NHS EPR Pre-Procurement Business Analysis project - Case Study

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By :
James Leslie-Smith

Princess Alexandra Hospitals NHS Trust and EPR Pre-Procurement Programme

Case Study - November 2020 


The Princess Alexandra Hospitals NHS Trust provides a full range of general, acute, outpatient and diagnostic services at three hospitals in Essex. Together, they employ 3,500 staff and provide services to a local population of 0.5m. 

The Trust operates on ‘Best of Breed’ approach and is looking to implement a new Electronic Patient Record (EPR) solution. They engaged Keystream to identify and develop the requirements for the new EPR system by assessing the current situation and identifying gaps. The work would then inform the Trust of the next steps needed to procure and develop an EPR model to fulfil their requirements.


Working collaboratively with the Trust Transformation Team, Keystream’s Consultants identified key stakeholders and arranged meetings to assess current workflows, identify gaps and benefits in all  Healthcare Groups throughout the Trust. Information was collected using a variety of methods including one-to-one interviews, workshops and short questionnaires.

Users were receptive and shared their experiences in their roles, highlighting pain points and quick wins. The AS IS process maps documented by the Consultants were presented back to Healthcare Groups for review and validation, which then became the basis for mapping the future state process maps and development of a Requirements Document, Gap and Benefits Register for the Trust.

The output collated included a total of 222 functional gaps and requirements across several user groups including Cancer, Cardiology, Clinical Support Services and Critical Care, and around 400 issues and risks were identified.


Our Consultants needed to work through a wide variety of systems to identify active systems in use. This was a challenging task, as over 80 systems were identified as ‘in use’, either as ‘view only’ or as a stand-alone system used by a specified cohort. Validating user access levels was another issue, and most systems only had a demographic feed from the main legacy EPR, some had no interface connection. 

Duplication of data entry in various systems and lengthy manual processes were a common theme, impacting patient experience, clinician time, data integrity and reporting.


Keystream’s experienced Business Analyst Consultants collaborated with the existing team and made an immediate positive impact. Working through a statement of works with a list of agreed milestones, the consultants were able to produce a thorough picture of the existing situation, business requirements and high level ‘process maps’, creating a visualisation for the procurement process. 

Several key benefits of having a ‘Single Source of Truth’ for an electronic patient record were highlighted, including:

•    Productivity and patient safety are optimised when healthcare professionals have one system to learn.

•    Patients feel better known throughout the organisation because their information is available to all healthcare professionals with appropriate access levels. 

•    Medication reconciliation is able to work safely and efficiently.

•    Accurate and quality reporting is achieved.


The Keystream Change Agents would like to thank the team for quickly embracing the Keystream Change Team and welcoming them as part of the Trust Team working collaboratively and pragmatically towards the same goal.


“As the CCIO I needed our local transformation team to undertake a huge piece of work to understand our current work processes at the trust. We just couldn’t do this with our local staff, so we engaged a team of five Business Analysts from Keystream.  

I have been really pleased to see the excellent collaborative working between Keystream and The Princess Alexandra Hospitals NHS Trust transformation team on the pre-procurement phase of our EPR project. The business analysts became embedded within the team immediately and engaged with our staff. In the difficult working environment of the COVID pandemic Keystream worked at pace to support the local transformation team and deliver the outcomes we needed.”

CCIO, Princess Alexandra Hospital NHS Trust


“We worked with Keystream to agree a Statement of Works which agreed the milestones for achievement of the project. We were very fortunate to then receive five very experienced Business Analysts into the Team who hit the ground running as soon as they came in. The project was reviewed weekly with support from both the agency and PAHT Senior Managers and a huge amount of work was achieved. 

The BAs have been adaptable, approachable and flexible to the needs of the Team and the wider Trust. They were a real pleasure to work alongside and it is my hope that they may return to support a Post Procurement project once we have selected our new solution.” 

IT Transformation Manager, Princess Alexandra Hospital NHS Trust


“Having the Keystream Business Analysts on board for the transformation stage of the EPR project meant that we were able to process map our clinical and admin activities timely and accurately. As part of the project, we created process maps for all the AS IS processes and gathered requirements for the future solution. Due to the relentless efforts and unwaning enthusiasm of the Keystream Business Analysts we have been able to meet all the project objectives. Thank you Tania, Maud, Carole, Susan and Afia.”

Business Analyst, Princess Alexandra Hospital NHS Trust


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