Add us as a preferred source
Achieving full EPR coverage is important, but it won’t solve England’s elective care challenge on its own, writes Barry Mulholland, chief executive and founder of MBI Health.
Finally, we’ve reached a milestone moment where every acute trust in England now has an electronic patient record (EPR) live, contracted, or in active procurement. A core requirement of the government’s digitisation mandate and the Fit for the Future 10 Year Health Plan has been met.
The NHS England Frontline Digitisation Programme invested roughly £1.9 billion to ensure all trusts hit a baseline capability. That is a massive investment, and it must now deliver on its promise of lasting operational value.
The truth behind the headline is that deploying an EPR was never the finish line: when staff are asked how these EPR’s are working, a third say not very well.
Now that nearly every acute trust has an EPR, the conversation is focused firmly on “optimisation”.
Too often, optimisation has become synonymous with refining the technology itself. But true optimisation is about creating operational stability, with technology acting as the enabler rather than the objective.
Operational stability
What I mean by operational stability is that organisations get to a place where they can trust their operational processes, data, and reporting enough to run services confidently and make informed decisions. But trustworthy data doesn’t emerge just because an EPR has been implemented. It is the product of consistent operational pathways. When those pathways are inconsistent, no technology can produce reliable operational data, and the financial and operational fallout can be severe.
In fact, analysis estimates that NHS trusts in England could spend more than £13.5 million this year correcting data problems that emerge after transitioning to new EPR systems. Hidden flaws in legacy data – duplicate records, incomplete pathways, and lost clinical history – frequently come to light only after go-live, destabilising reporting and forcing trusts into months of expensive remediation.
The impact is most clearly seen in patient tracking lists (PTLs), which increase by around 25% on average following an EPR go-live. This is not new patient demand, but a reflection of inaccuracies exposed or introduced during transition. And because PTLs underpin referral to treatment (RTT) performance – the primary measure of elective recovery – instability here makes it harder for trusts to understand who is waiting, directly undermining patient safety and operational control.
In my experience, most trusts do not routinely have clean, accurate data for their patient tracking lists (PTLs) or referral to treatment (RTT) status. Different departments develop their own workarounds – a patchwork of spreadsheets, paper, whiteboards, and EPR entries – and the resulting data is messy, inconsistent, and incapable of giving a true operational picture. A recent report from Public Policy Projects echoes this exact challenge, warning that digital adoption has drastically outpaced data coherence.
Every decision based on this data is compromised. And when elective recovery depends on accurately understanding who is waiting, where capacity exists, and which pathways need intervention, that uncertainty directly limits improvement.
EPRs were not designed to solve every operational problem
An EPR is fundamentally a system of record whose primary job is to accurately capture a patient’s clinical journey. It was never designed to manage complex elective waiting lists, direct operational performance, or redesign pathways on its own. Yet we are asking these systems to solve structural problems, and they are creaking under the weight.
Digitising them simply automates the noise. An EPR can only reflect the processes it is fed. If patient pathways are inconsistent, the resulting operational data will be inconsistent too.
Historic process flaws are digitised rather than removed, leaving leadership teams trying to tackle elective backlogs using reports they can’t fully trust.
Across the many organisations I’ve worked with over the past two decades, I’ve seen time and time again that trusts often believe they understand their biggest operational problem but are relying on data that has painted an incomplete or misleading picture.
I’ve seen this recently when working with a London trust following their EPR go-live. Inaccuracies exposed during the transition led to a surge in unvalidated RTT pathways, creating operational confusion, severe reporting pressure, and significant risk of ‘income leakage’.
By stepping in to rebuild the operational processes around their EPR and undertaking a targeted pathway validation programme, we cleaned up the underlying data and removed up to 70% of erroneous entries. Re-establishing a reliable PTL allowed leadership to regain operational grip and financial clarity, laying the groundwork for automated validation and helping the trust become recognised as one of the ten most improved in England.
The next phase needs to bring true transformation
Once organisations can trust their data, everything changes. This is why operational stability must go hand-in-hand with technology optimisation.
Trusts achieving real value from EPRs treat implementation as the start of the journey to operational improvement – not the end of it.
If I bring my argument back to the national picture, for the entirety of the NHS to realise the value of the EPRs we’ve spent so much time and money on, individual organisations must, as a collective, focus their energies on creating operational stability and building confidence in the decisions they make every single day.
The NHS has spent years ensuring every trust has an EPR. The next challenge is ensuring every trust can trust the data inside it. Until that happens, optimisation will stay focused on systems rather than services, and the full value of digitisation will be out of reach.
