Bleeps, bugs and the burden of change: implementing an EPR from the middle

CONTEXT/PROBLEM: NHS England's electronic patient record (EPR) mandate has put needed pressure on NHS Trusts to bring their practices into the 21st century. Despite this, there remains a yawning gap between this aspiration and frontline clinical engagement. PERSONAL POSITIONING: I was led into the world of the EPR as a resident doctor due to personal motivation following an incident affecting patient care, and became the sole resident doctor embedded in the EPR implementation team for 2 years. EXPERIENCE /CONTRIBUTION: I designed functionality, tested workflows and trained clinicians using my unique position with knowledge of their existing workflows and how they would change in the future. The challenges were myriad-overcoming barriers to change, influencing without authority, how to train colleagues, and finally seeing the project come to fruition. INSIGHT/IMPLICATIONS: Resident doctors have the potential to be hugely positive agents for change in the EPR and broader digital clinical space within the NHS. Deep involvement of clinicians in the design of the systems they use is essential, but is often overlooked or an afterthought. Digital clinical leadership from the ground up can change the digital future of the NHS for the better.