Executive summary

This guide is based on the insights shared by trust leaders. Those we spoke to have mature Electronic Patient Record (EPR) systems that continue to be optimised into clinical practice. They shared the previous mistakes they made during their EPR development to help others earlier in the journey:

  • Business cases. Avoid a business case that only resources licensing the EPR. You will only achieve your ambition if you factor in the human dimensions of change and infrastructure over the full EPR lifecycle.
  • Benefits realisation. Avoid an overly optimistic benefits case. Many of the benefits will take at least five years to achieve. Make sure you create a baseline and measure impact from the outset.
  • Don't try to do it all at once. Try to implement infrastructure upgrades and software sequentially.
  • Enabling change. Do the hard work around change management before you go live. Get people to work differently before you introduce the new technology; you can then focus on the technical bits required during the switch over.
  • Over-engineering. Avoid over-engineering your EPR at the outset by trying to make it solve every problem – you'll only have to simplify it later. Engage with staff to identify the most important functionalities and prioritise those first; create a roadmap for future improvements and ensure everyone has sight of them.
  • Information governance. Trust staff and avoid being heavy handed. However, make clear you will hold people to account who handle data inappropriately.
  • Set the direction of travel and stick to it. There will be colleagues who wish to optimise the EPR in ways which suit their specific needs or speciality. However, it is important to balance local wishes with trust-wide consistency to avoid complexity and data silos. Stick with a consistent approach or you will end up with unmanageable complexity.
  • Clinical champions. Avoid creating clinical champions with no dedicated time and back-fill. Their day job will take precedence which means they won't be able to properly lend their support.
  • Learning and development. Avoid creating training that teaches features and functions but isn't situated in clinical practice – it will be meaningless to end users.

A trust board needs to have a digital vision. Where do they want to be in five years? Once you have an EPR it's going to take at least a year for the organisation to adjust and then it’s about actually using the data to make things better. You can't just stop there – benefits realisation is a big piece that the board needs to be thinking about.

Dr Rakesh Patel    Chief Clinical Information Officer, The Hillingdon Hospitals NHS Foundation Trust
  • Transformation. Avoid siloing your digital team from your improvement and transformation team. Bringing them together maximises the opportunity for joined up transformation. See our previous guide on how trust leaders can build and enable digital teams.
  • Procurement and contracting. Know your supplier and their business model. Be conscious of hidden supplier costs and fair development clauses during contracting and procurement.
  • Accept speed bumps, but don't let them turn into roadblocks. As a board, you need to understand your starting point and then prioritise. Your digital teams will have a forensic understanding of the problems and also the solutions. Encourage the quick wins that will make the biggest difference to people. When challenges do occur, talk to your key stakeholders and make sure your rationale for solving the problem is widely understood with a robust communications plan.

If you haven't got executive leaders on board with an EPR implementation, you're onto a losing battle. The messages need to come down from the top as well as through working with people on the ground.

Corrina Hulkes    Chief Nursing Information Officer, London North West University Healthcare NHS Trust

Your role as a trust board

It is the collective responsibility of the trust board to lead these changes. Board leaders should keep focused on the fact that optimisation is ultimately about fully realising the benefits that were agreed in the EPR business case. Through our interviews we identified a list of questions that all board members – both executive and non-executives – may find useful to assure themselves on EPR optimisation:

  • Do you understand how the EPR will enable your trust's organisational strategy?
  • Is your organisation tracking the promised benefits in the EPR business case?
  • Is your board discussing your EPR as an investment opportunity rather than an ongoing cost?
  • Is your trust properly resourcing the EPR and the team around it? What else does the team need?
  • What are the key issues your clinicians currently face when using the EPR? What is the organisation doing to address them?
  • Are your EPR improvements clinically-led and designed for usability?
  • Do you have a data plan (this may be part of your digital strategy) that will help your trust to fully utilise information from your EPR?
  • As an executive director, do you understand how improving the trust's EPR will help the functions and teams you are responsible for?
  • As a non-executive director, do you understand how improving the trust's EPR will improve the overall performance of the trust?
  • As a board, do you acknowledge the hard work of EPR optimisation, do you celebrate the wins, recognise progress and are you keeping everyone focused on the benefits to patients and staff alike?