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A watchdog has drawn comparisons between the Government's £30m new electronic patient record system and a controversial £60m IT overhaul – as she revealed that there was no "transparent audit trail" for the health project and that it had been "hard to track" whether it had kept in budget.
In a new report published today, Comptroller and Auditor General Lynn Pamment also revealed that contractual negotiations for the Government’s £30m Electronic Patient Record system only took place after the procurement stage – meaning that "the final contract that was signed did not reflect the terms and conditions notified to potential bidders".
Her report also found that the financial information for the new system “does not enable a transparent audit trail to the funding for the programme”.
The Electronic Patient Record (EPR) system is a business process-based software solution that brings together key clinical and administrative information involved in the care and management of patients.
The main aim of the EPR system is to provide a single source of patient information available at the time and place where care is being delivered.
Ms Pamment found that that the “level of senior change” within those leading the EPR system implementation “may well have had a negative impact on the wider engagement with key stakeholders, particularly clinical stakeholders”.
“There is evidence that despite significant attempts made by the EPR programme team, levels of engagement from senior clinicians and managers fell below what was expected and hoped for,” she wrote.
Pictured: The main aim of the Electronic Patient Record (EPR) system is to provide a single source of patient information for Jersey's Health Department.
Since the system’s launch, there have been two changes in Chief Clinical Information Officer (CCIO) as well as changes in the leadership team of the Health department more widely.
The appointment of a new CCIO in July 2021 “provided a catalyst for a reset of the project at that time”.
However, Ms Pamment found that “if there had been a better original understanding of the market for these services during the initial procurement earlier in 2021, this reset and the associated procurement exemptions and breaches would not have been required”.
Prior to the new CCIO taking up post, the negotiations on contractual terms for the EPR system had been led by an external consultancy firm.
However, once in post, the new CCIO "identified significant risks to the Government with the contracts that had been proposed".
Pictured: "The final contract that was signed did not reflect the terms and conditions notified to potential bidders at the procurement stage," the report found.
The decision was then made to "seek to reduce the contractual risks to Government through further contractual negotiations that took place between July and October 2021", the report found.
Therefore, "the final contract that was signed did not reflect the terms and conditions notified to potential bidders at the procurement stage".
"While the final terms and conditions were more favourable for the Government, it is not best practice to allow post-award contract negotiations to take place," said Ms Pamment.
The C&AG also found that the financial information for the EPR system "does not enable a transparent audit trail to the funding for the programme included in the Government Plan 2021-2024”.
Ms Pamment criticised the fact that there wasn’t a Full Business Case produced at the end of the procurement stage, which meant that the financial information in the November 2020 Business Case “did not reflect the value of the agreed contract entered into after the procurement stage”.
Pictured: “It is hard to track whether the EPR programme is over or under spending," the report found.
She also found that the way in which the EPR system funding is drawn from a wider HCS digital transformation programme means that “it is hard to track whether the EPR programme is over or under spending”.
Despite finding that the financial benefits of the system implementation were “not overly ambitious”, the C&AG expressed concerns that “the programme will be stuck in short term operational delivery mode and that benefits realisation may be pushed back to the fourth quarter of 2024, or even forgotten”.
Ms Pamment found that the date for the new EPR system to go live was put back on two occasions – resulting in a seven-month total delay.
She found that the reasons for the first delay were issues with overall programme management, delays in engagement with staff, and delays in obtaining access to the ‘old’ patient information system for data migration.
The reasons for the second delay included specific programme risks that “had not been identified and managed effectively”.
Pictured: Difficulties in obtaining access to the ‘old’ patient information system for data migration meant that the implementation of the new system was delayed.
When the EPR system eventually went live, there was “concern around the number of issues that did present and the length of time it is taking to resolve all of them”.
The C&AG found that in September 2023 – three months after the the date when the EPR system went live – seven key risks remained on the EPR system risk register that “required urgent attention by the programme team”.
Announcing the publication of the report today, Ms Pamment said: “There is a large degree of similarity between the findings of this review with those of my previous reviews of the Integrated Technology Solution (October 2021 and April 2023) and Major and Strategic Projects, including Capital Projects (November 2023).
“While good practice frameworks have been established for projects such as the EPR implementation, in order to drive value for money from significant investments there needs to be a much greater focus on effective stakeholder and user engagement as well as more effective discipline around the identification, monitoring and delivery of benefits.”
The full Electronic Patient Record report can be found HERE.
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