Electronic referrals lack detail, study warns

A study comparing the quality of data content and clinical value of electronic and paper referrals in dermatology has found that electronic patient referrals contain less detailed information about a patient’s condition than paper referrals.

Writing for the British Journal of General Practice, Dr Lindsay Shaw, a dermatology specialist registrar and Dr David Berker, a consultant dermatologist at the Bristol Dermatology Centre, compared 131 GP referrals using a local electronic booking system with 129 traditional referral letters.

Their results showed that there was little difference in the demographic data provided between the two methods.

However, when it looked at clinical information, a gap between levels of information was found, which meant that consultants were receiving less comprehensive information.

Only 16% of electronic referrals recorded the size of legions compared with 39% of paper referrals, and only 44% of electronic referrals recorded whether there were concerns about malignancy compared with 67% of paper referrals.

The authors said: “For lesions, electronic and paper referrals performed similarly when communicating facts about the duration of the problem and site of the lesion, but paper referrals were significantly better at recording the lesion’s size and whether or not there was concern about malignancy. Electronic referrals for non-lesions (mainly rashes) were significantly deficient with respect to details of symptoms, current treatment, past treatment, and a proposed diagnosis.”

The results have raised concerns that electronic referrals will lack essential details on a patients’ condition, when they are brought to hospital for treatment.

The journal warns: “This study shows that electronic referral systems risk failing to communicate the clinical question and context when the GP is responsible for data entry. This may in turn lead to mistaken rejection of the referral through guidelines on

managing service demand or inappropriate triage and delays for the patient.”

Connecting for Health told Pulse magazine that this research is of an electronic system that is not connected to Choose and Book. They added that GPs could send an additional referral letter with their C&B request to add additional information.

However the authors warned: “There is pressure upon GPs to hasten the referral process with a looming stipulation that all referrals should be made within 24 hours of the GP consultation. This study highlights a risk that GPs will achieve the target of rapid referral at the cost of including a relevant and thoughtful assessment of the patient. Therefore, undue priority of the electronic process over the clinical one may compromise understanding of patients’ problems and their management.”

Links

British Journal of General Practice