OBJECTIVES: Despite the obvious need for improved technologies in healthcare, especially where the benefit is primarily a cost saving, there is a large amount of anecdotal evidence suggesting adoptions is sporadic even when accompanied by recommendations. Using the example of IOFM (Intra-operative Fluid Management) we have quantified the variation in uptake of IOFM and it’s potential economic impact for the UK health system. METHODS: Using a large variety of data sources we have quantified and compared the estimated use of IOFM enabling technologies across England from 2013. These data sources include national level “Innovation Scorecard data, HES records for admissions corresponding to NHS England IOFM adoption guidelines, specific IOFM use via OPCS code Y73.6 and HTA evidence for IOFM in the UK. Economic impact has been assessed based on methodology published by NICE. RESULTS: Despite national level recommendations on the adoption of IOFM, there has been an 11% reduction in the use of IOFM since 2013 and an approximately 10 fen-fold difference in utilization between regions. 47% of hospital admissions with a reported use of IOFM were not in the list of recommended procedures and represent only 1.3% of the total applicable admissions. The annual number of procedures suitable for IOFM is at least 71,000 but varies widely with recommendations and represents an annual missed saving to NHS England of >£70 million. CONCLUSIONS:  Despite a CQUIN (Commissioning for Quality and Innovation) pre-qualifier in 2013/14 and a positive recommendation from the NICE Medical Technology Evaluation Programme in 2011 estimating per patient savings of >£1,000, the adoption of a low cost technology requiring no changes in hospital structures has been woeful. The variation in the types of surgical procedures associated with IOFM suggest that this is at least in part due to suboptimal guidance on appropriate usage.