts would implement Lorenzo.

"The removal of exclusivity, and thus the volume commitment, is an option available to the department where the contractor commits a breach of the contract which cannot be remedied in an acceptable way or timescale," Connelly wrote.

Anthony Miller, managing partner with analyst house TechMarketView, said: "This will be an uncomfortable blow to CSC and weakens the whole Lorenzo case.

"If Pennine are an anchor customer for Lorenzo, then this clearly prejudices the prospect for Lorenzo in whichever parts of the NHS are still up for [taking] it.

"Any of the trusts that were sitting on the fence [about taking Lorenzo] will see that Pennine has blinked and they may well take their cue."

The DoH has issued several ultimatums to suppliers to speed up the delivery of electronic patient record systems. But despite CSC's repeated failure to hit targets for deploying the Lorenzo system, the DoH has never followed through on its threat to move to a new way of delivering healthcare IT.

Part of the reason for the department's reluctance to look for another provider outside the LSP contract could be the difficulty in finding a supplier willing to undertake the large-scale deployment of patient record systems.

CSC is one of only two LSP suppliers to the DoH that are left, after previous suppliers Accenture and Fujitsu pulled out of contracts.

An alternative way of implementing new patient record systems might be provided under an arrangement similar to the existing DoH Additional Supply Capability and Capacity, which are a series of framework contracts that allow NHS trusts to choose from a range of different clinical systems and suppliers.

It also still remains to be seen if CSC's plans to acquire iSoft Group will have any effect on the rollout of Lorenzo in the NHS.

Whatever the wider consequences of Pennine's decision, trusts across the east, north and Midlands that are due to receive Lorenzo will be keen to see they do not suffer further delays as a result of this latest setback.

These trusts were expected to receive the first release of Lorenzo in 2008 and have been forced to carry on with existing patient records systems or to implement systems to tide them over while they wait.

Fresh delays will only mean further prolonged reliance on legacy and interim healthcare IT.