Emily Harkleroad

www.cddft.nhs.net 

Executive Corridor 
Darlington Memorial Hospital 
Hollyhurst Road 
Darlington,  
DL3 6HX 

27th March 2024 

Rebecca Sutton,  
Assistant HM Coroner,  
County Durham 

Dear Ms Sutton,  

Re: Emily Harkleroad 

We are writing in response to your request for the Trust to take action in relation to the absence 
of RAG rating on the Emergency Department (ED) display screen in Oracle Cerner Millennium 
to prevent future deaths, which you issued to County Durham & Darlington NHS Foundation 
Trust following the patient’s inquest held on the 05th February 2024. 

The Trust would like to offer, once again, its sincere condolences to Emily’s family for their 
loss. We take very seriously the concerns which you have raised and have provided a detailed 
response below. In summary: 

  When implementing the Oracle Cerner Millennium system we put in place additional 
functionality  to  help  clinicians  to  recognise  and  act  on  patient  deterioration,  which 
improved upon the previous system in terms of ease of access, decision support and 
the detail of patient observations available to clinicians on the main dashboard. 

  We discussed with Oracle Health the potential to add and display RAG-ratings based 
on the patient’s Early Warning Score for go-live and were, at that stage, advised by 
the work-steam leads allocated to the Trust that it was not possible. We subsequently 
logged a further request from the ED teams for this functionality, internally, to discuss 
with Oracle Health for future development.  

  The  Emergency  Department  at  UHND  had,  with  the  support  of  our  Patient  Safety 
Leads,  already  put  an  action  plan  in  place  to  learn  from  this  case,  in  particular  to 
address issues with the way in which the new functionality above was used.  

  Following your letter of 5th February 2024, and discussions with Oracle Health we have 
expanded that action plan to include collaboration with Oracle Health on the addition 
of  a  further  column  to  the  ED  Screen,  which  will  RAG-rate  patients’  Early  Warning 
Scores  as  ‘High’,  ‘Medium’  or  ‘Low’  with  colour  coding.  It  is  understood  that  Oracle 
Health are looking to make this functionality available as part of their standard upgrade 
programme from around the middle of this year.  We note below further actions, either 
already implemented or in progress, to mitigate risk. 

 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 www.cddft.nhs.net 

Implementation of Oracle Cerner Millennium 

The Oracle Cerner Millennium system was implemented in October 2022 across the Trust’s 
acute hospitals, including its Emergency Departments. It provides three key applications for 
the use of the ED team: 

  Medanets: A mobile application which enables staff to capture patient observations 
from  hand-held  devices,  calculates  national  early  warning  scores  (NEWS)  and 
provides decision support for clinicians. The Emergency Department did not have this 
functionality  prior  to  the  implementation  of  Oracle  Health  and  it  was  put  in  place  to 
enhance patient safety. More information on Medanets is outlined below. It includes a 
RAG-rated view as shown in Appendix A.  

  Firstnet:  This  application  allows  for  data  entry  and  management  and  supports 
functionalities  including  registration,  triage  and  tracking  of  patients  through  their 
Emergency Department encounter and nursing documentation. 

  Launchpoint: This  is a dashboard  view  available on  Firstnet  which can be  used  to 
manage  and  monitor  all  patients  within  the  Emergency  Department.  Clinicians  can 
monitor test requests, workflow and key patient information. Launchpoint is the main 
interface through which the clinical team can view data entered through Firstnet.  

The previous ED system, Symphony, was replaced as part of this roll out.  Symphony did have 
a RAG-rated display based on Early Warning Scores. It is now the Launchpoint dashboard 
that provides the equivalent view to that which would have been available in Symphony. Whilst 
Launchpoint did not provide a RAG-rated view  based on early warning scores in the same 
way as Symphony, there was an alternative view available, the “Emergency Department list”, 
which displays the patient list so that the highest early warning scores are at the top of the list. 
Launchpoint  is  also  more  detailed  and  captures  the  individual  observations  whereas 
Symphony only captures an aggregated view. Appendix B shows views of the dashboards in 
both Symphony and Firstnet, both the Launchpoint and Emergency Department dashboards, 
(including the new view with the RAG-rated EWS column in development and outlined further 
below).  

The  ED  team  requested  the  same  functionality  as  that  in  Symphony  as  part  of  the  Oracle 
Health  system  at go-live  and this  request  was discussed with Oracle Health’s  work-stream 
lead  who  advised  it  was  not  feasible  at  that  time.  Taking  account  of  the  additional  safety 
functionality introduced into the department through Medanets and the overall functionality of 
Launchpoint, the Trust judged the patient safety risk to be mitigated.  

Subsequent to the roll out of the system, the Emergency Department made a further request 
for  a  RAG-rated  view  based  on  early  warning  scores  and,  given  the  previous  advice  from 
Oracle Health, this was logged internally as a potential future development.  

Medanets - Developments for Deteriorating Patient in ED  
Before  adopting  Cerner  Millennium,  the  Trust  utilised  Nervecentre  across  all  wards. 
Nervecentre,  compatible  with  both  Android  and  Apple  devices,  allows  for  the  recording  of 
patient observations, calculation of NEWS scores, and provides decision support to clinicians 
while automatically escalating any concerning NEWS scores to the nurse in charge and the 
junior  doctor,  thereby  alerting  them  to  a  patient's  deteriorating  condition.  Recognising  that 
Oracle Cerner Millennium lacked this specific functionality, Oracle Cerner collaborated with 
Medanets, a third party, to ensure these essential mobile capabilities were retained. 

 
 
 
 
 
 
 
 
 
 
 
 www.cddft.nhs.net 

While  Nervecentre  was  not  previously  implemented  in  the  Emergency  Department,  it  was 
decided  to  introduce  Medanets  into  the  ED  to  provide  staff  with  real-time  decision  support 
available to ward staff and enforce policies regarding patient escalation, thereby enhancing 
patient safety. 

The  Medanets  mobile  application,  which  includes  a  two-way  interface  with  the  Electronic 
Patient  Record  (EPR),  enables  bedside  recording  of  observations.  It  provides  staff  with 
essential decision support and guidance on patient escalation. Appendix A includes images 
of  Medanets  patient  lists,  which  utilise  a  RAG  rating  system,  along  with  examples  of  the 
decision support and escalation processes. The application is accessible on Zebra devices — 
similar in size to smartphones — and tablets. These devices have been available in inpatient 
wards  and  the  ED  (except  for  escalation  messages)  since  the  system  went  live  on  10th 
October 2022. 

Coroner Request to Ask Newcastle 
At the inquest HM Coroner asked that we consult with Newcastle to explore how they review 
their  patients  on  patient  lists  /  screens.    From  correspondence  with  the  Chief  Nursing 
Information Officer at Newcastle the following was established: 

  Newcastle  do  not  have  big  screens  in  the  department  as  at  CDDFT,  they  view  the 

patient lists on desktops. 

  CDDFT use ‘ED Launchpoint’ as the screen on display in the department, Newcastle 

do not have this screen on their version of Firstnet. 

  Newcastle  use  the  ‘Emergency  Department’  list  for  their  landing  page  /  patient 

list.  They have added colour to the EWS and any NEWS of 5 or above is red.   

Improvement work since Go Live 
In 2023, it was observed that ED teams were predominantly entering observations directly into 
Millennium  via  desktop  computers,  mirroring  their  previous  method  with  Symphony,  rather 
than utilising the provided mobile devices with the Medanets application. This practice results 
in a loss of decision support for the staff. In the case of Emily, two out of the three sets of 
observations taken were recorded directly into the desktop and not the Medanets application. 
Consequently, considerable efforts have been undertaken to ensure that ED staff fully utilise 
the  mobile  Zebra  devices  and,  by  extension,  the  Medanets  application  for  recording 
observations in the ED. These efforts included providing support directly at the point of care, 
formal training, and regular updates on compliance through key messages. 

Compliance with the ED observation policy, particularly whether observations were repeated 
within the required timeframes based on the score, is reviewed during monthly Quality and 
Performance meetings. The compliance data, which encompasses 100% of the observations 
recorded in the Oracle Cerner Millennium each month and is broken down by individual areas, 
is  meticulously  monitored.  The  data  presented  below  pertains  specifically  to  the  UHND 
Emergency  Department,  which  is  relevant  to  this  Regulation  28  notice.  On  average, 
compliance has reached 95%. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 www.cddft.nhs.net 

Planned Actions 
The action plan that accompanies this letter is the action plan from the Urgent and Emergency 
Care Group’s  original  investigation,  now  extended to  include Trust's  actions  in response to 
Regulation 28. To summarise, the actions include: 

  Activating escalation alerts within the Emergency Departments. 
  Deploying two tablets in each Emergency Department for use by the nurse in charge 
and the Emergency Practitioner in Charge (EPIC), enabling them to receive alerts and 
access the dashboard. 

  Collaborating with Oracle Cerner on the development of column with a RAG rating for 
the Early Warning Scores shown in Launchpoint. This is illustrated on the final slide 
included in Appendix B. We understand that Oracle Health are looking to make this 
functionality available for clients as part of their standard upgrade programme, from 
around June 2024.  

Improvement work already undertaken in relation to physiological observation recording and 
deteriorating patient escalation can be found in Appendix A. 

Enclosures 

Appendix A – Demonstrates the Medanets functionality and notes actions which have been, 
or are being taken, to embed its use 

Appendix B – Shows the different A&E Dashboards including the view in Symphony, views in 
Launchpoint (including the view sorted by the EWS) and the new view on which we are working 
with Oracle Health.  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Conclusion 

We trust that the measures already implemented and those planned are sufficient to address 
the concerns you have highlighted. However, please feel free to contact us if you need any 
additional information or have further queries. 

Yours sincerely 

www.cddft.nhs.net 

Executive Director of Nursing  

  Executive Medical Director  

cc.

Oracle Corporation UK Limited 

Oracle Parkway 

Thames Valley Park 

Reading 

Berkshire 

RG6 1RA 

http://www.oracle.com 

Ms. Rebecca Sutton, 
Assistant Coroner for County Durham and Darlington, 
H.M. Coroners Office, 
P.O. Box 282, 
Bishop Auckland, 
Co. Durham. 
DL14 4FY 

Dear Madam, 

27 March, 2024 

Re: Response to Regulation 28 Report to Prevent Future Deaths dated 5 February 2024 

1. 

This  is  Oracle  Corporation  UK  Limited’s  (formerly  Cerner  Limited)  (“Oracle  Health”)  response 
(the “Response”) to the Regulation 28 Report to Prevent Future Deaths dated 5 February 2024 
(the “Report”). The Report was issued by Assistant Coroner Ms. Rebecca Sutton (the “Assistant 
Coroner”) following an Inquest opened on 6 January 2023 into the death of the Deceased on 19 
December  2022  (the  “Inquest”).  Oracle  Health  was  not  invited  to  participate  in  the  Inquest  or 
given an opportunity to make representations and was not aware of it until receiving the Report. 

A. EXECUTIVE SUMMARY 

2. 

Oracle Health deeply regrets and was saddened to learn of the various medical omissions which 
ultimately caused the death of the Deceased and extends  its condolences to the family of the 
Deceased and others bereaved. Oracle Health assures the Deceased’s family that Oracle Health 
takes the contents of the Report extremely seriously and that in response to it, Oracle Health has 
conducted a thorough and in-depth review of the Millennium software deployed and in operation 
at the Emergency Department of the University Hospital of North Durham (“Durham Emergency 
Department”). 

3.  While there is no suggestion that the software was at fault, and many factors contributed to the 
death of the Deceased, based upon Oracle Health’s review and the facts and matters described 
more fully in this Response, it concludes as follows (key findings in this Response are highlighted 
in bold throughout): 

3.1. 

Oracle Health has not identified any evidence to suggest that the death of the Deceased 
was preventable by reason of any alleged defect in its software. The Millennium software 
was  working  as  designed  and  configured  in  conjunction  with  the  County  Durham  and 
Darlington NHS Foundation Trust (“CDDFT”). 

3.2. 

Launchpoint’s homescreen does provide clinicians with a colour coded ‘RAG rated’ Acuity 
Score for individual patients. 

Company Reg. No. 1782505 

Registered in England and Wales 

Registered Office: as above 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 3.3. 

3.4. 

Launchpoint’s homescreen also provides clinicians with a separate ‘Early Warning Score’ 
for individual patients (an aggregate assessment of certain vital signs and physiological 
measurements).  While  this  aggregate  value  is  not  colour  coded,  Launchpoint  does 
display  the  constituent  individual  vital  signs  and  physiological  measurements  entered 
through  Millennium  in  red  where  classified  by  healthcare  providers  as  ‘critical’.  The 
functionality also exists to colour code any other values by their risk level. 

Oracle Health has no record of CDDFT raising any clinical safety issues relating to the 
display  of  patient  Acuity  Scores  or  Early  Warning  Scores  in  Launchpoint  during  the 
Millennium training process or additional support period. CDDFT raised no service issue 
with  respect  to  the  display  of  patient  Acuity  Scores  or  Early  Warning  Scores  in 
Launchpoint  as  part  of  the  deployment  testing  process  or  subsequent  to  the  systems 
going live in October 2022. 

4. 

Notwithstanding  the  above  conclusion,  that  the  Millennium  software  at  Durham  Emergency 
Department was working as designed, configured and approved by CDDFT, Oracle Health fully 
acknowledges the importance of the Assistant Coroner’s observations. In particular, the Assistant 
Coroner’s desire to ensure that there is a “quick and clear way of identifying the most critically ill 
patients”, especially “in times of extreme pressure” on Durham Emergency Department, including 
through  the  inclusion  of  a  “RAG  rating  system”.  Oracle  Health  has  engineered  a  configuration 
enhancement, namely an additional colour coded column on Launchpoint’s homescreen charting 
individual  patient’s  ‘Early  Warning  Score  Risk  Level’.  This  enhancement  will  be  available  for 
deployment to CDDFT and other legacy deployments from around June 2024. 

B. ORACLE HEALTH AND MILLENNIUM 

5. 

6. 

7. 

Oracle Health‘s Millennium software has been successfully deployed globally, first in the United 
States in 1984 and since 1986 internationally. Oracle Health has licensed its solution at 28,000 
facilities  around  the  world,  and  has  adapted  Millennium  to  various  types  of  facilities,  including 
3,000  hospitals,  3,500  physician  practices,  200  home  health  facilities  and  200  employer  sites. 
Oracle Health’s clients include over 39 NHS Trusts. 

Oracle  Health  designed  Millennium  as  an  electronic  patient  record  solution.  The  solution 
automates the care process and workflows by creating an electronic medical record through which 
physicians can access near real time data. By organising the data around the patient, rather than 
the patient encounter, Millennium eliminates duplication and encourages best practice by placing 
data  only  once  in  a  central  repository.  Millennium  enables  information  from  disparate  clinical 
domains and multiple facilities to be seamlessly integrated. 

The  Millennium  solution  currently  comprises  nine  solution  and  service  sets  with  sub-modules. 
Within Millennium’s Emergency Medicine Solution, the relevant sub-modules for the purposes of 
this Response are as follows: 

7.1. 

FirstNet: is a data entry and management solution that supports functionalities including 
registration,  triage  and  tracking  of  patients  through  their  Emergency  Department 
encounter  and  nursing  documentation.  Features  of  this  solution  include  the  ability  to 
integrate with patient registration, the clinical patient chart, and patient tracking lists that 
can  be  customised  to  check  patient  status  and  view  test  results  quickly,  providing  ED 
clinicians with the information and tools they need to streamline patient care and patient 
throughput. 

 
 
 
 
 
 
 
 
 
 7.2. 

Launchpoint:  provides  a  clinician-focused  view  of  the  data  held  in  FirstNet.  It  is  a 
dashboard  that  is  used  for  managing  and  monitoring  all  patients  within  an  Emergency 
Department.  It  provides  a  single  location  for  the  Emergency  Department  clinicians  to 
locate and view the workflow, orders and patient information enabling them to drill down 
where  additional  detail  is  available.  It  is  distinguished  from  FirstNet  on  the  basis  that 
Launchpoint is the principal interface through which clinicians view clinical data entered 
through FirstNet. 

C. DEPLOYMENT OF MILLENNIUM AT CDDFT 

8. 

In December 2020, CDDFT signed an agreement to implement Oracle Health’s Millennium 
solution. Millennium went live in the Durham Emergency Department in October, 2022. 

(i) Configuration of Launchpoint by CDDFT 

9. 

The initial steps in the deployment of the Millennium solution involves an assessment of a client’s 
existing systems, an evaluation of their objectives and a demonstration of the relevant solutions 
in default configuration. Following the initial consultation process, Oracle Health hosted a series 
of design and configuration workshops for CDDFT between around June 2021 and mid-October 
2021. Workshops covering FirstNet and Launchpoint were hosted by Oracle Health’s Emergency 
Department and/or Clinical Documentation Teams and were attended by subject matter experts 
empowered  to  make  design  decisions  on  behalf  of  CDDFT.  It  is  critical  to  the  success  of 
deployments  that  appropriate  decision-makers  attend  these  sessions  and  they  are  required  to 
have a solid understanding of the workflow processes within their areas of expertise. 

10.  There are no specific Government or NHS regulations, or guidance, governing how patient Acuity 
Score  or  ‘National  Early  Warning  Score’  (“News2”)  information  is  displayed  in  electronic 
healthcare systems. However, as an experienced industry leader in electronic healthcare, Oracle 
Health  has  developed  content,  workflows  and  decision  support  to  meet  the  needs  of  its  client 
base. As part of the design and configuration workshops, CDDFT representatives were given the 
opportunity to tailor certain aspects of FirstNet and Launchpoint functionality to the specific needs 
and workflows of CDDFT. 

11.  Oracle  Health  understands  that  the  display  of  patient  information  was  only  raised  during  the 
course of oral evidence at the Inquest and that the Assistant Coroner may not have had the benefit 
of a written, or visual, description of Launchpoint. Such evidence also appears to have used the 
terms  patient  ‘Acuity’  and  ‘Early  Warning  Score’  interchangeably,  but  they  are  separate  and 
distinct concepts: 

11.1.  Acuity is a measurement of the severity of a patient’s condition and the urgency with which 
they  need  to  be  seen  by  a  clinician.  FirstNet  licences  and  incorporates  the  ‘Manchester 
Triage System’. Acuity is generally assessed at the point of admission to the Emergency 
Department  and  does  not  typically  change  during  a  patient’s  journey  through  the 
Emergency  Department.  A  patient’s  Acuity  Score  assists  Emergency  Departments  in 
determining  onward  patient  care,  including  the  timing  and  frequency  of  further  medical 
intervention and observations. The Acuity Score is to be contrasted with a patient’s Early 
Warning Score (described below), which typically will change through the patient journey. 

11.2. 

An Early Warning Score derives from News2, a system endorsed by the Royal College of 
Physicians,  NHS  England  and  the  National  Institute  of  Clinical  Excellence  (NICE).  The 
system  strives  to  improve  detection  and  response  to  clinical  deterioration,  by  scoring 
certain vital signs and physiological measurements that are routinely recorded at a patient's 

 
 
 
 
 
 
 
 
 
 
 bedside  (e.g.,  blood  pressure,  temperature  and  respiration  rate)  according  to  a 
standardised  NHS  scale  for  assessing  and  responding  to  acute  illness.  The  scores 
assigned individual vital statistics and physiological measurements are then aggregated to 
provide  an  overall  score.  As  a  patient’s  relevant  vital  statistics  and  physiological 
measurements change, so too will their Early Warning Score. 

12.  The following is a screenshot of Launchpoint as configured in conjunction with CDDFT: 

A 

B 

C 

Screen 1: Launchpoint as configured in conjunction with CDDFT. 

13.  By way of further explanation of the above screenshot: 

13.1.  The column labelled ‘A’ displays a colour coded, ‘RAG rated’ Acuity Score for each 
patient.  With  reference  to  the  Manchester  Triage  System,  clinicians  can  enter  the 
relevant score into FirstNet, which is then displayed in Launchpoint as above. 

13.2.  The column labelled ‘B’ displays a patient’s Early Warning Score. Unlike the patient 
Acuity Score listed in Column A, the functionality does not currently exist to colour code 
the Early Warning Score when FirstNet is used in conjunction with Launchpoint. CDDFT 
representatives did not identify this limitation as a clinical risk, or other impediment to go- 
live, during the design workshops and were content to proceed. 

13.3.  The  columns  labelled  ‘C’  display  a  patient’s  individual,  vital  statistics  and 
physiological  measurements,  including  certain  data  from  which  the  overall  Early 
Warning  Score  is  calculated.  As  demonstrated  in  the  screenshot  below,  Launchpoint 
displays  in  red  any  such  observation  entered  through  FirstNet  classified  by  the 
healthcare  provider  as  ‘critical’  and  the  functionality  exists  to  colour  code  the  other 
values by reference to their risk level. 

 
 
 
 
 
 
 
 
 
 Screen 2: Launchpoint as configured in conjunction with CDDFT displaying red colour coding. 

14. 

In addition, Launchpoint as configured in conjunction with CDDFT: 

14.1.  Generates a separate ‘pop up’ notification if a clinician clicks through the options 
to view a specific patient’s electronic health record and if their Early Warning Score 
has  started  to  deteriorate  significantly,  irrespective  of  the  task  currently  being 
performed on the system. 

14.2.  Contains  a  separate,  colour  coded  Early  Warning  Score  Risk  Level  that  appears 
when  a  clinician  clicks  on  any  field  in  columns  B  to  C  as  demonstrated  in  the 
screenshot below. The Early Warning Score Risk Level is determined by reference to a 
patient’s Early Warning Score, and is split into three categories, each appearing in colour 
coded capital letters: ‘LOW’ (black), ‘MEDIUM’ (orange, with an upwards or downwards 
arrow to indicate ‘medium high’ or ‘medium low’ risk), and ‘HIGH’ (red with an additional 
exclamation mark). 

Screen 3: Launchpoint Early Warning Score Risk Level shown in the Extra Information Window as configured in 
conjunction with CDDFT. 

15.  Millennium is not intended to replace the alarms or alerts generated by the hardware monitoring 
the individual, vital statistics and physiological measurements e.g., a heart rate  monitor, which 
alarms and alerts remain an important element of patient response. 

16.  Accordingly, Launchpoint as designed, configured and approved by CDDFT did provide a 
“a  clear  indication  at  first  glance”  of  a  patient’s:  (a)  Acuity  Score,  including  through  a 
colour coded, ‘RAG rated’ column; (b) Early Warning Score; and (c) individual vital signs 
and  physiological  measurements,  with  critical  values  displayed  in  red  where  entered 
through FirstNet. 

 
 
 
 
 
 
 
 
 
 
 (ii) Testing, Training and Ongoing Monitoring of Launchpoint by CDDFT 

17.  Oracle Health has no record of CDDFT raising any clinical safety issues relating to the display of 
patient  Acuity  Scores  or  Early  Warning  Scores  in  Launchpoint  during  the  Millennium  training 
process or additional support period. Further, CDDFT raised no service issue with respect to the 
display of patient Acuity Scores or Early Warning Scores in Launchpoint as part of the deployment 
testing process or subsequent to the systems going live in October 2022. 

D.  POTENTIAL ENHANCEMENTS TO LAUNCHPOINT AS DEPLOYED AT CDDFT 

18.  Oracle Health continuously engages in ongoing dialogue with its clients with regard to potential 
software code and configuration enhancements to its Millennium solutions. Such enhancements 
can arise at the global, or national, level in response to the knowledge and experience gained by 
Oracle  Health  from  working  with  its  extensive  client  base.  They  can  also  arise  in  response  to 
specific issues at the level of local deployments. In each case, Oracle Health will discuss with its 
client the appropriateness of taking a potential upgrade and its impact on existing workflows and 
the user interface. Ultimately, the decision on whether to take a particular code or configuration 
enhancement remains with the client and can involve clinical and commercial considerations. 

19.  Oracle Health is in discussions with CDDFT as to whether there are configuration changes that 
can be made to further support the Durham Emergency Department. In particular, Oracle Health 
has offered the following to CDDFT: 

19.1.  Duplicate the existing Early Warning Score Risk Level in a new colour coded Early 
Warning  Score  Risk  Level  column  in  the  Launchpoint  home  screen,  located 
adjacent to the existing Early Warning Score. The new column displays in a colour 
coded, capitalised letter format the risk level of each patient (i.e., ‘HIGH’, ‘MEDIUM’ 
or  ‘LOW’)  determined  by  reference  to  their  Early  Warning  Score,  and  includes 
exclamation  marks  for  those  at  ‘HIGH’  risk.  The  inclusion  of  a  colour  coded  Early 
Warning  Score  Risk  Level  is  comparable  to  having  a  colour  coded,  ‘RAG  rated’  Early 
Warning  Score,  but  achieves  it  through  means  of  a  separate  column.  This  additional 
functionality  is  an  enhancement  and  is  already  available  for  configuration  in  new 
deployments of Oracle Health’s Emergency Treatment solution. It is projected to 
be  available  to  existing  clients  through  Oracle  Health’s  standard  upgrade 
programme from June 2024. For the avoidance of doubt, the Early Warning Score Risk 
Level is already available to Durham Emergency Department where a clinician clicks on 
any field in columns B to C as demonstrated in Screen 3 above. 

19.2.  Any  supplemental  training  packages  by  Oracle  Health  of  the  Durham  Emergency 
Department staff in their use and operation of Launchpoint as may be considered helpful. 

Yours faithfully, 

Vice President and General Manager 

For and on behalf of Oracle Corporation UK Limited 

Copy to: 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 (i) 

,  Executive  Medical  Director  of  the  County  Durham  and  Darlington  NHS 
Foundation  Trust,  The  University  Hospital  North  Durham,  North  Rd,  Durham  DH1  5TW, 

(ii)  The  Chief  Coroner,  Room  C09,  Royal  Courts  of  Justice,  London,  WC2A  2LL 

(chiefcoronersoffice@judiciary.uk).