Trust: Patients ‘at risk’ as ICS delays new IT system

South Tees Hospital Foundation Trust, which runs James Cook University Hospital, says it is the only major trauma unit in England without an e-prescribing system, and that investment in its electronic patient record system is “critical” in order to prevent patient risk.

The FT says it has planned a major IT upgrade to address this, but it is on hold as the integrated care system it is a part of (The North East and North Cumbria) has not yet approved its business case, while NHS Improvement will not approve it until the system has done so. In addition, no funding source has been identified.

A report to the FT’s November board by head of digital programmes Ian Willis says: “There is significant financial, clinical and reputation risk to the organisation if it further delays or postpones the [electronic patient record] programme.”

It says: “Due to a lack of investment in IT over a number of years, the trust is not as digitally mature as its peers.

“It is now critical that investment is made in an EPR and the supporting infrastructure to prevent it from falling further behind and putting patients at risk.”

It says: “NHSI have indicated that they will not approve the business case until the [ICS] have given their approval and until a source of funding is identified. The trust has engaged with ICS, however, official approval has not yet been given.” The paper says the “two principle delays are ICS support of the business case and identification of a funding source”.

Currently, the trust does not have e-prescribing and medicine administration functionality, which it says “has been highlighted as a major patient safety risk for several years”.

The ICS told HSJ it was “yet to consider approval” for the project, which is a joint proposal with neighbouring County Durham and Darlington Foundation Trust.

Funding was due for approval by the end of September this year with NHSI approval by the end of October, according to timelines set by the trust. The FT, which first began looking at the case for an EPR six years ago, had hoped to begin the programme by April next year.

The new EPR would replace the current systems for patient administration, workflow, theatres, emergency department, maternity, bedside observations, spinal injuries, orthopaedic trauma, clinical utilisation review and the cancer information system.

Clinical risk

According to a clinical risk document prepared by the trust, the lack of an e-prescribing system “increases the risk of prescribing and drug administration errors”.

The assessment adds: “We do not have a clinical decision support solution with workflow to guide good practice and improve patient safety.

“Clinicians do not have timely access to clinical information, and no single ‘source of the truth’ with the majority of patient records still held on paper that is not always readily available.

“Ageing infrastructure and systems including IT and clinical equipment limits the flow of clinical information, reduces clinician’s confidence and impacts patient care.

“We cannot share information sub-regionally and regionally via electronic means ie Great North Care Record, which will impact patient care when patients present across the region.

“Staff (in particular trainees) are choosing not to come to South Tees due to the lack of electronic records.”

It goes on: “These risks can only perpetuate as the rest of the NHS continues to move forward digitally; we will be putting our patients at risk of harm, harm which could be mitigated or prevented.”

The full business case says if the trust does not now pursue a new electronic record system, it would have to invest a similar amount of capital and revenue just to keep its current systems running.

It says the deterioration and failure of old kit which “within the next 12-24 months… will directly impact a clinician’s ability to deliver safe and efficient care”.

A South Tees spokeswoman said: “A new system is expected to cost around £35m over 10 years and [our] current appraisal process involves the identification of suitable funding options.”

An ICS spokesman said: “North East and North Cumbria Integrated Care System have yet to consider approval for this.”

An NHSE and I spokesman said it was working with the ICS and FT “to find a viable solution to accelerate implementation of the electronic patient record programme”.