This document summarizes Neil Stevens' presentation on the development of an electronic health record (EHR) system across Somerset. Some key points: - Somerset had success implementing some clinical systems but faced significant failures and delays in its ambitious plan for a full EHR. - The initial implementation of an acute hospital EHR with Fujitsu faced many issues including 18 go-live date changes, credibility problems, and stress on staff and organizations. - Lessons included the need for strong clinical engagement, executive leadership, controlled project gateways, sufficient testing, and addressing both IT delivery and clinical workflow changes. - Currently Somerset has EHR systems in various clinical settings but continues working to better integrate records across

1. Development of an EHR across
Somerset
Neil Stevens
Director, Neil of Informatics
Director Stevens Consulting
16th November 2011
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2. Why am I here?
• Breadth and depth of experience in
implementing IT systems in healthcare
• Some great successes
• Some significant failures
• If it doesn’t kill you it makes you stronger
• Post Cerner (NPFIT) – career still intact!
• Hope to provoke thought and lively
discussion
• Will tell it how it is 2

3. HISI 2006 - feedback
It was a very rare thing –
an Englishman who tells
the truth
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4. HISI 2006
• MH EPR in place already
• Somerset Cancer Register (18 sites)
• Choose and Book (72%)
• Ambitious future plans for Somerset
– RIS/PACS
– Order Communications
– Summary Care records
– NCRS for 2 Acute trusts and 15 community
hospitals
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5. The NHS in Somerset
• Taunton and Somerset NHS FT - 700
beds
• Yeovil District Hospital NHS FT - 400
beds
• Somerset Partnership NHS FT - 40
sites plus 15 Community Hospitals
• NHS Somerset - 80 GP practices 5

6. Somerset Health Informatics
The Somerset Health Informatics
Service aims to provide a responsive
cost-effective and first-class services
to all our customers, which enables IT
systems and solutions to support and
enhance the delivery of high-quality
healthcare across Somerset.
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7. Somerset Health Informatics
• Programme and Project Management
• Application Support
• Application and Interface Development
• Business Services
• Training
• IT Development and Support
• IT Service Desk
• Testing
• Telecommunications
• Data Management and Processing
• IM&T Procurement
• IT Security and IG support 7

8. The best laid plans…
• NCRS was expected to be delivered (x2)
in early 2006 – Fujitsu and IDX
• Then early 2007 with Fujitsu and Cerner
• Cerner Millennium went live in West
Somerset 15th December 2007
• This was the best (and last)
implementation under the Fujitsu contract
before termination in May 2008
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9. Lowlights
• 18 go-live dates
• Significant credibility issues
• Repeated training of same staff
• Significant pressure to stick to dates
• Personal and organisational stress
• Inconsistent engagement
• No programme gateway controls
• Limited access to Cerner resources
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10. Lowlights
• Staff not released to support system
configuration and change process
• Choose and Book – Direct booking
• System used to replicate ‘as-is’ processes
• Implementation in parallel with FT bid and
18ww early adopter
• Fujitsu departure led to 2-year delay to
programme
• How much time and money we wasted! 10

11. Highlights
• Excellent Fujitsu staff on site
• Programme Director role
• We changed the rules!
• Gateway controls were introduced
• Mouse mats, Post-it
notes, Pens, Lanyards
• eLearning
• Cutover arrangements
• Fun! 11

15. Lessons Learnt
• Insist on Gateway controls
• Need good clinical engagement
• Executive leadership essential
• DIP was over-ambitious
• Lack of access to Cerner staff
• Testing on older versions of software
• Insufficient regression testing
• Training in parallel with testing
• Workarounds developed too late 15

16. Challenges
• Connecting for Health
• Commercial drivers difficult
• Delivery of programme vs the ‘day job’
• Need for basic IT literacy for some staff
• Technical implementation vs ‘how my job
will change’
• Scale of the IT-enabled change
programme
• Communication 16

17. 17

18. Framework for success?
The key issue with this Programme that the
Board needs to recognise is that it is not
just an IT Programme. It is an IT-enabled
change programme and the NHS needs to
pay full attention to both IT delivery and
implementation of the transformation that
IT makes possible
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19. Framework for success?
• Early engagement with users
• Senior sponsorship, clinical leadership
• Understand the desired outputs
• Appropriate access to supplier staff
• Do not be afraid to escalate
• Appropriate delivery of training for the end
users
• Insist on controlled project gateways
• Keep it fun! 19

20. So where is EHR?
• Mental Health – paperless (Rio)
• Acute – Cerner Millennium and HP/EDS
• Community Hospitals – as Acute + SADIE
• Primary Care – well established GP
systems
• Investment in Integration Solution (Mirth)
• Consideration of Clinical Portal Solutions
• Summary Care Record
• Spine connectivity 20

21. And finally……
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23. Any Questions?
neil@neilstevensconsulting.com
www.neilstevensconsulting.com
07806 664603
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