The National Cancer Strategy (2006)¹ recognised that information systems should be developed to manage cancer services. The National Cancer Control Programme (NCCP), in collaboration with a broad range of stakeholders, has developed electronic cancer referral for breast, prostate and lung cancer. 

The patient’s first interaction with the health service is often through their GP. The GP has a key role to play in the early detection of cancer. Enabling the GP to send a prompt referral to the relevant cancer team is maximising the potential for cure. 

The development of electronic cancer referral is a multi-agency project involving the following organisations:

• The National Cancer Control Programme 
• The National Healthlink Project 
• The ICT Directorate of the HSE
• The GPIT group (made up of representatives of the HSE and ICGP) 
• The ICGP.

Objectives

The project aim was to develop and implement electronic referrals for breast, prostate and lung cancer. The referrals are available in two formats:

• As online breast, prostate and lung cancer referral forms (Healthlink Online www.healthlink.ie) from the GP directly to the cancer teams 
• As integrated referral forms into ICGP-accredited GP practice management systems, which also goes directly to the cancer teams using the following GPIT accredited GP software systems – Complete GP, Helix Practice Manager, Health One and Socrates.

By the end of 2012, 20% of all breast, prostate and lung cancer referrals were sent electronically. 

Electronic breast, prostate and lung cancer referral are now available nationwide. Table 1 shows which designated cancer centres have electronic cancer referral available.

 (click to enlarge)

Is it easy to start using electronic cancer referral?

It is easy to register with Healthlink and the service is available free to all GPs. All you need is a computer and the internet. To register you just need to complete the following three steps:

• Complete a registration form which is available on
• www.healthlink.ie and send it to Healthlink
• Healthlink will then email you an encryption certificate and ring you to set this up over the phone
• Healthlink will set up a username and password for your online Healthlink account
• If you currently use Healthlink, the electronic cancer referrals will be automatically available to you.

For further information, contact the Healthlink helpdesk on Tel: 01 882 5606 or go to www.healthlink.ie. The helpdesk is open Monday to Friday 9am to 5pm.

Is sending an electronic cancer referral safe?

Sending an electronic cancer referral is a much safer than sending a fax. As soon as a GP sends an electronic referral, he/she will receive an immediate confirmation that the referral has been sent successfully. In addition, every breast, prostate and lung cancer team has signed a service level agreement to respond to each of these referrals within five working days.

This does not happen with a faxed referral. There is also no guarantee that a fax is sent successfully. For example, fax machines may run out of paper or ink, or the fax may fall onto the floor and be missed. In addition, with electronic referrals there is an audit trail of all referrals sent and received.

Do electronic cancer referrals go directly to the cancer teams?

All electronic breast, prostate and lung cancer referrals go directly to the relevant cancer teams. Each of the cancer centres has nominated personnel who are directly responsible for responding to GP referrals within five working days.

This is monitored closely by the National Cancer Control Programme on a daily basis.

Sending an electronic referral from your GP software system?

When you send an electronic cancer referral from your GP software system it saves time as the patient details are automatically filled in by your system. This also reduces any errors that may occur. A short video about the GP electronic cancer referral system can be viewed on www.hse.ie, (cancer services > health professional information). 

What are the benefits of using electronic cancer referral? 

The development of electronic cancer referral will improve the referral process. There are many benefits, including:

• Streamlining the cancer referral process and reducing communication difficulties
• Rapid access for patients being referred with a suspected cancer
• Aim to increase the number of patients diagnosed at an early stage and maximise the potential for cure
• Provide automatic confirmation of receipt of GP referral
• Provision of direct access for GPs to the cancer teams at the eight designated cancer centres
• Reduced costs to both the GP and HSE
• Introduces a greater degree of safety into the referral process
• Electronic cancer referral reduces stress for patients as it provides reassurance that the referral has been received by the cancer teams
• The GP often completes the electronic cancer referral with the help of the patient.

The recent HIQA report² states that implementation of electronic referrals will improve the patient referral pathway in Ireland. The NCCP referral model is being used to develop a platform for a national general electronic referral form. 

Breast, prostate and lung cancer rapid access clinics

The electronic cancer referral system has been set up to support referral by GPs to the NCCP rapid access clinics for breast, prostate and lung cancer in each of the eight designated cancer centres listed in the table. In the case of breast cancer, referrals can also be made to the satellite breast cancer centre in Letterkenny General Hospital.

The NCCP has developed GP referral guidelines for breast, prostate and lung cancer to ensure GPs are aware of the new rapid access clinics available in each of the designated cancer centres. These guidelines can be downloaded from www.hse.ie (cancer services > health professional information).

Effectiveness and success

The NCCP electronic cancer referral system has been a huge success with over 9,300 electronic cancer referrals in 2012, which was an increase of 113% from 2011. Currently 20% of all breast, prostate and lung cancer referrals being received electronically. Over 80% of all electronic cancer referrals are sent via the GPIT-accredited GP software systems.

The NCCP Electronic Cancer Referral Project was awarded an eGovernment Award in 2012 for the best project in a hospital. 

This electronic service is a mechanism to ensure health professionals delivering care to patients have accurate, complete and timely information available to make good decisions in individual patient cases. It facilitates good communication between professionals, which leads to faster and more appropriate services for citizens and health service users. 

Authors: Eileen Nolan, Marie Laffoy and Regina Codd of the NCCP; Brian O’Mahony of GPIT; Vincent Jordan, ICT HSE; Orla Doogue, Marie Lalor, Gemma Garvan of Healthlink; and Susan O’Reilly, NCCP

For further information contact Eileen Nolan, Project Manager, NCCP Electronic Cancer Referral Project NCCP eileen.nolan@cancercontrol.ie 

References

1. The National Cancer Strategy 2006 
2. Report and Recommendations on Patient Referrals from General Practice to Outpatient and Radiology Services including the National Standard for Patient Referral Information 2011; HIQA www.hiqa.ie