Your electronic patient record will be the never-ending story

An electronic patient record (EPR) is not a task to be delivered and checked off. While there may be milestones along the way, an EPR is never truly finished. Instead, it will become an integral part of your trust's core infrastructure, an enabler of clinical safety, productivity, staff experience and strategy delivery.

For NHS board leaders, the risk is not whether an EPR is implemented, but whether it is governed and optimised well enough to support trust and wider system priorities in an increasingly pressured NHS.

James Rawlinson reflects on how Rotherham pivoted from a poor implementation that contributed to special measures to a position where they are winning national awards for their high satisfaction. The technology didn't change but what did was an increase in clinical leadership, improving pathway integration, focus on reliability and shifting perceptions to an EPR that is owned and trusted by its workforce. Abigail Harrison shares how Lancashire and South Cumbria implemented their EPR quickly and safely but are now investing heavily in optimisation, infrastructure and service redesign to unlock the real benefits.

How to set yourself up for success

1) The software you choose is not the be all and end all

Multiple research sources demonstrate that EPR supplier choice alone does not determine user satisfaction or success of the system. In fact, the same EPR platforms appear at both the top and bottom of global usability rankings. What differentiates high-performing EPR systems is how the technology is configured, how usable and accessible it is in practice for staff and how organisations listen and respond to users.

Question for boards: How will we continually measure user satisfaction, including data or time to access, and ensure that frontline feedback translates into system improvement?

2) Don't mistake engagement for leadership

Clinical engagement is essential at every stage of an EPR journey, but engagement without leadership is not enough. Whether led by a chief nursing information officer, chief clinical information officer, or one of your clinical board directors, EPRs must be seen as a clinical tool, not an IT project. As Rotherham looks ahead to continuing their EPR journey, all of the board alongside James will be playing a key role in driving this forward.

Question for boards: Do we have clinical leadership for our EPR and are they empowered to make decisions at pace?

3) Make the data useful

Implementing an EPR places an additional data entry burden on staff. If that data is not used to improve clinical or operational care and decision making, buy-in quickly erodes. High-performing organisations invest time in building reports, dashboards and tools that support clinical, operational and administrative teams with useful data to make informed decisions.

Question for boards: Does the data we ask our workforce to enter into the EPR help them to do their jobs better?

4) Your core technology and infrastructure are critical to success

EPR programmes often focus on the visible transformation while underestimating the importance of foundational infrastructure. Raised expectations of today's workforce expect technology to work, this includes stable Wi-Fi, reliable keyboards, mice and screen equipment, as well as deep integration to allow electrocardiograms, vitals and observations to flow directly to the EPR. At Lancashire and South Cumbria, they received national funding for their EPR implementation but had to also consider the additional investment needed to modernise their technology infrastructure, such as data warehouses and ensuring they were protected against cyber-attacks.

Question for boards: How do we know our underlying infrastructure is secure, resilient and fit for purpose?

5) Treat EPR training like any other clinical tool

If digital is to be a key shift for healthcare, training needs to be treated the same as other mandatory training. Rotherham has embedded this through their EPR mastery mandatory training programme, focusing on professional standards rather than optional system training. This investment in people, not just the EPR technology, has been critical to adoption and performance.

Question for boards: Are we treating EPR training as mandatory and essential for safe clinical practice? If not, why not?

6) Use the EPR as an opportunity to optimise processes, not digitise poor ones

At Lancashire and South Cumbria, digital and improvement teams are fully integrated, supporting one another's projects. By ensuring that every meeting has representatives across both specialisms, they are shifting from digitising a poor process to optimising a process or service before digitising it.

Question for boards: Are we confident that the pathways we are digitising are optimised and ready?

7) Position the EPR as an enabler of trust strategic goals

An EPR might not save someone's life, but it can make the organisation more clinically safe, increase productivity and improve efficiency. At Lancashire and South Cumbria, the overarching digital strategy focused on releasing time to care, and this became the number one goal for the EPR. Aligning the EPR system to wider trust priorities helped shift digital investment from IT spend to strategic infrastructure.

Question for boards: Are we confident that the EPR is improving clinical safety, productivity and staff experience?

8) Think beyond organisational boundaries from the start

As health and care systems become more integrated, the true value of an EPR is unlocked when patient records can flow across organisational boundaries, including primary care, community, mental health, social care and regional partners. This requires sustained partnership working beyond the procurement phase, with industry partners, universities or system colleagues.

Question for boards: What does meaningful, ongoing engagement with our system partners look like for this EPR programme?

9) Be relentless on fixing the mixed economy of paper and digital

One of the key rules for EPR success at Rotherham was eliminating the mixed economy of paper and digital systems running in parallel. It created additional work, increased safety risks and created confusion. Fully digitised workflows require strong executive backing, robust change management and a wide recognition that this is more to do with the culture than the technology.

Question for boards: Are any legacy systems or paper processes still in operation without a clear clinical or operational need?

10) Go-live is just the beginning

For both trusts, EPR go-live marked the start, not the end, of their journey.

Rotherham is now preparing for procurement of their next EPR and Lancashire and South Cumbria continue to optimise access and functionality to meet their goal of releasing time to care.

For both trusts, success is underpinned by strong clinical leadership and reliable infrastructure, supported by multidisciplinary teams bringing together digital, improvement, operational and clinical roles.

Question for boards: Are we governing our EPR as a long-term strategic infrastructure or treating it as a once-and-done project?