Why NHS EPR Rollouts Still Have a Serial Device Problem (And How to Fix It)
Most NHS trusts have an EPR in place, but a significant proportion of bedside clinical devices still communicate via legacy RS-232 serial, creating a data gap that manual transcription cannot safely bridge at scale. Serial devices do not need to be replaced; connecting them to a serial-to-IP device server converts their output to standard network traffic, enabling automatic EPR data capture without device replacement or wide-scale EBME revalidation. The Digi Connect EZ TS provides a direct upgrade path from legacy ConnectPort TS and PortServer TS devices, maintaining RealPort driver compatibility so existing host applications continue to function without reconfiguration.
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According to Digital Health, 94% of NHS acute trusts had an EPR in place by 2025. That is a significant achievement. But a 2025 Digital Maturity Assessment covering 205 trusts and 42 integrated care boards found that only 30% had fully integrated bi-directional data flows. NHS England described that gap as “limiting system-wide productivity.”
The EPR is live. The data is not flowing. Something is still missing.
One of the most common contributing factors is not a software integration problem. It is a hardware one: legacy clinical devices at the bedside that communicate via RS-232 serial and have no way to connect to a modern IP network. Patient monitors. Infusion pumps. Ventilators. ECG machines. Equipment that is still clinically effective, still in use, and still producing patient data that nobody can capture automatically.
This is the serial device gap, and it is one of the most practical problems in NHS digital transformation.
“The EPR goes live and the trust expects the data to start flowing. What they find instead is that half the devices on the ward cannot connect to it. The serial device gap is the first problem every NHS system integrator encounters after go-live, and it is almost never in the project plan.”
Sat Bhatti, Managing Director, Rugged Limited
What is the serial device connectivity gap in NHS EPRs?
RS-232 serial is a communication standard that predates modern networking. Legacy clinical devices built around it cannot connect to an IP network natively. Data produced by these devices cannot reach the EPR without either a physical adaptor, middleware, or manual transcription. For NHS trusts mid-deployment, this typically means staff are entering data by hand at the point of care.
This is not an edge case. A significant proportion of NHS clinical devices, particularly those installed in the 2000s and 2010s, use RS-232 as their primary communication interface. In large trusts managing hundreds of wards, this represents a substantial number of devices sitting outside the EPR data flow.
Why can’t NHS trusts simply replace legacy serial devices?
Capital constraints, EBME revalidation requirements, and procurement timelines make wholesale replacement of RS-232 clinical equipment impractical in most NHS trusts. For devices that are still clinically effective, the case for replacement on connectivity grounds alone does not meet the threshold for capital expenditure approval.
NHS capital budgets are under significant pressure. Trusts typically replace equipment when it fails rather than proactively. Replacing equipment that is still functioning, purely to gain network connectivity, is a difficult case to make in a capital programme.
Beyond cost, there is the clinical revalidation process. New clinical equipment introduced into NHS environments requires sign-off from the Electro-Biomedical Engineering (EBME) team. That process involves testing, documentation, and training. For a single replacement device it is manageable. For a fleet of serial devices across multiple wards, it becomes a programme in its own right.
Serial devices that communicate via RS-232 do not need to be replaced. They need to be connected.
How does a serial-to-IP device server work?
A serial device server connects to a legacy RS-232 device via a standard serial cable, then converts that communication to standard IP network traffic. Using COM port redirection technology (also known as virtual COM port or RealPort), the EPR application server sees the remote serial device as a locally attached COM port. No middleware. No bespoke integration. No changes to existing applications or clinical workflows.
This approach is well established in clinical environments. Digi’s RealPort technology is the only COM port redirector that allows multiple connections to multiple ports over a single TCP/IP connection, rather than a separate connection per port. This reduces network traffic and congestion, which matters in busy NHS ward environments.
A single unit with four serial ports handles four bedside devices simultaneously: a patient monitor, infusion pump, ventilator, and printer, all through one device and one network drop. That is a significant reduction in infrastructure compared to per-device solutions.
The Digi Connect EZ WS also includes built-in Wi-Fi 6 (802.11a/b/g/n/ac/ax), giving system integrators additional flexibility in environments where a wired Ethernet drop at the bedside is not available.
The Digi Connect EZ WS: a serial device server built for NHS clinical environments
Digi Connect® EZ WS
The Digi Connect EZ WS is a four-port RS-232 serial-to-IP device server designed for deployment in patient care environments. Unlike general-purpose serial device servers adapted from industrial use, the Connect EZ WS has been evaluated to IEC 60601-1 and specified for the security, management, and physical requirements of NHS ward infrastructure.
Key specifications relevant to NHS deployments: four RS-232 serial ports (supporting up to four bedside devices per unit), built-in Wi-Fi 6 (802.11a/b/g/n/ac/ax), Power over Ethernet, Digi TrustFence security framework with TLS 1.2+ encryption and RADIUS/TACACS+ authentication, and a five-year warranty. The device is CE and RoHS compliant and carries SKU EZ04-WS00.
For trust-scale deployments, the Connect EZ WS is managed through Digi Remote Manager (cloud-based, SOC 1/2/3 compliant) or Digi On-Prem Manager for air-gapped NHS networks where all data must remain within the trust’s own infrastructure. Local commissioning is handled through Digi Navigator, reducing per-device setup time to minutes on site.
For trusts upgrading from older Digi ConnectPort TS or PortServer TS hardware, the Digi Connect EZ TS is a direct drop-in replacement available in four- and eight-port configurations with software-selectable RS-232/422/485 support.
What does IEC 60601-1 mean for serial device servers used in NHS wards?
IEC 60601-1 is the international standard covering electrical safety and essential performance of medical electrical equipment. A device server deployed in a patient care environment, in proximity to patients, should be evaluated against this standard. The Digi Connect EZ WS has been evaluated to IEC 60601-1, confirming its suitability for use in clinical settings where patient proximity is a factor.
Most serial device servers on the market are designed for industrial or general IT environments. IEC 60601-1 places specific requirements on devices used near patients: electrical isolation, leakage current limits, and electromagnetic compatibility. Meeting these requirements is not optional in a patient care area.
For NHS system integrators specifying connectivity hardware for ward environments, this distinction matters. General IT hardware is not automatically suitable for deployment in proximity to patients. A product evaluated against IEC 60601-1 removes that risk from the specification and removes a question from the EBME review process.
“We’ve been working with the largest names in healthcare for a few decades. We know Healthcare IT leaders expect turnkey solutions. Digi Connect EZ 4 WS delivers out-of-the-box security, compliance, and 24/7 support, backed by our proven healthcare experience.”
Brian Kirkendall, VP and GM of Infrastructure Management, Digi International
What security does a serial device server need for NHS network compliance?
NHS networks operate under the Data Security and Protection Toolkit (DSPT), which mandates minimum security standards for all connected devices. Serial device servers on NHS infrastructure must support encrypted connections, centralised authentication, and where required, VPN tunnelling. The Digi Connect EZ WS includes Digi TrustFence as standard: secure boot, TLS 1.2+ encryption, RADIUS and TACACS+ authentication, and AES-256 VPN support.
The DSPT sets baseline requirements for data security across NHS organisations. Any device connecting to NHS infrastructure needs to meet those requirements. Consumer-grade or generic IT device servers are typically not designed with this level of security architecture.
TrustFence also provides ongoing threat monitoring and is designed to adapt with evolving security requirements, which matters in an NHS environment where cyber threats to health infrastructure have increased significantly. For trusts running air-gapped networks, Digi On-Prem Manager provides the full fleet management capability without any data leaving the trust’s own infrastructure.
How is a fleet of serial device servers managed at trust scale?
Digi Remote Manager and Digi On-Prem Manager provide centralised visibility and control across all deployed units from a single portal. Configuration, firmware updates, health monitoring, and real-time alerts are managed fleet-wide. Digi Navigator handles local device discovery and commissioning, reducing on-site setup time to minutes per device.
Deploying serial device servers across a large trust is not a one-time exercise. Firmware needs updating. Configurations need applying consistently. Devices need monitoring for connectivity and performance issues.
Digi Remote Manager is cloud-based and SOC 1, SOC 2, and SOC 3 compliant, with HIPAA and NIST framework support. For trusts where all data must remain on-premises, Digi On-Prem Manager provides identical capabilities within the trust’s own infrastructure. Digi Navigator handles local commissioning: finding devices on the network, configuring IP addresses, setting up RealPort, and managing passwords. For a system integrator managing a large EPR go-live across multiple wards, this reduces site time significantly.
The serial device gap is solvable
The gap between EPR deployment and full data integration is real, and serial device connectivity is a direct contributor. The good news is that it has a clean, specifiable answer that does not require replacing clinical hardware, disrupting workflows, or commissioning bespoke integration.
The Digi Connect EZ WS is available through Rugged Limited for NHS trusts and system integrators working on EPR deployments across the UK. For connectivity solutions, technical documentation, or to arrange an evaluation unit, get in touch using the details below.
Talk to the Rugged Team
Connecting legacy serial devices to an NHS EPR does not need to be a large project. With the right hardware and guidance, a serial-to-IP deployment can be planned, costed, and commissioned with minimal disruption to clinical operations.
What is a serial device server and how does it work with NHS EPR systems?
A serial device server converts RS-232 serial communication to standard IP network traffic, allowing legacy clinical devices to connect to modern hospital networks. Using COM port redirection technology such as Digi RealPort, the EPR application server sees the serial device as a locally attached COM port, enabling data to flow automatically without changes to applications or clinical workflows.
Does the Digi Connect EZ WS comply with IEC 60601-1?
The Digi Connect EZ WS has been evaluated against IEC 60601-1, confirming its suitability for use in patient care environments. An information test report demonstrating compliance can be provided upon request.
Can a serial device server work with Epic, Oracle Health, and System C?
Yes. RealPort technology presents serial devices as local COM ports to any application server, regardless of EPR platform. The device server handles the physical connectivity layer, leaving EPR-specific configuration to the integration team.
What is Digi RealPort and why does it matter for EPR integration?
RealPort is Digi’s COM port redirection technology. It is unique in allowing multiple connections to multiple serial ports over a single TCP/IP connection, reducing network traffic. Installed on the EPR application server, it makes remote serial devices appear as locally attached COM ports, allowing standard serial communication across the hospital network.
How many serial devices can one Digi Connect EZ WS support?
The Digi Connect EZ WS has four RS-232 serial ports, so a single unit supports four devices simultaneously: for example, a patient monitor, infusion pump, ventilator, and printer at a single bedside location.
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