Electronic patient record systems – electronic referrals for ongoing care

We have launched an investigation that explores risks to patient safety where electronic patient record (EPR) systems, introduced to support referrals for patient care, have contributed to harm from missed or delayed care.

We have also launched an investigation to examine the risks associated with loss of functionality of EPR systems.

An EPR system is software used to collect, store, access and manage clinical information about an individual patient, in an individual organisation. An EPR system may consist of several components including management of a patient’s records, ordering of medicines and tests, and to review results. A single piece of software may provide one, some, or all of these components.

In November 2025 we published a thematic review of Healthcare Safety Investigation Branch and HSSIB investigation reports. Through that review, we identified that healthcare provider management of the implementation (procurement, configuration, integration and optimisation) of EPR systems created risks to patient safety and had contributed to incidents. Specifically, the transfer of information between providers created a risk to patient safety.

Informed by the findings of the thematic review, we reviewed evidence sources and engaged with stakeholders to identify where HSSIB might support improvements in patient safety. Stakeholders included national bodies involved in digitisation of the NHS in England, charities and those representing the patient and public voice.

The investigation will consider incidents where electronic referrals for patients between care providers have been delayed, missed or rejected.

It will examine how:

• EPR systems have been implemented to support the transfer of clinical information as part of a referral; this includes in the management of rejected referrals.
• Learning from reported hazards with EPR systems have been escalated and learnt from to improve systems and their use in a pathway.
• Oversight of pathways of care is undertaken and assurance is sought at a regional level.

It is intended that the investigation will examine incidents across several pathways, producing a report that summarises learning. The investigation will launch in January 2026 with a final report anticipated in the autumn of 2026.

We are keen to hear from anybody with an interest in this subject matter. This includes patients, families, carers and health and care professionals who may wish to share their experience. If you would like to speak to us about these investigations before we publish the reports, please email investigations@hssib.org.uk.