The digital transformation of the NHS has been a slow, often painful process. Nowhere is this more visible than in the rollout of Electronic Patient Record systems, the central nervous system of a modern hospital. These platforms, when working well, can replace outdated paper files, improve safety, speed up diagnoses and free up staff time. But for too many trusts, the reality is falling short of the promise.
This week, a senior NHS England official put her finger on the problem: the technology itself is not the only barrier. The support offered by the companies selling these systems; most of them large US multinationalism is inadequate, and they must be held to account. Speaking at an Institute for Government event, the former chief executive of the Royal Free London Foundation Trust called for suppliers to step up, especially in helping trusts make full use of the systems they have already paid for.
Electronic Patient Records, or EPRs, are complex beasts. They can hold everything from a patient’s allergy history to their latest test results, and they promise a “single source of truth” that follows the patient through their care journey. But like any large IT system, they are only as good as their implementation. Hospitals often find that key functions are left unused, either because staff have not been trained or because the features have not been configured correctly. The result is that the shiny, multimillion-pound system does little more than digitise old inefficiencies.
That is not entirely the fault of the NHS. Trusts are under enormous pressure to deliver care while managing budgets, and most do not have spare capacity to embark on ambitious tech programmes without help. That help should come from the companies who sell the systems. Yet too often, once the installation is technically complete, ongoing support becomes slow, costly or perfunctory.
The UK’s EPR market is dominated by two American players: Epic and Cerner. Epic has recently been rolled out at some of London’s most prominent trusts, including Guy’s and St Thomas’, King’s College Hospital, Great Ormond Street Hospital and The Royal Marsden. Cerner’s systems are in use at the Royal Free and are currently being implemented at Barking, Havering and Redbridge, as well as Epsom and St Helier. These deployments run into the tens of millions of pounds each, and they represent significant bets by NHS organisations.
Given the scale of investment, it is not unreasonable to expect that suppliers take a long-term interest in ensuring the systems work to their full potential. Yet the feedback from the frontline is clear: the change takes far longer than anticipated, and the promised benefits arrive late or in diluted form. This is not simply about the pace of the NHS adapting to technology: it is about suppliers walking away once the sale is made.
Accountability could take many forms. Contractual agreements might link a portion of payment to measurable outcomes, such as improved clinical workflow, higher data accuracy or reduced administrative time. Supplier teams could be embedded in trusts for months, not weeks, to help staff adapt and troubleshoot problems as they arise. And there should be transparent reporting on system performance, so both the trust and the public can see whether the technology is delivering.
The stakes are high. If EPRs succeed, they can free clinicians from bureaucracy and give patients safer, more joined-up care. If they fail, they drain money and morale. Worse, they risk entrenching a culture of cynicism about technology in healthcare: a culture the NHS can ill afford if it wants to modernise.
The NHS is right to look to the private sector for digital expertise. But expertise must come with partnership. Large US tech firms are more than capable of offering this support. They already do so in other industries where failure is not tolerated, from banking to aviation. It is time they bring the same commitment to healthcare in the UK.
The call from NHS leadership is not about scapegoating suppliers; it is about building a shared responsibility for outcomes. The technology exists. The investment has been made. The missing piece is accountability. Without it, EPRs will remain expensive tools that never quite live up to their promise. With it, they could transform the way the NHS delivers care.
