Advancing heart failure care through electronic patient record workflows
The effective use of electronic patient records (EPR), in secondary care, to deliver clinical workflows represents a transformative step for our healthcare system. Hear from heart failure specialists about the national ambitions for heart disease and testing the standardisation of the heart failure workflow through EPR configuration.
National context: Professor Simon Ray, National clinical director for heart disease
The NHS has recognised cardiology as a key priority within the Elective Reform Plan (January 2025), with a clear focus on improving elective care through innovative solutions. This was further cemented in the 10 Year Health plan and the recently published Medium Term Planning Framework (October 2025) reiterating the support needed from integrated care boards to reach the target of 25% reduction in cardiovascular disease (CVD)-related premature mortality over the next 10 years. Furthermore, the introduction of the CVD modern service framework will support more consistent delivery of high-quality services with digital by default leading the way for the CVD care pathway.
The national agenda emphasises the need for rapid access workflows for patients living with heart failure. This is not just about improving individual patient outcomes; it is about reshaping how we approach care of these patients at a systemic level. By embedding clinical workflows into EPR systems, we can streamline processes, enhance communication among healthcare providers, and ultimately ensure that patients with heart failure receive timely and effective interventions. Together, we are on a mission to reduce unwarranted variations in evidence-based clinical practice, be proactively responsive to patient needs and foster a culture of excellence in cardiac care across the NHS empowered by digital innovations.
In my national role, I am proud to lead initiatives that enhance the quality of care for patients with heart failure across the NHS. Over the past year, I have been actively supporting a new national initiative aimed at maximising the utilisation of EPRs at the local level, with a focus on achieving standardised EPR coverage regardless of the specific EPR system in use. The inaugural pilot utilising the Epic EPR system at Manchester University NHS Foundation Trust is currently testing the configuration of heart failure workflows. Dr Bakhai and Dr Whelan and their dedicated team have played a key role in supporting this important work in Manchester, building upon a heart failure workflow that was originally developed at the Royal Free London NHS Foundation Trust.
Background to the workflow: Dr Ameet Bakhai and Dr Carol Whelan, consultant cardiologists, Royal Free London NHS Foundation Trust
The Royal Free has been at the forefront of developing and implementing innovative workflows or clinical pathways and I have witnessed first-hand how integrating clinical workflows into EPR can revolutionise patient care.
The heart failure workflow we have designed, is built upon a foundation of collaboration among multidisciplinary teams which began back in 2018. This approach ensured that patients suspected of having heart failure receive comprehensive care, starting from initial diagnosis through to ongoing management. The workflow was designed to start with appropriate symptoms such as new onset breathlessness or new both leg swelling and a measurable trigger such as raised cardiac blood tests, for example NT proBNP, initiating a digital workflow during the admission in EPR, enabling expedited specialist cardiology review. This clinical pathway workflow then supports National Institute for Health and Care Excellence guideline-based care to not only decrease the likelihood of unplanned readmissions, but also demonstrate a reduction in mortality prior to discharge.
Looking to the future, the insights gained from our workflow at the Royal Free are being leveraged in a pilot project at Manchester University NHS Foundation Trust supported by Dr Lisa Anderson and NHS England Heart Failure Advisory Group. This pilot aims to standardise inpatient admissions for acute heart failure across the country, addressing the diagnostic uncertainties highlighted in the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) review. By building on the foundation we have established, the team at Manchester is working diligently to scale these best practices, ultimately enhancing the quality of care for heart failure patients throughout the NHS.
Pilot work and national ambition – Dr Lisa Anderson, Chair of the NHS England Heart Failure Expert Advisory Group and Consultant Cardiologist at St George’s Hospital, London
Acute heart failure leads to over 100,000 hospital admissions annually in the UK alone, underscoring the urgency for effective diagnostic strategies. With the NCEPOD review in 2018 showing the diagnostics uncertainty amongst heart failure patients leads to delays in triage and patients receiving unnecessary investigations and treatments, it is imperative that inpatient admissions are standardised nationally, and digital tools are optimised to help clinicians adhere to evidence-based guidelines.
In my national role I have been privileged to contribute to a pilot which has taken the Heart Failure EPR workflow design at Royal Free (Oracle Cerner) and piloted at Manchester University NHS Foundation Trust (EPIC). The primary goal of this pilot is to scale and spread best practices in EPR configuration while also gathering valuable insights on how to share EPR workflows between hospitals and technology providers. We are also focused on identifying potential cost and resource savings from this sharing approach as well as constructing large clinical workflow datasets for new insights for optimised care and resource use.
Our ambition is to continue to scale this nationally and I’m excited to see several organisations stepping up as early adopters. The continued progress of this work has the potential to transform the landscape of patients living with heart failure and ensure that they receive the earliest review and optimised specialist treatment to rapidly improve their quality and quantity of life.
Conclusion
The journey towards optimising heart failure care through EPR clinical workflows reflects our ambition to improve patient outcomes and optimise efficiency through digital innovations supporting our staff. The insights gained from the pioneering work at the Royal Free to create innovation and the pilot work in Manchester to adopt the innovation will serve as a blueprint for both wider uptake of this specific pathway but also encourage the era of broader implementation of clinical innovation into EPR clinical workflows across the secondary care systems in the NHS.
As we continue to spread and scale our heart failure workflows, the focus will remain on collaboration, innovation, and patient-centred care. We are working diligently to ensure that every patient receives the best possible care, grounded in evidence-based practices and supported by cutting-edge technology. The Modern Service Framework for CVD, which is currently in development, is a giant step towards this goal. The optimisation of our clinical workflows in our EPR systems is not just a technical enhancement; it is a fundamental shift in how we deliver cardiac care in the NHS.
Supporting NHS England resources
- Good practice approach, evidence-based report, heart failure workflow (Futures collaboration platform login required)
- Heart failure digitally enabled clinical pathway (Futures collaboration platform login required)
- NHS England Cardiac Transformation Programme webinar series: Integration of clinical pathways into EPR – Heart Failure with Manchester and Royal Free (14 July 2025 – recording and slides) (Futures collaboration platform login required)
Ameet Bakhai
Ameet Bakhai MBBS, MD, FRCP is a Consultant Cardiologist and Clinical Research and Development Director in the NHS in North London, a Harvard Scholar, and a Fellow of the Royal College of Physicians.
He has enabled innovation of drugs, devices and diagnostics in multiple cardiac areas of heart failure, atrial fibrillation, acute coronary syndromes and risk factor reduction for cardiovascular events.
Even as a front-line clinician, he has published over 150 papers and received a national award for a decade of work in clinical cardiovascular research from the Royal College of Physicians and is a recognised for clinical trials and research, technology innovation and medical education.
Dr Carol J. Whelan
Dr Carol Whelan BSc MD FRCP FBSE FESC was appointed as Consultant Cardiologist in October 2009 with an interest in imaging, heart failure and cardiac amyloidosis, at the Royal Free London NHS Foundation Trust. She was appointed as Honorary Associate Professor at University College London in recognition for her work at the National Amyloidosis Centre (NAC). She became the hospital clinical lead for heart failure in 2011 and is now the trust lead.
She was appointed lead for the Heart Failure Clinical Practice Group (CPG) work at the trust in 2018 and chairs a weekly meeting of the dedicated team cross site. Through the CPG, the team harmonises the automated clinical pathway for patients with heart failure to achieve excellence in a quality service across the trust.
In November 2025, Dr Whelan will become chair elect of the British Society for Heart Failure.
Dr Anderson
Dr Anderson is a Consultant Cardiologist at St George’s Hospital, London, Chair of the British Society for Heart Failure and Chair of NHS England Heart Failure Expert Advisory Group.
She has led the project to open the UK’s first Acute Heart Failure Unit and wrote the proposal for the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) into deaths in acute heart failure (2018).
Dr Anderson has acted as clinical expert for National Institute for Health and Care Excellence Technology Appraisals (TA10946, TA10942, TA388) and the British Medical Association Expert Review Group for TA267. She has research interests in variant isoleucine 122 (V122I) in transthyretin (TTR) cardiac amyloidosis, cardiorenal heart failure and acute heart failure.
Professor Simon Ray
Professor Simon Ray is National Clinical Director for Heart Disease and joint Cardiology Lead for Getting It Right First Time (GIRFT). Simon recently retired from clinical practice as consultant cardiologist at Manchester University Hospitals and is a Past President of the British Cardiovascular Society (2018 to 2021) and a former member of the Board of the British Heart Foundation.
Simon graduated from Bristol University in Pharmacology in 1980 and in Medicine in 1983. After house officer jobs in Bristol and medical senior house office and registrar jobs in Glasgow and Edinburgh he completed his Doctor of Medicine degree as a British Heart Foundation funded research fellow with Professor Henry Dargie in Glasgow.
He continued cardiology training at the Freeman Hospital in Newcastle before moving to Liverpool Heart and Chest Hospital as a senior registrar in 1992. From 1994 to 1995 Simon was an interventional cardiology fellow in Vancouver, British Columbia, with Ian Penn, Chris Buller and Donald Ricci before appointment as consultant cardiologist at Wythenshawe Hospital in 1995.
His clinical and research interests have focussed around valve disease, patent foramen ovale, cardiac involvement in neuromuscular disease and more recently cardio-oncology. Simon was Clinical Director of Cardiology at Manchester University NHS Foundation Trust (2006 to 2009), President of the British Society of Echocardiography (2007 to 2009), Vice President of the British Cardiovascular Society for clinical standards (2010 to 2013) and President of the British Heart Valve Society (2013 to 2016). Simon was appointed Honorary Professor of Cardiology in 2011.