There is a familiar moment in an EPR programme, usually somewhere around the second
year, when the deployment is technically on track and nobody can say what the trust has
actually gained. The system is live. The milestones are green. The benefits case has not
been opened since the board approved it.
This is not a technology failure. It is a design failure in how the programme was
set up. Benefits were treated as the argument for doing the work rather than as the
work itself.
Benefits are a clinical design decision
A system does not save money. A changed decision saves money. The saving appears when
a clinician orders three tests instead of seven, when a patient is not admitted because
the pathway offered a better option, when a discharge summary reaches a GP the same day
rather than a fortnight later.
Every one of those is a design choice made during configuration, not a consequence of
go-live. Which means the benefits case has to drive the build, not sit alongside it.
What that looks like when it works
The examples below all came out of configuration decisions taken with clinical
services, not from the software itself:
- Over sixty order sets developed with clinical services to standardise investigative
requesting. In renal dialysis alone this was worth around thirty two thousand pounds a
year, entirely from tests that were no longer ordered by default. - BMJ evidence care plans customised for upper gastrointestinal bleed, which prevented
admission in close to sixty five per cent of the patients presenting to A and E and
sharply reduced the use of expensive sclerotherapy. The saving was over one hundred and
fifty thousand pounds a year. - Alerts and flags configured for acute oncology, child at risk and learning disability
management, which met the CQUIN requirement without buying a third party product that
would have cost over sixty thousand pounds. - Powerchart functionality used to support the smoking cessation workstream, securing a
local CQUIN worth one hundred and fifty thousand pounds that the trust had been at risk
of losing. - Paperless endoscopy and pre-assessment processes, worth sixteen thousand pounds a
year in print and paper alone, and considerably more in staff time.
None of these are exotic. They are all ordinary uses of standard functionality. What
made them happen was that somebody was accountable for the benefit, not just for the
deployment.
The business case problem
We were once brought into a programme where the board had declined to approve the
business case because the benefits were not adequate. The programme’s instinct was to
treat this as a documentation exercise. It was not. The benefits were thin because the
configuration had been scoped as a technical migration, so there was genuinely very
little to point at.
Working through the clinical pathways with the services identified five million pounds
of benefit realisable across five years. The case was then approved, but more importantly
the programme that followed was shaped by that analysis rather than by a system
implementation plan. The two produce different builds.
Three questions worth asking your programme
- Who owns each benefit by name? Not the programme, not the finance
team. The clinical or operational leader whose service will change. If the answer is a
committee, the benefit has no owner. - What is the baseline? A benefit you cannot measure before go-live
is a benefit you cannot claim afterwards. Baselining is dull, cheap, and almost always
skipped. - Which configuration decision delivers it? If a benefit cannot be
traced to a specific build decision, it is an aspiration rather than a plan.
Adoption is the whole job
Deployment ends at go-live. Adoption starts there and takes considerably longer. A
trust that treats go-live as the finish line will spend the following two years
discovering that clinicians have built workarounds, that the order sets are bypassed,
and that the benefits case has become a historical document.
The programmes that realise their value keep a clinical engagement function running
well past go-live, and keep measuring. It is not glamorous work. It is where the money
actually is.