Background The Secretary of State for Health has recently committed £4.2 billion to NHS IT, of which £1.8 billion is to be allocated to support the government’s vision for a paperless NHS. To justify this political and financial commitment, it is crucial to look at previous policies and identify areas where lessons can be learned. Our aim was to explore the developments in national NHS IT policy in relation to the implementation of Electronic Patient Records (EPRs) between 1998 and 2015.

Methods 6 NHS IT policy documents and 10 evaluations of NHS IT policy that were commissioned by NHS England, or the Department of Health, to report on the progress of national policy in achieving its aims met the study’s inclusion criteria. Documents were analysed thematically using a priori themes that were based on the study’s research questions. Socio-technical thinking provided the theoretical framework for interpreting study findings.

Results Since 1998, there has been inconsistency and uncertainty surrounding the terminology used for EPRs. However, the aims of NHS IT policy have remained relatively unchanged, with all policies striving for integrated electronic records for health and social care within their proposed timescales. Evaluations of policy attributed a range of social and technical factors to why policy has not achieved its aims including: poor programme management, ambitious and ambiguous policy aims, challenges with integrating systems, staff engagement, insufficient infrastructure and poor management of EPR contracts.

Conclusion If the NHS is to succeed in implementing integrated electronic patient records, then policy should focus on producing unambiguous, feasible ambitions that use consistent terminology. The lack of detail and consistency in the definitions for EPRs, Integrated Digital Care Records and a paperless NHS needs to be addressed if the NHS is to have a shared sense of purpose and work towards common, unified goals. Lastly, the repetitive nature of policy aims that have remained unchanged since 1998, suggests a lack of reflection, placing the utility and purpose of government commissioned evaluations into question.