Lancashire Care NHS Trust NHS Care Record Service

Lancashire Care NHS Trust NHS Care Record Service ‘The deployment experience’

About the Trust • Specialist Mental Health Trust – Size = average acute trust – 68 sites across 200 Sq Miles – 11 hospital sites, 750 beds – 6 legacy PAS’, not much else – 9 PCTs, 3 Local Authorities – 4 COINs (Good infrastructure)

Topics for discussion • Project planning • Deployment • Where are we now • Lessons Learnt

Why go live first? • 6 PAS’ with little or no access – LTH switching off – Risks no worse – Greenfield site – Organisation ‘up for it’ – Support of SHA & CSC

Project planning • Developed good working relationship with CSCA – Strong project management • Spent time on brief and PID – Trust keen to get full bundle functionality – Little or no external validation by NHS – Lots of scrutiny by CSCA

Pre-deployment work • Training – Good master training – Didn’t cover full scope – Time lag between training and live – Unstable training environments – Different builds training vs live – No spine access (PDS & Postcoder)

Pre-deployment work • Training Continued – No time to configure environments – Local confusion over modules – No time to customise to local operation • Registration Authority – Changes to RA software build – Linking role to real job role (Af. C) – Use SMS to deploy.

Pre-deployment work • No visibility of application – Lack of knowledge - Trust & CSCA • Data migration – PMI and Casenote details – in house work – Lots of testing, but no resolution to health records problem until night before! – Problems with incremental loads – Changing data migration spec

Pre-deployment work • Configuration – Lack of understanding (more Trust than CSCA) – Dubious I-Config – Consequences of coding on application • Impact on future reporting • Shared sites • Impact on strategic instance • How codes appeared to users (order etc)

Going Live – th March 29 2005 • Long days and nights • Confusing process for authorisation • 100% commitment from CSC – Technical bridges worked well • Lots of configuration problems – Unstable at first – Fail-over didn’t work

Where are we now? • Over 10 months live • Deployed in all hospital areas • First community sites deployed • Psychology in progress • HDM installed & ‘working with errors’ • Most staff are positive.

Where are we now? • More stable recently – 683 Faults logged – 4000+ records failed CDS • Much greater understanding of the product • Reporting should be fixed in Erlanger • Upgrading could be better – Erlanger still a mystery with 2 days to go • No signed Deployment Verification Document

Key themes • Better communication • No assumptions • Clarify expectations • Learn from this experience

Things that didn’t go well • Product Knowledge • Testing / configuration – Access to the live environment • TOO Many Faults – Not tested properly! • Lack of understanding – The Authority & CSCA

Recommendations • Spend time on your PID • Insist on access to the software ASAP • Testing, Testing • Training, Training • Establish post go-live support • Formalise handover of project to operations • Be patient!

What goes around, comes around “That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations. ” The London Times in 1834…the stethescope

Questions?