9 January 2024 Articles

Opinion – Navigating the Deployment Dilemma: Mental Health EPR – Getting it Right First Time or Landing and Expanding?


The implementation of Electronic Patient Records (EPR) in the mental health sector presents a pivotal decision point for healthcare organisations. A dominating question persists: should NHS trust strive for perfection from the outset, meticulously addressing all intricacies before going live, or is it more prudent to embrace the Land and Expand approach, launching safely but swiftly and refining based on local trust user experience? At Apira, our Managing Director and our Founder presents differing perspectives on this dilemma.

Getting it Right First Time – The GIRFT Method

Alan Brown, the Managing Director at Apira, presented the “Getting it Right First Time” (GIRFT) method. According to him, the GIRFT approach involves:

1. Catering to Specialist Requirements: Building a Mental Health EPR that comprehensively addresses all specialist requirements is crucial for user acceptance right from the outset. The emphasis here is on creating a system that resonates with the unique needs of mental health professionals.

2. Mitigating Unsafe Workarounds: Alan highlights the potential risk of implementing unsafe workarounds if the system fails to meet specific needs initially. This stresses the importance of a robust and tailored EPR to ensure safe and effective clinical practices.

3. Data Migration for Safety and Continuity: Migrating and archiving data is deemed essential not only for user acceptance but also for ensuring safety, efficiency, and service continuity. The seamless transfer of data from existing systems to the new EPR and/or an archive is pivotal for maintaining a consistent and reliable patient record.

4. Legal Duty of Care: Alan emphasises the legal duty of care, asserting that a comprehensive and fully functioning system must be in place from Day 1. This highlights the ethical and legal responsibility healthcare organisations bear in providing a reliable and secure patient information infrastructure.

Land and Expand – The Minimal Viable Product Approach

In contrast, Geoff Broome, Director, and Founder of Apira, presented the Land and Expand method, advocating for a Minimal Viable Product (MVP) first. His perspective includes:

1. Refining Based on local Trust Experience: Geoff advocates for implementing an EPR with an MVP and refining the solution over time based on local Trust user experience. This approach prioritises adaptability and responsiveness to the evolving needs of clinicians and patients.

2. Starting with Basic Functionality: The Land and Expand approach involves commencing with basic functionality, including standardised assessments, basic care plans, and minimal data migration (with a corresponding comprehensive data archive). This minimises the risk of deploying an overly complex and potentially unusable system.

3. Avoiding Unnecessary Features: Geoff emphasises the importance of avoiding unnecessary features during the initial deployment to prevent the creation of a system burdened by superfluous functionalities. This streamlines the system for optimal performance and usability.

4. Ensuring Clinical Pull and Buy-In: The Land and Expand approach prioritises clinical pull, ensuring that clinicians actively engage with and endorse the changes. Buy-in from staff is critical for the success of the deployment, avoiding resistance to new technologies.

Understanding Both Perspectives

To comprehensively understand the rationale behind each approach, it’s essential to delve into the reasoning provided by both sides.

The Land and Expand approach holds merit for several reasons. Firstly, clinicians, known for their experiential nature, thrive on real-world experiences. Immediate deployment provides them with firsthand evidence, fostering user acceptance as they engage with the system directly. Secondly, clinical practice is inherently dynamic, necessitating a constant refinement approach.

The Land and Expand model aligns seamlessly with this dynamic nature, allowing for ongoing adjustments based on the evolving clinical needs of healthcare professionals.

Moreover, the Land and Expand approach is perceived as more cost-effective, with lower project costs compared to the meticulous planning involved in the GIRFT method. This agility is particularly beneficial in managing timelines and external costs.

Lastly, the immediate deployment characteristic of Land and Expand ensures that the benefits of the Electronic Patient Records system are realised sooner, avoiding unnecessary delays, and allowing organisations to swiftly reap the rewards of their investment.

Alternatively, the “Get it Right First Time” (GIRFT) method is underpinned by several key principles. Foremost, it places a strong emphasis on quality over speed, prioritising the need for a robust and reliable EPR system in the complex landscape of mental health.

This commitment to quality aligns with the overarching goal of ensuring that the system meets the highest standards from its inception. Additionally, the GIRFT method involves a greater financial commitment upfront for the full project, strategically aligned with external funding sources.

Moreover, the method actively aims to minimise the risk of losing key team members in later phases, safeguarding continuity, and stability within the project team for a seamless and successful implementation.


In the continuing debate between Getting it Right First Time and the Land and Expand approach, there is no definitive answer. Apira emphasises a flexible approach, accommodating organisations based on their preferences and experiences.

Whether it’s the meticulous GIRFT method or the agile Land and Expand approach, the key is to learn from both and adapt strategies to the unique needs of mental health organisations.

The journey to an effective Mental Health EPR involves not just choosing the right approach but learning and adapting as the healthcare landscape continues to evolve. For more information on how Apira can assist with your EPR deployment, contact us at info@apira.co.uk.