Who is this for?

This guide is for trusts who have an electronic patient record system (EPR) already in place and want to realise the transformational opportunities it presents. It focuses on the role of the board in leading these changes. In December 2022, NHS England estimated that over 85% of trusts in England had some form of EPR and set a target for EPRs to be implemented in at least 90% of trusts by December 2023.

A well implemented and optimised EPR improves patient safety, staff satisfaction, patient flow and data quality. But this can only be achieved with continuous optimisation and investment. A poor EPR implementation, followed by a lack of investment in its ongoing development, can frustrate staff and create disillusionment. This in turn leads to poor usage and unsafe workarounds. In time this will negatively impact productivity and result in substandard data informing clinical decision making.

If you are part of an integrated care system (ICS) looking to share or align EPRs across a number of organisations, this guide will also help you consider issues of convergence, scale and shared governance. It does not address procurement and implementation. Please see our previous leadership guides for content and case studies that explore these areas.

The starting point for the chief executive is to really understand what the organisational needs are. Basically, you want to optimise care for patients and make things as easy as possible for clinicians, and so my role is really about specifying the functionality and what’s really important and making sure there’s a line of sight to that.

Julian Emms    Chief Executive Officer, Berkshire Healthcare NHS Foundation Trust

What you will learn

This guide is based on interviews with clinical and operational digital leaders who have told us how their board has supported the ongoing development of their EPR. It is supplemented by conversations with board members from trusts which have already gone some way to optimising their EPR, along with a review of key literature.

The insight, case studies and resources in this guide are intended to equip trust executive and non-executive directors with the knowledge and understanding they need to ensure the board prioritises and resources the ongoing optimisation of their EPR. Ultimately this is about improving clinical care and enabling service transformation.

It’s not about putting more and more forms on your electronic system. What you’ve got is an opportunity to work out how pathways and journeys start to change using technology and data as a catalyst, and then you reimagine that component and the wider experience. That’s what optimisation is.

Mike Cavaye    Director of Digital Strategy and Transformation, Surrey and Borders Partnership NHS Foundation Trust

Case study

Doing the hard yards of transformation to unlock benefits

While everyone accepts that digital presents huge opportunities for the NHS, doing the hard yards of transformation is difficult. There is a difference between digitising an existing paper process, such as scanning a prescription and saving it as a PDF, and fundamentally using your EPR to change the way services operate. The board must be aware of its own leadership role in enabling these changes to take place.


Following Cambridge University Hospitals' (CUH) deployment of its EPR in 2015, the following benefits are now being achieved:

  • electronic prescribing: at least 850 significant adverse drug reactions prevented each year with electronic allergy-related prescribing alerts (saving 2,450 bed days/£0.98m a year)
  • automatic EPR alerts: in 2018/19 at least 64 lives saved because of sepsis alerts improving the more timely administration of antibiotics
  • physiological devices in theatres: saving £2.6m through the EPR automatically recording data and 18% increase in main theatre case volume through faster theatre turnaround and analytics in EPR
  • EPR - Pharmacy integration: 50% reduction in time it takes to prepare discharge medications because the EPR 'talks' directly to medication dispensing robots.

The trust shared their lessons for achieving these benefits over time. Building the EPR vision at CUH was important in underpinning digital transformation. This was initially focused on quality, but then broken down into different components, such as safety, patient centredness, timely care and sustainability. The trust then began exploring the ways digital could support each of these.

Changes to the EPR are managed through a number of design authorities, composed of clinical groups with senior oversight. At board level, digital, transformation and improvement reports to one executive director. The 'binding' of these disciplines gives the trust a better sense of how to prioritise. It also means there is a free flow exchange of ideas. The operational and clinical teams focus on the who, what, when and why, to describe 'what the ideal circumstance is'. And then it is determined how digital can support that process from start to finish.

There is an embedding of clinical and operational staff within the digital team, which include nurses, pharmacists, allied health professionals and junior doctors. But increasingly CUH wants more digital personnel embedded in clinical and operational teams too. The result is that requests for digital changes are becoming more sophisticated, for example from changing the colour of buttons to now redesigning care pathways such as those in the diabetes out-patient clinics.

At an ICS level, staff have developed an even greater appreciation for standardising and the consistency of data and documentation structure and content because of the increased information sharing with primary care, social care and other providers in support of driving up the quality of delivered care.