One Patient, Many Systems

The NHS’s tech tangle

Scott Sampson, executive director – health & care, Civica

Years after EPR go-lives, hybrid records are still keeping the NHS disconnected

On a Tuesday morning at a busy district hospital, a consultant scrolls through an electronic patient record in search of a test result. The bloods are in one system, the clinic letters in another and the scan report sits somewhere on a shared drive. To confirm an allergy, she has to open a scanned note from 2016. It’s routine, frustrating and familiar to thousands of NHS clinicians.

Behind every moment like this lies possibly the biggest information challenge in the UK today. The NHS holds billions of pages of medical history, from handwritten notes to scanned letters and legacy systems, spread across hundreds of organisations and decades of care. Managing and connecting that archive is a digital task of extraordinary scale, that still weighs heavily on frontline staff.

In a consolidated digital future, the consultant will tap in the search request and see the test result instantly, surfaced from a single, seamless and secure system. How close that future is depends on the steps we take today.

The vision for electronic patient records (EPRs) was simple: a complete, unified digital view of every patient. But years after the first EPR go-lives, that vision remains distant. In acute trusts across the NHS, the typical patient’s story is still scattered across disconnected systems.

To determine the most effective way forward, we need to look at what’s holding trusts back.

The persistence of the hybrid record

The NHS met its target in late 2023 for 90 per cent of trusts to have an EPR, but the milestone disguises a more complex truth.

EPRs were designed to give clinicians a complete digital view of a patient’s care within a hospital or trust. The broader ambition, the single patient record, is now a central part of national digital strategy, reaffirmed in the 10 Year Health Plan. It promises a secure, joined-up record across the NHS, accessible to the patient themselves from their NHS app. That larger vision of record keeping though, depends on solving a more immediate problem: the persistence of hybrid records.

The NHS still spends around £230 million each year on records management, with three-quarters of that on paper storage alone. More than 70 per cent of NHS trusts still operate using a mix of paper health records, scanned archives and partial EPR coverage.

This isn’t due to lack of ambition or effort. It’s the consequence of history: decades of systems introduced at different times under different budgets. Interoperability across organisations is now a national focus, but for many trusts, the more pressing challenge is internal. They need to unify their own fragmented record before they can fully connect to the wider system.

A 2023 BMJ survey found that three in four trusts still rely on paper notes or drug charts and most run hybrid systems. As Lord Darzi, co-director of the Institute of Global Health Innovation, put it: “Electronic health records have been heralded as a solution to increasingly stretched healthcare systems, yet our research shows the challenge is far greater than simple adoption. Policy-makers must act with urgency to unify fragmented systems and promote better data sharing, or risk the safety of patients.”

Hybrid record keeping in practice

A records manager looking for a 2010 referral letter might need to open five systems, one for imaging, one for notes, one for scanned documents, a shared drive and an archive. Each requires a separate login. None connect to the EPR.

EPRs have revolutionised structured data – labs, prescribing, observations – but unstructured content remains largely untouched. Historical notes, letters and documents that don’t fit into neat data fields are left outside the digital loop.

Post-EPR doesn’t mean paperless

When EPRs were rolled out, many trusts had to pause archive digitisation and now the gaps are being exposed by audits, compliance reviews and data requests.

Digitisation strategies remain inconsistent. Some focus on “day-forward” scanning, others on bulk digitisation or born-digital content, each with its own formats and metadata quirks. Integration is patchy. As one NHS trust admitted: “We’ve gone live on Epic but we still scan so much every day.”

The result is paradoxical. The NHS is more digital than ever, yet clinicians still chase missing records and administrators still ferry files between departments.

Hybrid records are the unfinished business of digital transformation. Unstructured data without consistent governance is a blocker to further digital transformation goals and creates inefficiencies and risks that ripple through information governance and patient care.

Towards a complete digital record

Clinicians need real-time access to the full patient record. That means bridging the gap between the EPR and everything that still sits beyond it: paper, scanned files and decades of legacy data.

At Mid Yorkshire Hospitals NHS Trust, that bridge is already being built. Civica worked with the trust on a document management solution. They have since digitised over 50 million documents and 473 million images, creating a unified patient view across 26 systems. Clinicians now see complete patient timelines through a single interface integrated with the EPR, saving 19,000 staff hours a year and cutting record-handling costs. The trust has been recognised as one of the ten lowest spenders on medical records nationally.

As Integrated Care Boards face cost pressures and the NHS redefines its next decade of digital priorities, many organisations are taking stock. The lesson is becoming clear: “good enough” digital maturity isn’t good enough.

Hybrid records hold back safer, faster and more sustainable care. The next phase of digital maturity will be less about new systems and more about finishing what was started, ensuring every patient’s record, however old or unstructured, is visible, governed and accessible when it’s needed. To get there, trusts will need to connect unstructured data, standardise archives and integrate document management directly with EPRs.

Only then will the NHS begin to solve its records challenge and connect its past to the future of care.

Closing the gap with Civica Document Management

Civica Document Management is a secure, clinical document management system that integrates seamlessly with your EPR.

• Complete the patient record: give clinicians full patient histories at the point of care for safer, faster decisions

• Find what you need fast: use smart search to access all records, past and present

• Digitise at scale without disruption: reduce hybrid friction and eliminate fragmentation

• Consolidate and retire old systems: cut costs and risks on storage and maintenance

• Simplify compliance and governance: strengthen control with digital audit trails for SARs, FOIs, retention and audits.

By bringing historical and unstructured content into view, Civica helps trusts maximise their EPR investment and move closer to a truly complete digital record.