Digital transformation in secondary care has made significant progress in the NHS over the last decade, with electronic health records (EHRs) now firmly embedded across many trusts - helping clinicians access patient histories, imaging, referrals and notes more efficiently.
Progress here matters. This access strengthens co-ordination between teams, improves pre-operative planning and helps create a more connected view of patient care.
But the conversation must now shift from adoption alone towards optimisation - specifically, how healthcare organisations can make better operational use of the systems and data they already have. Recent NHS England data shows that while 93% of providers now use EHRs, only 30% report fully integrated, bi-directional data flows[1] - highlighting the ongoing challenge of translating digital adoption into connected operational insight.
Nowhere is this more consequential than in the operating room (OR). Surgery is one of the most-resource intensive and demanding environments in healthcare, where theatre capacity is finite and clinical teams are under sustained pressure. Even relatively small inefficiencies can have a direct impact on patients - contributing to delayed procedures, last-minute cancellations, underutilised theatre capacity and ultimately longer waits for surgery.
Improving visibility into how care is operationally delivered inside the OR is therefore becoming an increasingly important part of elective recovery and productivity improvement across the NHS.
ORs generate enormous amounts of operational and procedural data every day. The challenge is not that this data doesn't exist - it is that many organisations still lack consistent visibility into how workflows unfold in practice. A digital record can confirm that a procedure took place, but understanding how a list actually ran is far more complex.
Without clear operational visibility, it becomes difficult to accurately understand where delays occur, why lists overrun, where turnaround time is being lost, or how capacity could be better utilised. At a system level, this has clear implications for productivity, waiting lists and patient access to care.
Across every procedure, numerous workflow events shape operational performance: from patient entry through anaesthesia and the key procedural stages, to delays and turnover time between cases - all of which directly influence throughput and utilisation.
However, capturing this information accurately and consistently in real time remains challenging. Data capture can be inconsistent for a number of reasons, whether spread across multiple systems, documented retrospectively, or recorded manually under pressure. The impact of this inconsistency is reflected in the data itself: documentation error rates can increase twenty-fold when data entry is delayed, while a single high-volume OR may generate more than 400,000 inaccurate data points annually.
Across the NHS, there is a strong focus on improving elective recovery, increasing utilisation and reducing unwarranted variation in surgical performance. Visibility is key to achieving these improvements - accurate, timely insight into how operating lists function day-to-day can help pinpoint the causes of late starts, extended turnaround times and underutilisation.
Many hospitals may have excellent records of activity and outcomes while still lacking a clear operational picture inside the OR itself. The next phase of digital maturity in surgery therefore requires more than simply recording activity - it requires clearer, more actionable visibility into surgical workflows as they happen.
This is where connected surgical technologies are beginning to play a vital role. Rather than replacing existing EHR infrastructure, these platforms complement systems of record by helping create a real ‘system of action' - moving beyond static records towards systems that help teams understand how care is delivered in real time, enabling more informed operational decision-making and workflow optimisation.
By integrating with existing clinical and operational systems, connected surgical technologies can help capture procedural timing, workflow milestones, device data and intraoperative context more consistently and with less reliance on retrospective manual entry.
The goal is not additional documentation burden - in fact, the opposite is true. For operational visibility to be genuinely useful, data capture must be as seamless and low-burden as possible for frontline clinical teams.
When visibility improves, the operational benefits are significant. Clinical teams gain a better understanding of how lists are performing, supporting more informed debriefing, identification of recurring bottlenecks and opportunities for process optimisation. Operational leaders can more clearly identify where capacity is being lost, while patients benefit from fewer cancellations and greater access to surgical care.
This is not about creating a one-size-fits-all model for surgery. Different hospitals operate with varying infrastructures, workflows and digital environments - some organisations already have highly mature intraoperative systems and integrations, while others continue to manage fragmented workflows across multiple platforms.
That is why interoperability matters. The ability to integrate across existing infrastructures - including EHR systems such as Epic and Oracle Health, alongside wider perioperative technologies - will be essential to creating more connected, usable operational visibility without adding further fragmentation.
Improving operational visibility also creates the foundation for future innovation. Artificial intelligence clearly presents major opportunities for healthcare and surgery, but AI is only as effective as the data that feeds it. Without accurate insight into how procedures unfold in practice, the potential of AI tools will remain limited.
The next step in the digital transformation of the NHS is to ensure healthcare organisations can truly see, understand and optimise how care is delivered in real time. It is to create a ‘system of action' complementing the patient record by providing the operational visibility to support better utilisation, stronger performance, and improved patient access.
At a time when every operating list, every theatre session and every available minute matters, improving real-time visibility into the OR has the potential to unlock meaningful value for patients, staff and healthcare systems alike.
