Ethical Healthcare’s electronic patient record (EPR) Domain Lead, Jennifer Dunne, has used her extensive experience of EPR procurement and implementation to write a 6-step guide to support those on their EPR journey.   

In step 5, Jennifer explains how to incorporate Agile methodology in EPR implementation.  


Step 5: Implementation  

The implementation of EPRs has revolutionised the healthcare industry, streamlining patient information management and improving the overall quality of care.  

Traditionally, the classic Waterfall methodology has been the go-to approach for EPR implementation due to its structured and sequential nature. However, with the ever-evolving needs of patients and healthcare providers, it is crucial to consider how Agile methodology can be applied to ensure a successful and user-centred EPR implementation.  

Classic Waterfall methodology in EPR implementation  

The classic Waterfall methodology follows a linear and phased approach, consisting of sequential stages, including requirements gathering, design, implementation, testing, deployment, and maintenance.  

In the context of EPR implementation, this structured process allows for thorough planning and clear milestones, which can be beneficial when dealing with complex and highly regulated healthcare environments.  

The advantages of Waterfall in EPR implementation include:  

  • Comprehensive planning: With EPRs being mission-critical systems, comprehensive planning is essential to ensure the successful integration of the technology into existing healthcare workflows.  
  • Regulatory compliance: Classic Waterfall’s documentation-heavy approach aligns well with regulatory requirements, allowing healthcare institutions to meet industry standards.  
  • Budget control: By defining requirements and scope upfront, classic Waterfall minimises the risk of budget overruns that might be encountered in more iterative approaches.  

Agile methodology in EPR implementation  

Agile methodology, on the other hand, focuses on incremental and iterative development/configuration, encouraging continuous collaboration and feedback throughout the project lifecycle.  

Agile empowers cross-functional teams, including clinicians and IT professionals, to work collaboratively, resulting in a more adaptive and responsive EPR system.  

The benefits of Agile in EPR implementation include:  

  • Iterative adaptation: Agile methodology allows for the continuous integration of user feedback, enabling quick adjustments to meet the ever-changing needs of healthcare providers and patients. 
  • Enhanced user experience: With user-centred design as a core principle of Agile, EPRs developed through this approach are more likely to be intuitive and user-friendly, improving overall efficiency and user satisfaction.  
  • Faster deployment: Agile’s incremental development/configuration and testing approach facilitate faster deployment of usable features, ensuring quicker access to improved healthcare processes.  

Blending Agile and Waterfall in EPR implementation  

While classic Waterfall provides a solid foundation for EPR implementation, blending it with agile principles can enhance the project’s success and user experience.  

  • User-centred design from the start  

User-centred design must be at the forefront of the entire EPR implementation process, commencing as early as the strategy phase.  

Engaging healthcare professionals, administrators, and patients from the outset ensures that the system is tailored to meet their unique needs. This collaborative approach is a perfect fit for agile, where continuous feedback is encouraged.  

  • Agile requirements gathering  

Rather than collecting all requirements upfront, Agile methodology promotes a more iterative approach to requirements gathering. By regularly seeking feedback from key stakeholders, healthcare institutions can validate and prioritise requirements more effectively. 

  • Continuous feedback  

Agile’s focus on frequent feedback loops allows for early validation of design concepts and functionalities. This approach reduces the risk of misaligned expectations and enhances the overall user experience.  

  • Incremental feature development  

By combining classic Waterfall’s structured approach with Agile’s incremental development, EPR implementations can deliver core functionalities within predetermined milestones while leaving room for subsequent enhancements.  

Challenges and considerations  

While blending methodologies offers numerous benefits, it’s essential to address potential challenges. Balancing structured project planning with Agile’s adaptive nature requires effective communication and collaboration between teams.  

  • Availability of key resources  

EPR implementations rely on investment of time from clinical and operational staff as well as back-office functions. Ensuring the balance of effort required versus availability needs to be agreed and communicated and closely managed. 

  • Project governance and change control  

Adequate project governance and change control mechanisms are essential to maintain a balance between accommodating new requirements and adhering to predefined timelines and budgets.  


The successful implementation of EPRs is essential for improving healthcare efficiency and patient outcomes.  

Classic Waterfall provides a structured foundation, while Agile methodology allows for user-centred design, continuous feedback, and iterative development. Blending these methodologies offers healthcare institutions the flexibility and responsiveness required to meet the dynamic needs of patients and healthcare providers.  

By striking the right balance between classic Waterfall and Agile, EPR implementations can deliver a user-friendly and efficient system that positively impacts the entire healthcare ecosystem.  


Catch up on the previous steps:  

Step 1: Strategy 

Step 2: Procurement 

Step 3: Investment 

Step 4: Readiness activities 


Follow our blog, LinkedIn and Twitter pages for the next steps in Jennifer’s 6-step guide to electronic patient record (EPR) procurement and implementation.  


Get in touch  

If you’d like to discuss your EPR strategy with Jennifer, contact her on