U.K. e-referral and e-booking prove to be e-ok

The largest implementation of an electronic referral system within the U.K. has been successfully accomplished, a large step toward satisfying the U.K. government's mandate that all clinician referrals be e-booked by next year, according to a scientific paper presented at the 2004 SCAR meeting.

"The goals of patient and primary physician acceptance, as well as improvements in radiology department workflow, have been achieved," said project manager Maria Principe of Nottingham City Hospital.

Nottingham's home-grown e-system now covers 99% of all clinician referrals.

E-referral and e-booking became necessary when national and local radiologist shortages combined with an increasing workload at the U.K.'s busiest emergency room overwhelmed the radiology department, making it difficult for radiology to manage the traffic.

"Patients were waiting up to three hours for their examination," Principe said.

After e-implementation, 75% of patients are now seen within 10 minutes of their appointment.

The conventional system also did not allow compliance with new European-wide radiation protection legislation that compels radiologists to justify every request for an x-ray exposure prior to the procedure.

All clinicians in the U.K. are linked to the National Health Service intranet (NHSnet), the largest intranet in Europe. This makes it easier to extend the e-referral system so that clinicians can request imaging studies electronically.

A radiology e-referral and e-booking system between primary and secondary care has not previously been attempted on this scale in the U.K. Anecdotal comments indicated some concern that an e-referral system would not be acceptable to general practitioners because many of them expected the system to be slower than the traditional handwritten referral card, Principe said.

Interestingly, radiology referrals dropped by 30% from previous levels during implementation. This drop may have resulted from clinicians using cross-border referrals to neighboring communities to avoid the new e-system, but a survey of nearby radiology clinics showed no change in their workload.

"It was therefore assumed that the reduction in referrals was likely the result of more careful requesting practices," Principe said.

It has been estimated that 20% of all radiology referrals in the U.K. are of no clinical benefit to patient management, which accords with the reduction in referrals experienced.
with the reduction in referrals experienced.