For much of the last decade, the Electronic Patient Record has been framed as the destination of NHS digital transformation. Yet for many NHS leaders, the lived reality is more complex.

The EPR may be live, but clinicians still duplicate data.
Referrals still arrive incomplete or inappropriate.
Operational teams still rely on spreadsheets and workarounds.

The problem isn’t ambition. It’s friction.

The myth of “done”

With over 90% of trusts now invested in an EPR, the conversation is shifting. The question is no longer “Have we implemented an EPR?” but “Is it actually making day-to-day care easier?”

As Paul Roll, former NHS digital leader and now at Aire Innovate, put it bluntly: “An EPR doesn’t automatically fix the day-to-day frictions clinicians experience. It gives you a core record, but the last mile still matters.”

That last mile is where progress often stalls. Large-scale transformation programmes struggle to adapt when pathways change, services merge, or patient needs evolve faster than procurement cycles allow.

Small changes, outsized impact

Increasingly, NHS teams are finding that targeted, high-value changes deliver more immediate benefit than another wholesale system replacement.

Instead of redesigning everything, they ask:

• Where is data being captured multiple times?
• Which workflows slow clinicians down at the point of care?
• Where does paper still sit between digital systems?

These questions point to a different model of change: incremental, clinician-led and fast.

The “weeks, not years” approach

At Aire Innovate, this has led to a modular way of working. Using Aire Blocks, organisations can deploy specific digital components, such as smart forms, workflow automation or integration, without disrupting their core EPR.

Sham describes it simply: “Our sweet spot is filling the gaps. We take what’s already there and make it work better, without introducing another ‘system’ clinicians have to fight with.”

In practice, this means:

• MVP deployments in 4 to 8 weeks
• Configuration over custom development
• Data captured once and reused everywhere
• Integrations that respect existing systems rather than replacing them

One community service reduced referral turnaround from eight days to under 24 hours, while cutting inappropriate referrals by 73%, simply by digitising and structuring what had previously been paper-based.

Designed around real lives

The most compelling argument for this approach doesn’t come from architecture diagrams, but from lived experience.

Sham spoke openly about navigating NHS services as a parent of children with complex needs: “Each service does its part well, but as a patient, you’re left to join the dots. That’s where the system still isn’t patient-centred.”

Digital tools alone can’t fix that. But tools designed around workflows, not software, can reduce the burden on both families and frontline teams.

What comes next

The future of NHS digital transformation is unlikely to be defined by single, monolithic systems. Instead, it will be shaped by adaptable platforms, strong integration, and a relentless focus on removing friction.

Progress doesn’t need to take years.

It needs to start where the pain is, and move quickly.