Significant numbers of patients are referred directly to hospitals under the care of consulting physicians for urgent admittance by GPS, Walk-in Centre, and other hospitals. These emergency or urgent referrals often bypass A&E and go directly to the accepting ward. The patients are greeted by other members of the team for example the nurses and the doctors. At this point, problems are faced at all levels due to insufficient or the lack of information and handover. At the operational level patients turns up onto the ward unexpectedly by the receiving junior doctors and nurses. The information that is handed over to the doctor or nurse by the patient is often:

• A handwritten doctor’s letter that is poorly written or may not have all the required details
• A prescription print-out sheet, which does not have all of the patient’s vital information
• The patient does not have any of the above.

With these emergency referrals, there is often a problem for the receiving team to build up an accurate picture of the patient’s presenting problem and their social circumstances. Sometimes the patient is unable to answer questions about their presenting problems and the care they receive before admission to the hospital. This can lead to:

• Ambiguity in the care received before admission
• Delay with prescribing treatment on admission
• Increased errors due to lack of information available
• Delayed discharges
• Readmissions

The E-referral application will be the first to the Healthcare market that will deal with referral information in real-time across sectors and within the Hospitals.

• There is limited funding available.
• The application is dependent on the ability to search and capture data of various programming languages. The Department of Health has set the HL7 standard for inter-operability (XML)
• This will be the first to market therefore uptake may be slow.
• Cross-sectional users with varying ability to use IT
• The hospital is subjected to political changes to the health services.
• Due to sensitive data content security is of utmost importance.
• Need to follow standards that are set by the Department of Health for IT developers.

An area where letters and reports are generated electronically using current details of that referral and search features to search for information that is stored in healthcare records/databases. To generate the letter the user must first identify the patient that needs referring. In the community, patients are identified using the NHS Number, and in the hospital, the patient is identified using the Hospital Number. Once the patient is identified, the patient demographic information, medical history, and current medications which are already stored in healthcare record databases are displayed. Information that is needed to complete the referral letter is the current information, these are as follows:

• Date and time of referral
• Details of the person making referral & their location
• Details of the person accepting the referral (the receiver), their location, and contact details
• Reason for referral
• Present signs and symptoms
• Results of observation & test completed within the last month
• Social intervention that is in place

 An alert mechanism that alerts the receiving team that the referral details are waiting to be viewed with the referralidentification number (Referral ID). Once the message is received, an area where the receiver can locate, view, and accept the information. The intention is that when the receiver accepts the referral the E-Referral system can then upload the information into the receiver’s information system where it can be reused.

The features of the system include:

• Allow the referrer to enter into the E-Referral application during the consultation.
• Use the patient’s unique identifiers to display the patient details.
• Allow the user to use the organization’s existing username and password.
• Allow the user to select the Make a referral option.
• A report must be displayed containing the Referring Organization’s Details, Date and Time of referral, the Referrer Details, and the Patient Demographic Details.
• Allow the referrer to navigate back to edit the information displayed.
• Allow the user to save the information to the system.
• Save a copy of the referral in the referrer’s system.
• Allow the user to submit the referral report into the system.
• Alert the receiver that referral information is waiting to be viewed by giving the Referral ID.
• Allow authorized users to enter into the system.
• Allow the user to enter the referral ID.
• Allow the user to view the referral details.
• Allow the user to accept the details.
• Allow the user to print the report.
• Allow the receiver computer system to upload the referral details.
• Allow the receiver to send back information in the form of feedback to the referrer.
• Alerts the medical records at the hospital that a patient notes is needed on a specified ward by giving medical record, patient NHS number, patient’s First Name, Surname, Date of Birth, and Address.

The purpose of the E-Referral system is to have a communication and alert system that will enable the clinicians in the community to communicate with the clinicians at the acute hospitals and vice versa. The intended purpose is to have a system that supports the admission and discharge process for emergency or urgent referrals into and out of acute hospitals.

• Programming Language: Asp.Net (version 3.5), C# language
• Frame Work: .Net Framework 3.5
• Database: MS-SQL 2008
• Page Designing: Adobe Photoshop CS4
• HTML Designing tools: Adobe® Dreamweaver CS3

An electronic referral system tailored for hospitals is a complete solution for the acute care sector. The E-referral application links the patient information from the community to the hospital. The objective is to have one application that can be used by the clinicians in the community, which will support and ease communication with acute hospitals. The system will be web-based and require that users access the application using their medical information network username and password. The system will allow clinicians in the community to enter new referrals by generating a letter with patient details and sending it directly to the acute hospital. This will notify acute hospitals of urgent or emergency referrals, accept referrals into a paperless environment, alert acute hospitals that paperless referrals are ready to be viewed. The user can search for a specific piece of information relating to a patient without having to scroll through different pages.