Chief Information Officers (CIOs) that are procuring and implementing an electronic patient record (EPR) solution can find themselves in contractual agreements that don’t benefit their trusts in the long-term. 

In this article, our EPR expert Rebecca Trewinnard highlights the pitfalls to look out for and provides CIOs with a seven-step checklist for getting the best from their EPR contracts.  

 

The policy and procurement landscape 

The NHS’s Frontline Digisitation programme is investing £1.9 billion to support trusts to reach a core level of digitistion and maximise the benefits of digital transformation for clinicians and patients.  

EPRs have been at the forefront of that digitisation and 90% of trusts had a system in place by the end of 2023. The target is to reach 95% adoption by March 2025 with the remaining 5% implementing EPRs by the following year.  

The 10% of trusts without EPRs are running implementation programmes in parallel with a changing procurement landscape. The London Procurement Partnership’s Clinical Digital Health Solutions (CDHS) contract launched in October 2024 with the promise to offer a streamlined framework of qualified suppliers and “easy access to digital and clinical solutions”. Trusts are very likely to accelerate or minimise their procurement processes in response.  

 

How to avoid contractual pitfalls 

Rebecca and Martin have combined their extensive EPR experience to help CIOs avoid contractual pitfalls when it comes to EPR procurement and implementation.  

Here are seven ways CIOs can get the best from their EPR contracts:  

 

1. Engage commercial and legal advisors early 

 

We’ve worked with many organisations that have procured products and services without the involvement of their commercial and legal advisors – and come to regret it.  

Professional commercial and legal advice are essential in ensuring the contract you’re signing is fit for purpose.  

The terms and conditions that you agree to must meet your organisation’s thresholds for risk and financial investment, and include the practical considerations required to get your EPR implemented on time and to the desired standard. If you’re bidding for Frontline Digitisation funding, it’s even more important to understand the parameters in which you’re agreeing to a commercial relationship and how you’ll report its impact back to the funding body. The Frontline Digitisation programme will also have expectations around the details of your contract.  

Engagement with commercial and legal experts should come as early as possible – ideally, before an Invitation to Tender (ITT) is issued to the market.  

 

2. Agree the best way to contract 

 

NHS organisations now have a number of ways to contract products and services, so it’s a good idea to agree the best approach from the start.  

If organisations are coming together to purchase an EPR system as part of a network, outlining how commercial negotiations will be conducted across the partners is vital. You should consider risks, each partner’s contractual position and whether the contract delivers best value for everyone.  

Futureproofing contracts – particularly those that involve multiple partners – is essential so that systems can continue to be deployed in the event of mergers, network changes or place-based partnerships being introduced.  

Choosing a robust scoring methodology, including limits and sliding scales, will also make getting the right contract easier.  

 

3. Keep senior leaders involved  

 

Board members need to be aware of your EPR project from the early stages.  

Their understanding and support for the project will help it move smoothly through approval processes. The terms of the commercial agreement should not be a shock to senior leaders who are asked to sign off on significant financial and operational investments.  

The Senior Responsible Officer (SRO) plays a key role in ensuring this senior-level buy-in from the start.  

 

4. Build a contingency into project timelines 

 

Procurement processes always take longer than you think they will, so make sure you have a contingency built into your project timelines. Also be aware of any options and obligations when it comes to contractual negotiations – for example, the Frontline Digitisation framework allows trusts to choose between negotiating a contract with a supplier or the supplier having to accept the trust’s defined terms and conditions.  

Building a contingency to accommodate these issues will ensure you have the capacity to get the best commercial agreement in place – and that you can launch your implementation strategy (which must include good communications, training and engagement with everyone in your organisation) at the right time.  

 

5. Secure the capacity of the project team  

 

Identify your project team as quickly as possible and ensure they have the capacity to deliver.  

Commercial negotiations involve a lot of questions, meetings and reading so project team members’ work plans need the space to accommodate that. Ensure your project team has the capacity to handle the tasks involved and that roles are back-filled where necessary to ensure business-as-usual work continues.  

Team members also need to have high standards when it comes to discipline and attention to detail. They’ll be reviewing intricate commercial and legal terms so must be able to spot errors, inconsistencies or other loopholes that might disadvantage the organisation.  

 

6. Read supplier responses in detail 

 

ITT submissions will include a wealth of information that must be thoroughly reviewed. Service Level Agreements (SLAs), Key Performance Indicators (KPIs) and Digital Technology Assessment Criteria (DTAC) can all be included alongside a set of standard commercial and financial terms and conditions.  

It’s hard work but these responses must be analysed in painstaking detail to ensure they meet the brief, can be delivered on time and to budget, and respect the commercial and financial comfort zones of your organisation. 

If you’re entering into a Collaboration Agreement or Memorandum of Understanding with partners, there are additional complexities to consider, including:  

  • The procurement approach – one trust may have already procured the solution and others are joining that agreement or a number of trusts could be procuring a solution jointly.  
  • Contract ownership – will each trust have its own contract or will one trust have Contract Change Notice powers? 
  • Payment – how will the contract be paid and will their be reimbursements if one trust delivers activities like administration, configuration and implementation? 
  • Employment – do you need to recruit additional staff? What are the employment implications (such as TUPE) if staff are being moved to support this project? 
  • Day-to-day management: what governance will be in place to manage the contract and its workstreams? 
  • Disputes – how will the partners manage and resolve disputes? 
  • Exit strategy – what are the options for ending the contract and what does that process look like for each partner? 

 

7. Remember it’s a partnership 

 

While commercial negotiations are heavy on the practical details of a project, it’s important to remember that you’re in the process of creating a partnership with a supplier.  

In finding the best way to contract and the best commercial and financial arrangement for your organisation, you’ll be establishing partnership working principles that will last the life of your contract.  

Suppliers can – and should – support organisations to successfully implement its system and grow together to ensure it can be optimised in future.  

 

Get in touch 

If you’d like our help to get the most out of your EPR contract, contact info@ethicalhealthcare.org.uk