Key takeaways

  • You cannot rely on staff motivation alone for the EPR to be used as it is intended.
  • Start by simplifying the EPR and making it as easy to use as possible.
  • Take into account other factors and dependencies in EPR improvement.

As explained earlier in this guide, EPRs are more-often-than-not over configured when they are first implemented. The process of optimisation is as much about simplification as it is about adding new fields and functions.

You cannot rely on motivation alone for the EPR to be used as it is intended – it is critical to ensure it is as easy as possible for colleagues to do the right thing.

It is important to use data to optimise your EPR or else you are in danger of being led by whoever has the loudest voice. You can analyse data from within the EPR to assess how well it is being used and what you need to do to improve.

It is also important to keep in mind that successful optimisation means having the wider infrastructure working effectively. This can be everything from devices and connectivity through to plug sockets and workstations. A rolling replacement policy for hardware is critical along with regular audits of IT service desk issues and clinical incidents to identify challenges around themes such as reliable Wi-Fi.

Where you are looking to scale across an ICS, it is important to consider different organisational cultures and ways of working from the outset. Remember change is a social rather than simply a technological process. Framing the change as an opportunity to unify good practice and learn from each other is a good starting point to create enthusiasm and focus on improving clinical practice. Ultimately, the great benefit of convergence across organisations is the ability to see the whole patient pathway and make improvements at each point.

Optimisation is about saying 'how can I take clicks out of your workflow?' or 'how can I make whatever you’re doing today easier?' At the beginning, everyone will over-engineer their EPR and the temptation is to make everything mandatory.

James Bird    Joint Chief Nursing Information Officer, Imperial College Healthcare NHS Trust, Chelsea and Westminster Hospital NHS Foundation Trust, The Hillingdon Hospitals NHS Foundation Trust

Case study

Optimising a home-grown EPR

It's an amazing [EPR] team because people are invested in the product and people like it. We believe in what we're doing. You can't apply to a software developer for a change and then expect it to appear in the system within a few months. But in our systems, we've really got the leverage to do that. And also because we built the system, we can download all the data.


University Hospitals Birmingham (UHB) is a large acute trust in the Midlands with a home-grown EPR called Prescribing Information and Communication System (PICS).

Control over the development of every aspect of the EPR along with ownership of data, has resulted in a highly usable and well liked system. Not only does data follow the patient, but a data lake affords rich research and innovation opportunities. 

In recent years PICS has developed the PHR through which patients can access results, upcoming appointments, letters and patient information leaflets as well as uploading information such as blood pressure readings to share with the clinical team. If patients are concerned about their results they have an easy way to get in touch with the clinical team directly.

The PHR is taken up by around 50% of patients to whom it is offered and is well liked and used by many. Uptake of the PHR is well spread across age ranges, although less used by people from ethnic minority backgrounds and those experiencing poverty and social exclusion. This raises the issue of digital inclusion for those less likely to access digital services, which the trust is looking to address.

As well as executive and clinical leadership, the trust has found that an EPR which people believe in has been key to successful adoption. Having the right infrastructure, including computers and Wi-Fi, has removed barriers to EPR uptake. Finally, realistic and properly funded management of change has ensured facilitated adoption.