Published: 13/10/2005 Volume 115 No. 5976 Page 8
A London foundation trust and its local primary care trust have been operating block contracts since the introduction of payment by results because the hospital's computerised patient administration system has been unable to provide reporting information.
Homerton University Hospital foundation trust's problems lie with the Cerner Millennium electronic patient record. Despite the installation going live in August 2003, the system has so far been unable to provide the information needed by City and Hackney Teaching PCT under payment by results.
The trust is currently rated amber by foundation regulator Monitor as a direct result.
Insiders say the situation may threaten the PCT's financial stability as well as its monitoring of demand management. It could also delay developments in practicebased commissioning.
Although the Cerner installation at Homerton and Newham hospitals was outside the national IT programme, observers are watching developments with interest. The same Cerner Millennium programme was chosen as the core solution for the Southern cluster by local service provider Fujitsu Alliance in June 2005, making it the likely electronic patient record for over 60 trusts in the south of England.
Homerton deputy chief executive Pauline Brown last week confirmed the reporting problems. She said:
'This is a fully functioning electronic patients record and we are managing patient pathways. However, we have had problems with the reporting. It is inevitable that there will be difficulties in translating a US system for use in the UK.' She was 'comfortable' that the issues would be resolved. 'Information is now beginning to come through and we anticipate that by mid-November we will be reporting fully to the PCT.'
She added: 'We are in contractual discussions, seeking to resolve the problems in collaboration with Cerner and the PCT.' A spokesman for Monitor said Homerton is one of only four foundation trusts rated amber for governance. 'This is specifically because they haven't got their electronic records in place and are operating under a block contract, ' he said.
HSJ understands that the PCT and trust agreed to operate a block contract for the first six months of the financial year. This ended on 30 September, by which time the trust had been expected to provide reporting information.
One insider said: 'We were supposed to start getting information from 1 October, but frankly I am not holding my breath.' City and Hackney Teaching PCT chief executive Laura Sharpe said the trust and PCT had already moved out of block contract arrangements to payment by results. 'Everyone is pulling out all the stops to deliver under payment by results and we are confident things are progressing, ' she said.
Cerner Corp, based in Kansas City, describes itself as the 'leading supplier of healthcare IT'. It has been working in the UK with private and NHS clients for 15 years.
Alan Fowles, Cerner's programme director for core business, said: 'Cerner and the trust's electronic patient record team are working on the reporting element as we move forward. Our focus is to create acceptable data extracts and we are confident of a successful outcome.' A spokesperson for NHS Connecting for Health said the problems would not affect the Southern cluster: 'This issue is a result of the Cerner solution using 'encounters', as in the US, rather than 'episodes', as in the NHS.' He added that Newham and Homerton trusts would receive a 'maintenance release' - a software add-on - in the autumn which will overcome the problems. 'The Southern cluster solution includes this release, ' he said.
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