Frontline digitisation: people over functionality

Digital investment

The NHS is investing £1.9 billion in its Frontline Digitisation programme to maximise the benefits of digital transformation for patients and clinicians, harness the power of data and ensure the right digital foundations are in place. 

Much of the investment has been focused on supporting the roll-out of EPR systems, with a further £75 million provided to help integrated care systems (ICSs) to scale-up the use of digital social care records (DSCRs).  

The aim is to level up trusts to a baseline of digital capability and use interoperable record systems to improve care and working practices. 

While 90 per cent of NHS trusts had EPRs in place at the end of 2023, with the remaining 10 per cent expected to on board by March 2025, the procurement and implementation experiences of those trusts have been vastly different and there is a lot to learn from what we’ve seen so far. 

People over functionality

When deploying a new EPR, lots of emphasis is placed on system architecture, functionality and choice of system supplier. Although this is important, the human factors are equally important - if not more so. By that, I mean we need to invest equal time and effort in our clinical colleagues, building a view of how care can be delivered differently or improved when deploying a new EPR and working towards a common vision.

There is all too often too much focus on procuring the system and rolling it out, when in fact that’s just the first step

As an ICB digital leader, I’m constantly challenged to think about system convergence and how this can best support genuinely integrated care. In some instances, these considerations are happening before the system has had an opportunity to establish a new service model. Transformational opportunities are limited if we are sourcing and then deploying a shared EPR across multiple trusts without spending sufficient time with our operational and clinical teams, as well as patients, to design new ways of working. There is all too often too much focus on procuring the system and rolling it out, when in fact that’s just the first step. 

Organisations need to understand their own capabilities fully before planning their implementation strategy. This includes assessing the training needs of their staff and auditing their infrastructure, from the devices used to the network’s capacity. If people are working on outdated equipment and don’t fully understand how to use the new system, the benefits of the EPR will not be realised. 

The evidence indicates training and support influence positive user experience, rather than functionality

Frequently, trusts spend millions on a new EPR and still struggle with system adoption and user satisfaction. The KLAS EPR Usability Survey, commissioned by NHS England in 2022, evidenced this trend. The research tells us that users - ie our clinical and administrative staff - are more positive about their EPR system when they have received appropriate and ongoing training and have mastered how to use the system properly.

The evidence indicates training and support influence positive user experience, rather than functionality. Indeed, we can see from the KLAS data examples of organisations with very high EPR user satisfaction using the same system as organisations with some of the lowest satisfaction measures. Focus on the users is often the key differentiating factor.

We need to treat an EPR as a long-term project, ensuring that our people are engaged and considered throughout the project life cycle. If their needs aren’t factored, providers will find it difficult to realise the benefits outlined in the Frontline Digitisation programme. 

John Llewellyn is chief digital and information officer at NHS Cheshire and Merseyside. You can follow John on X (formerly Twitter)  @JohnLlewellyn11