More Clicks, Fewer Conversations: A Technical Report From Urology Registrars on the Introduction of the Epic Electronic Patient Record in a District General Hospital in England

Electronic patient records (EPRs) are a national priority for the National Health Service (NHS) in England, yet published accounts of the implementation of Epic, a commercially supplied EPR platform, come largely from teaching hospitals and rarely describe its effect on surgical trainees.This experience-based technical report describes the observations of urology registrars in a district general hospital (DGH) in England during the first year after Epic went live on October 2, 2025.Reported benefits included legible documentation and prescribing, remote access to results and imaging, a single trust-wide record, structured data to support audit and pathway tracking, and improved patient communication through the MyChart portal (Epic Systems Corporation, Verona, Wisconsin).However, several implementation challenges were observed.Training comprised eight hours of generic instruction without specialty-specific content, and key clinical information remained in legacy systems.On call, telephone referrals were largely replaced by electronic referral orders, frequently without a defined clinical question.During one sampled week before and one after go-live, the median number of daily calls and referrals to the on-call registrar rose from 18 (range 12-30) to 41 (range 30-60), and registrars estimated that the time needed to handle a query rose from 1-2 to 20-30 minutes.In elective practice, reduced secretarial support transferred administrative tasks to clinicians, all investigation results were directed to a single consultant in-basket, and near misses without patient harm were identified.Registrars reported that administrative work increasingly extended beyond rostered hours and that clinicians who configured personalised views and results filters worked more efficiently, suggesting that many difficulties stemmed from implementation rather than the system itself.These exploratory, single-department observations may also reflect concurrent staffing changes.Specialty-specific training, a referral standard operating procedure with triage categories built into the EPR, structured results management, and electronic tracking safeguards warrant prospective evaluation in DGHs implementing or optimising Epic.