Two NHS trusts in Cheshire are entering a critical new phase of digital transformation, as they move beyond the initial rollout of a shared electronic patient record (EPR) system and into a prolonged period of optimisation aimed at unlocking clinical and operational benefits. Leaders at East Cheshire NHS Trust and Mid Cheshire Hospitals NHS Foundation Trust say the work now underway highlights a key reality of NHS digitisation: go-live is only the beginning.
From implementation to optimisation
The trusts jointly deployed the MEDITECH Expanse EPR system in June 2025, marking a major milestone in their digital transformation journey. However, speaking at Digital Health Rewired 2026, chief information officer Danny Roberts stressed that the programme has since entered a dedicated optimisation phase running from September 2025 through to June 2026.
This phase focuses on refining workflows, addressing gaps in functionality, and delivering elements that were not included at go-live. Roberts described the process as “settling it in” and “really starting to sweat the asset”, underlining the shift from deployment to value realisation. The trusts are also working to eliminate workarounds that emerged during early use, a common issue in large-scale EPR implementations where staff adapt systems to immediate operational pressures.
Data quality and reporting challenges surface
One of the most significant issues emerging post go-live has been data quality and reporting accuracy, problems that only became fully visible once the system was live. According to Roberts, inconsistencies in how staff input data are already affecting performance metrics, including waiting list and activity reporting.
“The real issue is data quality,” he noted, warning that delays or errors in data entry can distort operational visibility at a time when trusts face intense scrutiny over elective backlogs and referral-to-treatment targets. Both organisations have also experienced challenges with outpatient productivity following the rollout, reflecting a broader trend seen across the NHS where digital transitions can initially slow clinical workflows before efficiencies are realised. These findings reinforce a growing consensus across the sector: EPR systems do not automatically deliver improvements without sustained investment in training, standardisation and governance.
Collaboration and standardisation at scale
A defining feature of the Cheshire programme is its shared delivery model. Rather than implementing separate systems, the two trusts developed a joint governance framework and a unified “Digital Clinical System” (DCS) to standardise processes across both organisations. This approach was driven partly by necessity. Individually, each trust was considered too small to deliver a major EPR programme efficiently, but together they were able to reduce duplication, share expertise and mitigate delivery risks.
However, achieving standardisation has proved challenging. Aligning clinical workflows, documentation practices and organisational cultures required significant negotiation, with leaders acknowledging that creating a single “way of working” across two trusts is inherently complex. Despite these challenges, the shared model is increasingly seen as a blueprint for integrated care systems seeking to scale digital transformation while controlling costs.
Managing upgrades and operational disruption
The optimisation phase has not been without disruption. A recent major system upgrade required the same level of preparation as the original go-live and resulted in approximately eight hours of downtime across both trusts. Such events highlight the operational risks associated with continuous system improvement, particularly when upgrades coincide with ongoing optimisation work. Balancing system stability with iterative enhancement remains a key challenge for digital leaders.
At the same time, the trusts are progressing additional priorities, including further digitisation of paper records, expansion of e-prescribing capabilities, and integration of pathology and referral systems. These developments are aligned with wider ambitions across the Cheshire and Merseyside Integrated Care Board to build shared digital infrastructure, including a potential “digital centre of excellence” and greater use of data platforms and AI tools in the coming years.
A wider lesson for NHS digital transformation
The experience in Cheshire reflects a broader shift across the NHS, as the national Frontline Digitisation programme moves from implementation towards optimisation and benefits realisation. While nearly all trusts are expected to have EPR systems in place by 2026, the challenge now lies in making those systems deliver measurable improvements in productivity, patient flow and care quality.
For Cheshire’s trusts, the message is clear: digital transformation is not defined by a successful go-live, but by the sustained effort that follows. As Roberts put it, the real work begins after deployment, when systems must be embedded, refined and fully integrated into everyday clinical practice. In that sense, the optimisation phase is not simply a technical exercise, but a test of organisational change, requiring strong leadership, clinical engagement and long-term investment to translate digital infrastructure into tangible outcomes for patients and staff.
