The NHS must get more out of the EPRs it has purchased

The NHS is on the cusp of achieving 100% electronic patient record (EPR) coverage in England, a significant milestone that has been both difficult and expensive. EPR systems are key to achieving the government’s ‘three shifts’ – from analogue to digital, sickness to prevention, and hospital to home.

Used well, they can offer productivity improvements too: in recent Health Foundation research, clinical staff named EPRs as one of the technologies most likely to save them time over the next 5 years. What is more, without the infrastructure provided by these systems, the NHS will not be able to capitalise on innovations such as AI tools for prevention or risk identification.

However, coverage is not the same as effective implementation. The Health Foundation’s research also surfaced concerns among NHS staff that EPRs are not yet being used effectively, and results from the first year of the Digital Maturity Assessment (2023) revealed that only 10–30% of trusts are using key EPR functions such as integrated prescriptions or record-sharing with other hospitals.

To start reaping promised benefits, the way EPRs are used will need significant improvement. In new Health Foundation analysis, we argue that now is the time for the government to put in place a strategy for the next stage of the NHS’s EPR journey, covering both how to get the basics right and how to develop more advanced usage beyond this. As part of this, trusts should be asked to develop their own plan to sit alongside the national roadmap.

To explore the challenges in realising the benefits of EPRs, the Health Foundation undertook interviews with leaders in five acute NHS trusts in England, as well as in a leading US medical centre, NYU Langone Health in New York.

It is not surprising that using higher order EPR functionalities (such as automatic triaging and real-time decision support) is proving such a challenge for many NHS organisations.

The resources (both financial and human) needed to reap the intended benefits of an EPR are often significantly underestimated. Our interviewees emphasised the large amounts of time and money required just for upkeep of these systems, let alone to convert them into intelligent tools that can transform the way care is delivered.

This all exemplifies a wider challenge across the NHS when it comes to adopting technologies: procurement is merely the starting point on a much longer journey. Simply digitising current processes and information will leave the NHS in much the same position it is now, but ensuring trusts can use EPRs effectively will allow the NHS to capitalise on their transformative potential.

Our interview with NYU Langone revealed the time, effort and resources needed to achieve this. As one of the most digitally sophisticated hospital systems in the US, through an intensive process of planning, prioritisation and cultural change, they have gone well beyond using the EPR as a digital record and established it as a clinical decision support tool.

They are now routinely building and embedding AI and other predictive models into their care, running statistical tests, and using a sophisticated set of system-wide performance and operational dashboards. Having introduced its EPR in 2008, it has taken 15 years to reach this position.

Government policy has also played an important role in the rollout of EPRs in the US. This was guided by the Health Information Technology for Economic and Clinical Health Act, and included a ‘Meaningful Use’ programme, backed by incentive payments, which established three stages of EPR adoption, each with specific requirements and timeframes: basic adoption and data gathering; advanced clinical processes; and improved outcomes.

While fundamental differences between US and UK health care systems rightly mean that lessons should be applied with caution, this example highlights the importance of focusing on the productive use and optimisation of EPRs beyond initial procurement and installation.

A similarly consistent, long-term focus is now needed for the NHS. A decade ago, Robert Wachter’s review mapped out a path for the digitisation of secondary care that helped the NHS get to where it is now. We need a fresh route map that sets out first, what trusts must do to ensure basic EPR functionalities are being used as intended, and second, how to go beyond this to develop more advanced uses. This must be coupled with trust-level plans that can consider organisational context such as current digital maturity.

There’s no avoiding the fact that capitalising on EPRs is going to require more funding and support – which will be challenging to find in the current financial environment. Existing efforts, such as the procurement of ‘tiger teams’ to support with resources, expertise and information are a good start.

By and large, it will require investment in less ‘glamorous’ digital innovation – such as IT departments and analysts to do the fundamental work of coding and optimising data. But the prize further down the line should be advances in care quality and productivity. Particularly given the scale of the investment already made in procuring EPR systems, it is essential that we push forward to ensure benefits realisation.

There is no time to waste in improving the use and capabilities of these systems. The longer EPRs are in place without delivering benefits for staff and patients, the harder it may become to bring people on board. With funding, workforce and demand pressures steadily building, the NHS cannot wait to reap the potential benefits that such systems offer.

This blog was originally published by the Health Service Journal on 16 April 2025.