From Competition to Collaboration: Rethinking Digital Transformation in Healthcare Systems
Iain O'Neil, EPR Transformation Director, NHS East Midlands
This article explores how healthcare systems can unlock greater impact by shifting from siloed, competitive models to radical collaboration. Drawing on lessons from the UK’s NHS, it shares practical insights on collective digital procurement, shared EPR implementation, and the cultural shifts needed to deliver patient-centred, technology-enabled care at scale.
Introduction
For decades, healthcare systems have wrestled with the promise of digital transformation. Technologies arrive full of potential, yet scaling them meaningfully across complex systems often proves elusive. Too often, fragmentation, duplication, and institutional competition prevent healthcare providers from delivering the joined-up, patient-centred care that modern technologies are capable of enabling.
The National Health Service in England has been no exception. But my experience, contributing to national digital services such as the NHS App and now supporting a large-scale shared Electronic Patient Record (EPR) implementation in the East Midlands, has convinced me that radical collaboration, not competition, holds the key to unlocking meaningful digital progress.
The Problem with Competition in Healthcare Digitisation
While healthy competition can drive innovation in some industries, healthcare systems structured around competition often create perverse incentives:
- Providers procuring different solutions for the same problem
- Variation in data models and system interoperability
- Duplication of contracts, costs, and supplier effort
- Fragmented patient experiences as services fail to join up
The result is a patchwork of partial solutions, with frontline staff struggling to navigate multiple systems, and patients encountering disjointed care pathways.
Digital transformation in healthcare is not a race to be won by individual organisations, it’s a collective capability that must serve entire populations.
Lessons from National Collaboration: The NHS App
The NHS App offers a clear example of what becomes possible when national coordination supports local delivery. Launched nationally in 2018, it aimed to give patients simple digital access to primary care services, medical records, and national platforms like COVID vaccination records.
One of the biggest technical challenges was not building the app itself, but integrating with dozens of GP systems run by multiple suppliers, each with its own APIs, data structures, and implementation quirks. As part of the national programme, we worked closely with system suppliers like EMIS and TPP, helped build translation layers, and — critically — engaged directly with hundreds of GP practices to activate integration locally.
Success came not from national mandates alone, but from a pragmatic partnership approach:
- National standards and infrastructure
- Collaborative supplier engagement
- Hands-on support for local organisations
- Persistent conversations with frontline staff to build trust
By 2020, millions of patients were regularly using the NHS App — a testament to what sustained national-local collaboration can achieve.
Scaling Collaboration at the Regional Level: The East Midlands Acute Provider Collaborative
Now, in the East Midlands, I am fortunate to support five Acute National Health Service Trusts in England working together to implement a shared Electronic Patient Record across their hospitals. This isn’t a pre-packaged system imposed from outside; it’s a joint clinical and digital partnership with suppliers to design, build, and deploy a system that works for the local context.
Key features of this collaborative model include:
- Shared Procurement: A single procurement process reduces duplication, drives better commercial terms, and ensures consistency across organisations.
- Clinical-Led Design: Clinicians from all five Trusts co-design workflows, building a system that reflects real clinical practice, not IT abstraction.
- Shared Implementation Teams: Instead of five isolated go-live projects, implementation is being managed collectively, sharing skills, resources, and lessons learned.
- Collective Ownership: Perhaps most importantly, the five Trusts see themselves as partners, not competitors, in delivering digital transformation that serves the entire East Midlands population.
This approach also makes capitalisation of digital investment easier, as shared assets and infrastructure are recognised as long-term system capabilities rather than fragmented operational spend.
The Cultural Shift: From Protecting Turf to Shared Stewardship
Technology is only half the story. Collaboration at this scale requires significant cultural shifts:
- Trust between organisations: A willingness to pool sovereignty for collective gain.
- Alignment of incentives: Moving from institution-focused KPIs to population-level outcomes.
- Leadership maturity: Boards and executive teams who understand that digital transformation is not an IT project but a service redesign journey.
- Staff engagement: Bringing clinical, operational, and digital teams together early to shape solutions that work for them.
In both my national and regional roles, I’ve seen that investing time upfront to build these relationships pays dividends during delivery. Shared digital infrastructure is a tangible output — but building shared purpose and trust is what sustains it.
Looking Forward: A Model for System-Level Digital Transformation
Healthcare systems globally can draw lessons from these examples in England:
- National platforms work best when designed with local integration in mind.
- Regional collaboratives can deliver economies of scale while remaining clinically sensitive.
- Shared ownership reduces waste, improves interoperability, and delivers better patient experiences.
If we are serious about digital transformation, we must move beyond organisational boundaries. Our patients don’t live their lives according to our funding silos — they need seamless, joined-up care. Collaboration isn’t an aspiration; it’s a necessity.
Iain O’Neil is a digital health leader supporting large-scale digital transformation programs within the National Health Service (NHS) in England. His work includes leading initiatives on national services such as the NHS App, as well as regional shared Electronic Patient Record (EPR) implementations across the East Midlands Acute Provider Collaborative.
