Patients discharged without notes in Lorenzo EPR blunder at Lister Hospital
[Hertfordshire, UK] An investigation at East and North Hertfordshire NHS Trust has found ‘insufficient evidence’ that discharge summaries of around 14,600 people were written and sent from September 2017 until July of this year following the introduction of DXC Technology’s Lorenzo Electronic Patient Record (EPR).
Dr Michael Chilvers, the trust’s Medical Director, detailed the extent of the incident, uncovered in July, in a letter sent to GPs and practice managers last Friday (7 September), leaked to HuffPost UK.
The document reveals that the trust received reports of missing discharge summaries from patients’ GPs before July, but this was not thought to be an ‘unexpected occurrence’ as similar issues had previously been reported by other NHS trusts introducing similar systems.
However, a review was ordered after concerns were raised by Lister Hospital’s emergency department, where the failure took place.
“Looking across all of the Trust’s service dating back to September 2017 when the new electronic patient record was installed, some 14,600 records have been identified where it is not clear on the system whether or not the discharge summary was sent to both the patient and their GP,” Dr Chilvers explained.
Nearly 2,400 cases with 'potentially unsent' discharge summaries, dating from the beginning of April until the end of July this year, will now be prioritised by the trust 'on clinical grounds', with the records of patients that attended acute medical services being reviewed first, followed by the remaining 12,200.
“It is expected that a very significant percentage will have been issued to the patient and/or their GP - it’s just that these actions have not been recorded properly.
“There will, of course, be a significant number where this has not happened, which is why each record is being reviewed individually by the relevant consultant,” the letter said.
But the document also reveals that GPs had been raising concerns about the ‘quality and timeliness’ of the trust’s discharge summaries even before Lorenzo was introduced, as its previous Patient Administration System (PAS) was described as 'so old (...) that it was no longer supported by its original provider’.
It was then explained:
“In seeking national support from NHS Digital to replace it, switching to Lorenzo was the only option available to the Trust – and not to have taken that step would have put patient safety at risk had the old PAS failed."
DXC Technology declined to comment on the incident and referred all inquiries to the NHS when contacted by BJ-HC.
In a statement, Dr Chilvers said:
“At present, there is no evidence that any patients have come to harm. The Trust is prioritising the review of discharge summaries for those patients where a follow-up action (such as a further appointment or test being carried out) might have been needed.
“These patients will have their records reviewed individually and should any outstanding actions be discovered, the Trust will take the lead in getting them sorted – this will include informing any individual patients involved, as well as their GPs.
“Although the majority are expected not to contain any follow-up actions that have still to take place, where they are identified then the Trust will ensure that these are completed as a matter of urgency. There is no evidence that any patient has come to harm as a result of not having had their discharge summary. However, this position will be kept under review whilst the incident investigation continues.
“Although we will be speaking with any patient directly should a follow-up action be found that still needs to take place, anyone is worried about their discharge summary should call our patient advice and liaison service (PALS) team – 01438 285811 (Monday to Friday, office hours only) or firstname.lastname@example.org.”
Separately, a recent report from KLAS looking at the EPR market in Europe found that DXC Technology’s ‘growth and progress’ had 'stagnated' in the UK, with Lorenzo customers reporting that the company had ‘overpromised and underdelivered in the past regarding additional functionality and development’.
“Those that are most frustrated report additional challenges and frustrations, such as system performance issues, poor usability, and lacking relationships," KLAS researchers found.
The company did not comment on the report.