For years, the conversation around electronic patient records has often focused on implementation.
Which system?
When will it go live?
How will the transition work?
How do we support staff through the change?
But once the system is live, another set of questions begins.
Is it working as well as it could?
Are teams using it effectively?
Are workflows supporting staff, rather than creating unnecessary friction?
And are organisations getting the value they expected from their investment?
For many NHS organisations, the next stage of digital transformation isn't simply about implementing an EPR. It's about making the most of the one they already have.
Going live isn't the finish line
An EPR going live is a significant milestone, but it doesn't necessarily mean the transformation is complete.
Once a system is being used in a live environment, organisations start to see things that aren't always visible during implementation.
A workflow that looked logical during testing might not work quite as well in practice. A process may have changed since the original design. Staff may find that certain tasks take longer than expected. Data quality issues may become more apparent. Teams may identify opportunities to improve integration with other systems.
These aren't necessarily signs that an implementation has failed.
They are often part of the reality of running a complex digital system within a complex organisation.
And that's where optimisation becomes important.
From implementation to optimisation
NHS England's current digital agenda places a strong emphasis on maximising the impact and usability of EPRs. With the March 2026 milestone for trusts to have implemented or upgraded an EPR, attention is increasingly turning towards what organisations can achieve with those systems.
Optimisation can mean different things to different organisations.
For one Trust, it might involve refining clinical workflows.
For another, it could mean improving reporting, strengthening integrations or making better use of functionality that has always been available but hasn't been fully adopted.
It could also involve looking at the experience of the people using the system every day.
Because an EPR isn't operating in isolation. It sits within clinical pathways, operational processes and the day-to-day working lives of thousands of people.
The frontline experience matters
It's easy to measure whether a system has gone live.
It's harder to measure whether it's working well for the people who use it.
A technically successful implementation doesn't automatically mean that every clinician, administrator or operational team member is getting the best possible experience.
That is why feedback from the frontline matters.
What feels like a small issue within a system can become significant when it is repeated hundreds of times a day.
Equally, a relatively small change to a workflow or configuration can sometimes make a meaningful difference to how a team works.
Optimisation therefore isn't just a technical exercise. It requires an understanding of the organisation, its processes and the people using the technology.
What happens when priorities change?
There's another challenge that makes EPR optimisation particularly interesting in the NHS: priorities don't stand still.
Operational pressures can change. Services evolve. New national requirements emerge. Organisations restructure. Clinical pathways develop.
The EPR needs to support those changes rather than becoming a fixed point that everyone else has to work around.
That means optimisation is unlikely to be a one-off exercise.
It's an ongoing conversation about whether the technology continues to support the organisation's current needs.
The expertise needed after go-live can be different
The people required to deliver an EPR implementation aren't necessarily the same people an organisation needs six, twelve or eighteen months later.
Implementation requires people who can help design, configure, test, migrate and deploy a system.
Post-go-live work may require a different combination of skills - people who understand the system deeply, but who can also look at processes, troubleshoot issues, work with users and identify opportunities for improvement.
In some cases, organisations may already have that expertise internally.
In others, bringing in specialist support for a particular project, optimisation programme or period of change can provide additional capacity and experience when it's needed.
The important thing is understanding what the organisation actually needs at that stage of its journey.
So, what's next for EPR programmes?
For NHS organisations that have recently implemented or upgraded an EPR, the question doesn't necessarily need to be:
"What else can we add?"
It might be:
"How can we make better use of what we already have?"
That could mean improving workflows, addressing adoption challenges, strengthening integration, making better use of data or simply listening more closely to the people using the system every day.
The technology may already be in place.
The next challenge is making sure it continues to work for the organisation, its staff and, ultimately, the patients it serves.
Because going live may mark the end of an implementation project.
But it can also be the beginning of the next phase of digital transformation.
