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Fears over e-referrals

Electronic patient referrals contain less detailed information about a patient's condition than paper referrals, a study has found.

This raises concerns that pushing GPs to refer electron-ically though Choose and Book will mean consultants receive less comprehensive information.

Details of 131 GP referrals using a locally devised electronic system were compared with 129 traditional referral letters received by the Bristol Dermatology Centre in 2004/5.

Although little difference was found in the demographic data provided (name, date of birth and address), electronic referrals contained fewer details about symptoms, the study published in the British Journal of General Practice found.

Only 16 per cent of electronic referrals recorded the size of

lesions compared with 39 per cent of paper referrals; and only 44 per cent of electronic referrals recorded whether there were concerns about malignancy compared with 67 per cent of paper referrals.

Electronic referrals were also less likely to record symptoms of non-lesions (mostly rashes), the patient's current and past treatment and a proposed diagnosis.

Dr Gillian Braunold, GP clinical lead for Connecting for Health, said that, unlike the electronic system studied, a referral letter could be attached as a Word document with Choose and Book.

'Ninety-nine per cent of GPs are sending a referral letter with Choose and Book,' she said. 'That is how it has been designed to be used. Clinicians need the flexibility to add more information when it is appropriate.

'We are quite happy to fill in basic details on a referral form and for the secretary to add a letter later. There was tendency with IT to push people towards tick-box stuff.'

Dr Lindsay Shaw, one of the researchers and a specialist registrar at the Bristol Dermatology Centre, said that although the electronic system assessed did not have this facility, there was a free text box.

'You just had to post the information into the box, which expanded to whatever you wanted to put into it,' she said.

The Bristol Dermatology Centre has now also started to receive referrals by Choose and Book. 'I must say I have not had enough referrals come through Choose and Book yet to say whether that system is any

better,' said Dr Shaw.

pulse@cmpmedica.com

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