The single patient record should build on shared care records

Shared care records already link millions of patients and professionals. The next step is to build on them through open platforms, not dismantle a decade of progress, writes Matt Cox, chief customer officer at vitagroup

England is advancing the single patient record (SPR) initiative to create a unified, patient-centred digital health record that consolidates data from across NHS services, from hospitals and community care to primary care. According to NHS England, the SPR will be “a single patient record, owned by the patient, shared across the system, so that every part of the NHS has a full picture of the patient”.

In July 2025, this ambition was enshrined in the 10 year health plan for England, which commits to giving patients “a single, secure and authoritative account of their data … to enable more co-ordinated, personalised and predictive care”.

Three architectural approaches

To make that vision real, NHS England has launched a test-and-learn phase looking at three technical models for the single patient record. Only one offers a sustainable path forward: building on existing regional shared care records through shared data models and interoperable application programming interfaces (APIs).

Central integration model or  virtual data layer approach risk fragility, lock-in, and continued data fragmentation.

The approaches, however,  show that how the system is built matters more than the specific setup. Its success depends on adopting a standards-based, data-first platform capable of governing, validating, and reusing clinical information across the system. That principle will be essential if England’s SPR is to become a sustainable national operation.

A platform, not a product

The SPR cannot be treated as a product to be installed or procured once. It must be built as a continuously evolving foundation – a shared, standards-aligned environment that connects and sustains every layer of the health system.

Where applications deliver functionality, this foundation delivers continuity, consistency, and control. It allows information to move safely across care settings while keeping data locally governed and clinically meaningful over time. It also creates reusable data services, common data models, and interoperability layers that allow innovation to scale across the NHS rather than remain siloed within it.

Building such a foundation demands more than technical integration. While linking diverse electronic patient records (EPRs) and coordinating change across a complex landscape are essential, the deeper task is to re-engineer how information flows through the NHS.

This is not an EPR procurement exercise. It is a long-term transformation in how health data is managed, shared, and trusted, and that transformation requires a cultural shift as much as a technical one.

Central to that shift is recognising that the SPR will never be ‘finished’. It must be fed, maintained, and be responsive to change. It cannot be deployed like traditional software projects, tested with users and then left to run. It requires continuous management, active governance, and ongoing investment in data quality and standards.

Ultimately, building the SPR means treating data as a living clinical asset: governed, monitored, and cared for with the same care as the patients it represents. To make this shift real, the NHS must address several key questions:

• What data truly adds value at the point of care, and how can we avoid the paralysis of ‘collecting everything’?
• Who governs the data, and how are changes or deletions managed?
• What rights do patients have over their own records?
• Who actually is needed to make the integration work and how does this get funded?
• How will external applications integrate safely into the SPR ecosystem?
• And are we fully harnessing the value of the data the system already generates?

Answering these questions requires a data-first mindset. And at the centre of that approach should be an open health data platform with a clinical data repository (CDR). This foundation is built to manage structured, longitudinal data in ways that support safe sharing, clinical decision-making, and secondary uses such as AI and research.

Open platform with CDR is essential

An open platform with CDR is not simply another database. It is a vendor-neutral foundation where critical clinical data – past, present, and future – can be stored, structured, and governed independently of any single application or supplier.

Crucially, it supports both read and write capabilities, allowing the two-way data flow between systems while maintaining integrity, auditability, and control. This turns the record into a living resource rather than a static archive.

This architecture transforms what’s possible. Legacy data is preserved and accessible by migrating historical records into a common, standardised model, ensuring nothing is lost in the transition. New data is captured once and stored independently of vendor systems, reducing lock-in and keeping governance in the hands of healthcare providers while avoiding future data-access costs.

Because the data follows shared, standardised models and exchange formats, integrations become reusable. APIs and interfaces can work across applications without the need to rebuild or reconfigure each time, allowing every new system to build on, rather than replicate, what already exists.

From this foundation, a single, trusted record emerges. Data from EPRs, laboratories, and care settings is harmonised into a longitudinal record accessible to both clinicians and patients. Interoperability becomes inherent through open standards such as openEHR and FHIR, allowing information to flow securely across organisations and regions.

Security and governance are embedded from the outset: access controls, audit trails, and data traceability ensure lawful, ethical use and build confidence among professionals and citizens alike.

The operational benefits compound over time. A stable, standardised backbone simplifies integration and scalability, reduces project risk, and allows new applications to be added seamlessly as needs evolve.

High-quality, longitudinal datasets in turn power AI, analytics, and research, making healthcare more predictive, personalised, and efficient, while improving the fairness and reliability of the AI models they support.

Lessons from Catalonia

Catalonia is widely recognised as a European leader in digital health innovation and data-driven care. It has established one of the most advanced connected-care ecosystems in the world, connecting 13 million electronic health records, more than 1,000 healthcare and social-care centres, and 57,000 professionals through a unified, standards-based infrastructure.

Its Digital Health Strategy 2026–2031 sets an ambitious, data-first vision for an integrated, person-centred health system, building on more than a decade of progress in digital infrastructure and governance.

At the core of this success lies the Shared Clinical History (HC3), which consolidates data from around 30 different EPR and EMR systems into a single longitudinal record accessible across the public healthcare network.

Building on the Shared Clinical History foundation, the region is taking the next step with the implementation of vitagroup’s open-platform architecture, which is underpinned by the openEHR standard and incorporates a CDR at its core.

This CDR unifies and standardises health data across the region, enabling advanced interoperability, better data management, and faster innovation. It already operates at impressive scale:

• Holds over 1.245 billion clinical compositions and 314 million documents – one of the world’s largest openEHR-based deployments.
• Stores longitudinal health records dating back to 2007, ensuring continuity of care across the population.
• Includes 388 million vital signs, 309 million medical and care reports, and 152 million patient care and condition records – reflecting the scale and diversity of data managed across the region.
• Delivers real time data access to clinicians, even under high query volumes across the region.
• Supports 100 PROMs (patient-reported outcome measures) templates, showing how patient-generated data can be standardised and scaled.
• Upcoming integrations include radiotherapy, allergy records, and patient access via La Meva Salut.

This approach goes far beyond what the SPR alone could deliver. Without the open platform CDR, data would remain fragmented and locked within vendor systems.

With a CDR, clinicians access a single, trusted record. Citizens can engage with their own data through portals and apps; and researchers gain access to high-quality datasets for AI, public health, and innovation.

Catalonia’s experience shows that sustainable digital transformation doesn’t come from ripping out what exists, but from building on strong foundations. Their gradual, standards-based approach has delivered one of the most advanced and resilient health data ecosystems in Europe.

England faces a similar choice. Every integrated care system already has a functioning shared care record, developed locally through years of collaboration, trust, and investment.

These records are not pilots; they are proven systems used daily by clinicians and care teams across the country, supporting coordination, reducing duplication, and improving outcomes.

They represent an enormous collective achievement that deserves to be strengthened, not replaced and they offer the only credible foundation on which a truly national patient record can be built.