对这个新闻发表评论的也都很有意思。NHS这个项目真是麻烦，现在为这个事情忙活的公司越来越少了。
Fujitsu’s £896m NHS IT contract to be terminated28 May 2008
NHS Connecting for Health is to terminate the £896m contract with Fujitsu to upgrade NHS IT systems across the South of England after the IT services giant withdrew from contract re-set negotiations.
Negotiations to 'reset' the Fujitsu local service provider contract have been underway since July 2007 but broke down.
Senior NHS staff in the South of England were told of the news today, after last ditch attempts to broker a deal failed last Friday with a final unsuccessful effort made on Tuesday. By withdrawing from the contract re-negotiations Fujitsu placed itself in breach of the original CfH contract.
In a statement NHS CfH told E-health Insider: "Regrettably and despite best efforts by all parties, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties. The NHS will therefore end the contract early by issuing a termination notice."
In a statement to EHI Fujitsu said: 'Fujitsu Services can confirm that we have now taken the decision to withdraw from the National Programme for IT (NPfIT) contract re-set negotiations with NHS Connecting for Health as we did not feel there was a prospect of an acceptable conclusion. The NHS has advised us that they intend to end the contract early by issuing a notice of termination.
The Fujitsu statement added: “For the moment our work on the contract reverts to the terms of the original programme. We will work closely with the NHS to provide a smooth transition to the new arrangements.'
CfH has begun a crash programme of working up contingency arrangements. The agency said it acknowledged the work Fujitsu had done and “commitment to smooth transition arrangements”, but stressed it had to “protect the interests of the taxpayer and preserve the basis of contracts which ensure payment on delivery.
Gordon Hextall, the chief operating officer and interim director of programme and systems delivery for CfH, said in a letter today to trust chief executives in the South: “There are no immediate implications for live sites and Fujitsu Services Ltd will continue to support these Trusts to current service levels in line with the contract. We are working co-operatively and constructively with Fujitsu Services and the NHS to review the overall arrangements for providing systems to the sites that have not yet gone live with Cerner Millennium.”
EHI Forum Link
Discuss the implications of Fujitsu's departure as LSP in the South in the EHI Forums
Jon Hoeksma
© 2008 E-HEALTH-MEDIA LTD. ALL RIGHTS RESERVED.
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Reader's Comments
1
Deckchairs on the Titanic?28 May 08 18:48
So we can imagine that BT will "volunteer" to take on the new challenge. At what point does anyone in authority ask the more fundamental question - were these contracts ever deliverable?
2
Excellent news - but model also broken28 May 08 22:44
My dealings with Fujitsu demonstrated repeatedly that their staff appeared not to really understand what they were delivering, and that the little of the commercial terms that were visible to the service did not stack up as good value. So I believe termination is the best outcome. And I say that knowing the uncertainty, delays and difficulties ahead. But I believe that the model was always wrong, and the products poor. Just substituting another LSP in their place will not fix this morass. What was intended as an integrated record for a locality has shrunk to a very imperfect Acute system, with nothing for mental health or community staff, and poor integration with GPs. I believe that the centre should go back to defining message and system interchange standards, and providing ring-fenced funds and potentially accredited products, but not monopoly monocultures, that undermine rather than underpin local joined up working.
3
Why did we have a middle man?28 May 08 23:03
I have never understood why there was a middle man. Homerton's installation of CERNER works because they worked directly with CERNER, and knew what they wanted and needed. Why Fujitsu? Why BT? But what will now happen to Southern Cluster Trusts saddled with R0? Who will enable them to reach Homerton level of functionality?
4
Then there were two....28 May 08 23:36
So presumably BT will pick up the pieces - not much competition left, is there.....?
5
Group what's there around a new Social Enterprisegerard@careprovider.com
29 May 08 01:07
Now there is an opportunity to do something different. We could start by grouping togther current players/suppliers and their local software houses around a local co-op Social Enterprise to devlop services. Having the remaining LSPs take over another patch is simply not good enough. ps I'll be Chief Exec....
6
Re-run of Accenture?maryhawking@tigers.demon.co.uk
29 May 08 07:58
Last time an LSP withdrew from two contracts, the contracts were passed - without being tendered again - to a different LSP - CSC. The number of possible existing LSPs has now shrunk to two - CSC and BT. Under EU law, does a contract of this size have to be re-tendered? and if not, are there consortia in existence able - even if willing - to undertake a project of this size and complexity, either from the beginning or, in the case of CSC and BT in addition to their current commitments? I live close to the border between CSC and Fujitsu - and my patients also receive treatment in London. Do clinicians (who, according to Lord Darzi, are supposed to be leading all changes from now on) have any right to timely information?
7
And the next please...29 May 08 08:14
So, to avoid a near-monopoly for CSC and/or iSoft/IBA, presumably it'll be BT for the South so that the Cerner Millennium strategy can continue unabated? But will it be "London Millennium" or "Southern Millennium"? Can't wait to find out...
8
Other Fujitsu offerings29 May 08 09:23
One wonders how this will affect onher offerings that Fujitsu have negotiated with CFH ??
9
CSC29 May 08 09:34
When can we expect to see the announcement relating to the CSC negotiations?
10
Who went wrong?29 May 08 09:39
Was it Fujitsu or Cerner who have failed here? Fujitsu as an LSP have proven their ability to deploy products which are fit for purpose in a timely and efficient manner (i.e. PACS). How come its Fujitsu's fault that they cannot deploy a Cerner product that clearly appears to not be fit for purpose? If BT take over and carry on deploying Cerner will it be any different? Is the problem with an American product which is not fit for NHS purpose? Are Fujitsu taking a fall due to the fact that they have no product to fit the needs to the Southern Cluster?
11
What now for NHS staffken.stafford@nhs.net
29 May 08 09:49
What happens now to all those members of staff employed just to work with Fujitsu and Cerner.
12
In France it was the same29 May 08 10:41
The National programme will never work. In France we tried the same and it did not work, it will not work in england either.
13
Time to bring in more clinical information suppliers.29 May 08 10:42
Somehow CfH must find a way of bringing more secondary care clinical information system (CIS) suppliers into the process for the medium / long term solution. Strategic Health Authorities and Acute Trusts need a choice of about 6 CIS suppliers who are competing against each other driving forward innovation and service levels. Maybe each LSP must be "told" to offer trusts a choice of at least 4 secondary care CIS suppliers whose products conform (or are very close to conforming to) SNOMED CT, HL7v3 and dm+d standards. Better still, cancel all LSP contracts and let Trusts work directly with suppliers under the overall control of their Strategic Health Authority. By the way I would define a CIS as a combined PAS and Clinical System working from one database with a minimum number of interfaces to other specialist systems.
14
Time to pause and take a breath29 May 08 11:03
Now would be a great time to pause, take a breath, and work out what would work best for the South before rushing into another LSP arranagement. Possible action?: 1) Review whether another LSP arrangement would work - what are the alternatives? 2) Stabilise current Cerner installations - most sites still seem to be struggling with the implications of the new systems. 3) See if anyone else does actually want to take Cerner as planned - most sites seem to be avoiding roll out as long as possible but someone may be desparate for a new PAS. 4) Actually work out once and for all whether Rio is the right MH solution for the South. 5) Review how Cerner is being implemented. I hear rumours from North America that it's a good system being badly installed. How can we make a good system work for the NHS needs? Personally I don't care who's to blame for the situation - let's look forward and make something work!
15
Its the Market Stupid29 May 08 12:10
Stalin tried building tractors this way. Mao tried to produce steel this way. It didnt work for them either. Big centralist Governement controlled projects almost always results in disaster. What we need is an open and well regulated market, with opportunities for service providers to buy the systems their business needs at the time that they need it and at a cost that they can afford. The Governement should provide ring fenced IM&T funds to support service providers if they want things to improve. Giving money to the DoH or the SHA or any other none provider agency will see it squandered on ever more facilitators and auditors. The market will bring prices down. The market will provide innovation. If you want a vision of a grand unified system, set high level interoperability standards and reward suppliers for producing systems that meet them.
16
What went wrong.......?29 May 08 12:11
Where can we start diagnosing this? Whose fault is it? Let’s look at this objectively....... Can we blame Cerner for arrogantly thinking that an American PAS system built around the principals of billing and not being patient centric could be simply changed to fit? I think we can to a degree as the complexity of morphing a system from that starting point to a point where it caters for the UK policies, procedures, legislation & law (for example mental health and capability & consent) is a very large undertaking. Can we fault Connecting For Health in the South for letting this continue for so long? I think we can as the governance and oversight in the region was poor to non existent in most areas except for the contract monitoring. There is plenty of blame here although to their credit this was recognized last year and changes have been made under NLOP. Can we fault Fujitsu? Indeed we can. The people at the coal face were working hard and encountering much resistance due to the product suite they were being asked to deliver. The failings were further up the chain where there was a lack of fundamental understanding of what needed to be delivered and how to deliver it. I don’t think, given my experience of the southern contract, that any party is without blame here and we should recognize that when we move forward. However what can we move forward to? BT taking over seems a natural choice given its use of Cerner within London however are we asking for the same problems? BT has hardly set the world alight with the provision of their Cerner services. The Newham configuration was purchased for use in the South and provided little impact so the hope of BT using that model is ill founded. CSC is an option. It has been supplying services to large regions and has being doing so successfully. It's bad press has been centered around the lack of provision of Lorenzo from iSoft however the solutions they have been putting in have been largely fit for purpose and have provided the core services needed. This is a proven architecture and with Lorenzo actually being brought into the country for limited trial implementations the prospect of the full Release 2 of Lorenzo is a reality before the close of the year. Additional suppliers could be an option. There are many suppliers out there who have solutions that are suitable for provision into the National Program. One such solution is SystemC's Medway PAS which was recently successfully installed on the Isle of Man alongside clinical, community, emergency and other systems. This can be regarded as a template for a LSP contract and it is notable that the project was delivered on time and on budget. However there is the problem of scalability both in terms of the solution and the resources to deliver. I would personally favor the CSC option however I am sure the Competitions commission would have many things to say about this and I would discount BT which leaves CfH in a difficult position of having to take a chance but one that could pay off. Who'd want to be in the hot seat over the coming weeks............?
17
Centralised not so good29 May 08 12:39
This whole Stalinist project has got out of hand. Managed by ignorant and greedy politicians, it has been sold to an ignorant and greedy industry who are all finding out piecemeal what a pile of poo it really is. I believe in the dissemination of information to the control and ownership of its subjects. In short, with the cost of mass storage now so low, there is little reason why the patients should not own their own data. For the majority of records a few megabytes will do, while for more complicated cases the currently available gigabytes should be ample. The central role should be restricted to elaborating and publishing an agreed data structure for records, together with guidelines for data coding. At present we have neither in any meaningful sense. The patient, or their guardian should have control over who has access to the record, and this should be granted on registration at GP or presentation at hospital. The grant should be permanent, or temporary at the patient's choice, and all copies should be erased on withdrawal or expiry of the patient's permission. There should be a master copy held by the patient's GP which would serve as a back-up for the patient's own copy. This would not be an inconsiderable project, but it would have a chance of success and would provide the badly needed security which the current project so conspicuously lacks. It also might be quite a bit cheaper and less prone to catastrophic failure.
18
Response to Poster 10ted.yeoman@nhs.net
29 May 08 13:01
Poster 10 ended up by asking the question "Are Fujitsu taking a fall due to the fact that they have no product to fit the needs to the Southern Cluster?" My understanding is that each LSP sourced it's own choice of software to meet the specs laid out in the contract. thus it was Fujitus who gambled on being able to get away with deploying a cheap (slightly modified) off the shelf American offering rather any other system. They Lost ... simple Sadly the NHS, the tax payer, the patient and possibly the NHS Staff and contractors working with Fujitsu lost too
19
The problem of multiple specialties29 May 08 13:20
Secondary care computing will always be difficult because it is a complex matrix of care providers and support services. If a Trust has 30 specialties interacting with 20 support services then the one thing you certainly have is an interoperability challenge. If this had been fully taken on board from the start then the futility of trying to shoe-horn legitimate requirements into a single size box might have been recognised much sooner. Abraham Lincoln said "You can fool some of the people all of the time, and all of the people some of the time, but you can not fool all of the people all of the time".
20
Core PAS Standards29 May 08 13:37
What is now needed is a core PAS system that conforms to specific coding, data sets and bi-directional interfacing standards in a similar way to the electronic standards. This would open up excellent competition for quality clinical systems to be interfaced and allow Trusts/PCTs to select best of breed. In a similar way a PC motherboard can interface to various electronic components from different manufacturers. Systems are likely to have much better chance of successful implementation if they are driven by the client/clinician then having a top down approach from people who are not on the shop floor so to speak.
21
DIFFICULT MADE IMPOSSIBLE29 May 08 13:41
The Southern Cluster was always going to be a tough nut to crack. The same money was allocated to it as for other much smaller clusters. Arithmatic dictates therefore that in order to deliver it the Trusts had to shoulder considerably more of the workload using resources of the skills and quantity that didn't exist. In their infinite wisdom CfH elected not to tell the trusts this so recipe for strain. Furthermore CfH agreed on the Trusts behalf that Newham and Homerton would be adequate to be rolled out as R0. Unachievable as the Trusts wouldn't take it. Didn't meet their needs and they couldn't afford to release the people required to define their needs - get out of that without moving. In Fujitsu's shoes I'd head for the door too.
22
Allow the software provider into the NHS Hospitals' with immediate effect.29 May 08 15:19
By the looks of things Cerner are a company that deals strictly in Healthcare IT. Cerner must be allowed to work with the trusts first hand and therefore have a greater rapport with the NHS. This in turn will produce a system that will be delivered on time and on budget. Seems that Cerner have been able to deliver time after time in the USA with a proven methodology that works – They must be allowed to use a methodology that delivers for them and the NHS hospitals. After all they are not the market leaders in the USA because they have a cheap system. It is a general rule of thumb and well known, that if you pay the extra you will get the quality. But once you get into the realms of micro managing a company that is used to working as the prime contractor, you are then in un-chartered areas. Therefore with a project like NPfIT it is important to use proven project methodologies and people who know what they are talking about. We must not experiment with a company that has clout in order to save money. Now it is understandable why the government chose to go with Fujitsu, as a brand they are renown, however having said that. Just because Mercedes-Benz makes quality cars, one would not task them with making planes or spacecrafts; even though they may have the capacity to do it. The point is one must not experiment with a controversial project that involves Billions of pounds of tax payers money. The tax payer cannot see the project and how it is developing. So there is naturally going to be contention around the project. It is not like engineering a bridge, at least with a bridge or the Olympic stadium you can see it being built piece by piece. A Billion pound IT system is virtually intangible to the politicians, public and staff up until the point it is switched on. So it will not get the level of respect that it deserves and that I am afraid is the way of the world. The NPfIT deserves the respect and the backing for it to be successful, or the people will have to sacrifice parts of the NHS as we know it today. There are advances in DNA mapping and medical science happening everyday. The NHS needs to be on the bleeding edge of Health IT if it is to be a leader in research and patient care. Therefore an IT system that will stand the test of time must be deployed in this NPfIT cycle. Not interim solutions that keep the NHS fragmented and disconnected. Not only the nation but the world will be watching us and must not disappoint, if we are to keep the NHS at the forefront of patient care, we must deliver!
23
Doomed to failure29 May 08 15:26
I have always thought, and argued, that CRS could never work. It didn't have a chance. History has shown that large government computer projects, without fail, are disasters. CRS is gargantuan. They either don't work, come in late, or are over budget. Too often, they go in, eventually, but do not do what they were intended to do. As to blame, this has to be laid squarely at the top of the NHS, and Richard Grainger in particular. Computer systems always sound as if they're the panacea to all our illnesses. Money is thrown at them, but without thinking them through, or considering the consequences. It should have been obvious at the very beginning that a one size fits all strategy could not possibly work in an organisation as big or diverse as the NHS. The BMA and health professionals at the sharp end should have been partners, not opposition or worse, kept out. This was the first mistake. Whether it's BT, CSC or someone else doesn't matter as much as the product which has to be the most important factor. The Barts and the London BT Cerner system went in recently, and still has problems, as someone else has noted, although not as bad as it could have been. This was a political decision, and was imposed on the Trust against the advice of experienced ICT staff who forsaw significant problems. Unfortunately, all that they predicted came to be. It's about time that management realised that their own staff have so much experience, and therefore a lot to offer. And they're cheap. I wonder when common sense will take over? Time to reflect and reconsider CRS. I doubt it ever will happen.
24
Gone but not forgotten29 May 08 16:26
Contract may be terminated but the next trust due to go live on Millennium in July with Fujitsu in the South (RUH) is still continuing to do so. Good Luck!
25
Suppliers?29 May 08 16:47
I worked with Fujitsu, Cerner and CFH on four Millennium Implementations. CFH seemed to learn lessons from previous implementations, but Fujitsu and Cerner never did. The same problems would re-appear time and time again. Fujitsu are partly at fault for employing people without the relevant skills to deploy these systems. I saw people working as specialists who had no idea of hospital workflows or even good communication skills. Fujitsu project managers though on the whole were good. Cerner staff were a mixed bag. the American staff were extremely good, but again some of the British staff did not have much knowledge about the product. This could however be down to the unflexible approach that Cerner has to solving problems. The main issue is that the system will never work well unless they have people working on it who understand the NHS... or at least try to.
26
Gone but not forgotten 2 - RUH29 May 08 16:54
And good luck to RUH (Royal United Hospital Bath) for deciding to continue with their Fujitsu/Cerner implementation. I'll think of them every time I drive by in my Rover.
27
A service is more than software29 May 08 18:38
Given the experience of the few trusts that have gone live with the Cerner software it’s understandable that attention is focussing on whether Millennium functionality will support NHS working practices. However, let’s not forget that the contract is not just for software, but for a “service” provided from a remote data centre. Operational issues such as seamless software upgrades and local software configuration without adversely impacting live sites, not to mention resilience and disaster recovery take on a whole new meaning with a user base of more than 40 acute and 30 primary care trusts. So before jumping from the frying pan into the fire, we must also ensure that the next supplier demonstrates an ability to provide a level of service that is appropriate for organisations depending upon it for the delivery of clinical services.
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发表于 2008-5-30 09:24:36
发表于 2008-5-30 10:50:24