91% of NHS trusts have an EPR. So why can't they talk to each other?

As of mid-2025, 189 out of 208 NHS trusts have an active electronic patient record system. The government wants the remaining 19 done by March 2026. On paper, that looks like a success story. The Frontline Digitisation programme that started in 2021 has moved faster than most people expected, and the 90% target set for December 2023 was actually met.

But having an EPR and having EPRs that work together are completely different things.

The interoperability problem

Most trusts bought their EPR from one of a handful of vendors: Altera Digital Health, System C, Oracle Health, and a few others. Each system stores data differently, uses different terminology, exposes different APIs. A patient discharged from one trust and referred to another often falls into a gap where their records don't follow them cleanly.

GP surgeries run different systems again. Social care runs yet another set. The result is that a clinician treating a patient with a complex condition across multiple settings still can't see the full picture without picking up the phone.

The Connecting Care Records programme is trying to fix some of this. So is the Federated Data Platform, which got £480 million in funding to build shared data infrastructure across the NHS. But the hard part isn't the platform itself. It's the integration layer underneath: getting systems built by different vendors, at different times, to different specifications, to actually exchange structured data reliably.

What we see from the delivery side

We've worked on health systems where the EPR exists but the data stays locked inside it. Referral information gets re-keyed manually. Discharge summaries arrive as PDFs. Allergy data sits in one system while prescribing happens in another.

The technical work to fix this is well understood. It's HL7 FHIR APIs, consent management, data mapping between different coding systems, and a lot of testing against real clinical workflows. None of it makes for good conference slides. But it's the work that actually moves the needle.

The NHS doesn't need more EPR deployments. It needs the ones it has to actually talk to each other. If you're building health technology right now, that's where the work is.