The UK’s National Health Service (NHS) sets out a bold vision to shift the paradigm of care settings from paper to paper-free over the next few years. At the centre of the paper-free programme lies the roll-out of EMR across the nation and the creation of local care records that follow a patient through primary, secondary and tertiary settings. The approach taken to roll-out has been the creation of a Smart Hospitals- a 'Global Digital Exemplar' cohort of leading hospitals who will reach HIMSS 7 in the next couple of years and who will share their knowledge and experience with the next cohort of fast-followers. The lessons learned have highlighted the importance of efficient and agile hospital design, integrated care masterplans, extensive user engagement and the benefits of building competence and capability ahead of complex implementation.