Electronic patient record systems in England: what do NHS staff think?

Implementing EPRs in health care systems has been a major policy focus across many countries for over two decades. The NHS has been supported in this by successive government programmes and substantial public investment – most recently the £2bn Frontline Digitisation Programme. EPR systems are seen as critical to improving productivity and delivering more effective and coordinated services. They also provide the foundations for other uses of technology and data, such as tools that help identify patients’ health risks, support clinicians to make decisions and plan and coordinate local services.

Today, EPR use across the NHS is near universal. Yet the extent to which these systems deliver value depends not only on their technical capabilities but also on how they are implemented and used. Results from NHS England’s 2021 EPR Usability Survey suggest that around two-thirds of users’ experience of EPRs is shaped by the way the system was implemented rather than by the technology itself.

Understanding how staff interact with EPRs and how these systems are currently supporting or hindering care delivery is therefore essential. Previous Health Foundation analysis drawing on qualitative interviews with five acute trusts in England found that the challenge of purchasing and rolling out EPRs left limited capacity or funding to optimise how they are used. Most NHS organisations currently primarily use EPRs for basic tasks such as core documentation and administration. More advanced features – such as clinical decision support or tools for population health management (the use of data and analytics to improve the health of a whole population) – remain underutilised. As a result, potential benefits are being lost.

To explore current use of EPRs further, we commissioned a survey to better understand NHS staff views towards them. Staff views provide valuable intelligence about the performance of EPR systems in practice. And as the primary users of these systems, staff support is essential if EPRs are to be implemented and used effectively. Buy-in from staff can help EPR systems become more useful and reliable, improving data quality and increasing opportunities for refinement and innovation. 

As of May 2025, 91% of secondary care NHS trusts in England have an EPR system. In line with this, 83% of NHS staff respondents said they use EPRs as part of their job (Figure 1). 15% said they do not use EPRs, and 2% said they don’t know. This use level was broadly consistent across different types of NHS organisations.

However, the pattern was less consistent when looking at different regions across England. For example, 13% of respondents in London reported not using an EPR, compared with 25% in the West Midlands. This variation aligns with longstanding concerns about variation in digital maturity across the NHS. 

Although over half of the staff surveyed (57%) agreed that EPRs are currently functioning effectively within their organisation, 37% felt EPRs are not currently working well, highlighting significant room for improvement. 

Survey results indicate that staff face several challenges when using EPR systems. Only 13% of respondents reported that there are no major barriers to more effective use of their organisation’s EPR system (as seen in Figure 5). 

Effective training is essential to realise the benefits of EPRs. The 2025 Health Services Safety Investigations Body’s report into patient safety issues associated with EPRs found that limited training negatively influenced both staff views of and engagement with EPR systems, and that refresher training was rarely delivered. 

When asked what kind of training they had received on their organisation’s EPR system (Figure 6), fewer than half of respondents using their organisation’s EPR system reported receiving training on its basics (46%), and fewer than half reported receiving role-specific training (49%). These kinds of training gaps risk preventing the NHS from realising the benefits EPR systems can offer. In our question on barriers to more effective use of EPRs (Figure 5), 27% of respondents said a key barrier to more effective EPR system use was a lack of training. 

Progress towards widespread adoption of EPRs has been slow, but our survey suggests that staff think benefits are beginning to emerge. Most NHS staff now use an EPR system and feel these systems are already saving time and offering benefits to patient safety and care.  

However, the overall picture is complex, and a range of challenges remain. More than a third of staff say EPRs are not currently working well in their organisation, and many face barriers such as navigating multiple systems, insufficient training and limited support when problems arise. These challenges risk limiting the potential gains from the substantial investment that has been made into EPR systems to date. The next phase of EPR policy must tackle them head on. 

Create a national roadmap for improving EPR use

The results of this survey reinforce the need for a national roadmap focused on improving how EPR systems are used across the NHS. While national policy has rightly prioritised ensuring that all NHS trusts have an EPR system, significant work remains to ensure that the value of these systems is maximised. 

Despite the challenges identified, staff attitudes towards the future of EPRs remain strikingly optimistic – the vast majority believe EPRs are either already delivering benefits or will do so in the future. A national roadmap should build on this underlying confidence, supporting organisations to move beyond basic digital record keeping towards more advanced uses, including clinical decision support, quality improvement and population health management. This will require coordinated action across national bodies, system leaders, health care providers and EPR suppliers to improve usability, support staff engagement and ensure EPR systems are successfully embedded into everyday practice.

Coordinate action to overcome fragmentation 

The Department of Health and Social Care and NHS England should coordinate action across providers to improve the effective use of EPRs throughout the NHS. Priority should be given to addressing interoperability challenges, enabling information to flow safely and efficiently between NHS organisations and preparing the ground for initiatives such as the single patient record. Given that the most reported barrier to more effective use of EPRs was differences between EPR systems making it harder to work across organisational boundaries, action on this is urgent. This should include strengthening adherence to information standards and investing in enabling infrastructure. 

The Data (Use and Access) Act 2025 and the forthcoming NHS reform legislation present key opportunities for government to accelerate progress on interoperability, clarifying enforcement arrangements for information standards and ensuring relevant patient data can be shared effectively across the health system.

Provide more training and support for staff to use EPRs effectively

It is striking that over half of respondents reported not having received training on ‘the basics’ or how to use the EPR system for their specific role. Increasing the number of staff who have access to these two types of training will be essential if the NHS is to reap further benefits from EPR systems. 

As explored in our previous qualitative research, staff need to be trained on the tasks involved in basic, day-to-day uses of EPRs – such as how to use shortcuts and correctly code medical conditions – as well as why to do these things and the positive impact they have on the system. This would help give them ownership and awareness of the benefits these systems can bring. Only then can more advanced functionalities – such as quality improvement tools or decision-support features – be meaningfully introduced. When implemented well, these more complex functionalities can offer benefits to productivity, safety and quality of care. 

Several of the other barriers to more effective EPR use that our survey identified could be addressed through ensuring staff have better access to real-time support and that EPRs are better integrated into workflows. On the latter, respondents reported that EPR systems have added new tasks or made some tasks take longer. Improving the use of these systems will require greater attention to the design and implementation of new ways of working, ensuring EPRs reduce rather than add to the administrative burden.

Staff engagement is a critical factor in unlocking value from EPRs. While overall NHS staff perceptions of EPRs are positive, our survey suggests that issues around usability, training and support may be limiting the benefits these systems can deliver. Staff experience should be treated as a core performance metric for EPR optimisation and used to guide prioritisation of investment and improvement efforts.