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The applications accessible from this site are for demonstration purposes only. They have not been validated for clinical use and must not be used for real patient encounters.

Demonstrations of clinical applications
ERA    UKEarly Referrals Application
System to support the early referral of patients with suspected cancer

developed by clinical domains keywords
Advanced Computation Laboratory, Cancer Research UK, London;    InferMed Ltd., London, 2000-2001. Cancer, primary care Decision support for early referrals
status access demonstrator
Advanced prototype, in clinical use



ERA is an interactive decision support tool which has been designed to help primary care physicians comply with the 2-week standard outlined by the UK Department of Health's Referral Guidelines for Suspected Cancer. The guidelines set out criteria for deciding whether to refer suspected cancer patients for urgent specialist services. ERA includes textual material from the paper guideline (translated into web pages) augmented with an enactable procedure written in PROforma. This procedure captures the patient history, interprets it, and advises whether or not referral is appropriate under NHS policy. The ERA application encompasses twelve types of cancer.

ERA screen
The ERA application entry screen.

ERA is being piloted by the UK NHS Information Authority. ERA has been integrated with the EMIS Practice Management System prior to implementation within two NHS Trusts (Leicester and Southampton). The system will be used by around ten GP practices and sixty GPs.
J Bury, M Humber, J Fox. Integrating Decision Support with Electronic Referrals. Proceedings of the Tenth World Congress on Health and Medical Informatics (Medinfo2001), London, UK. September 2-5, 2001

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M Humber, H Butterworth, J Fox, R Thomson. Medical Decision Support via the Internet: PROforma and Solo Proceedings of the Tenth World Congress on Health and Medical Informatics (Medinfo2001), London, UK. September 2-5, 2001.

[paper - CRUK]   []

" This paper describes the development and application of an integrated technology to support the authoring of intelligent medical knowledge services, such as decision and guideline support, and disseminate them over the Internet. Decision support and guideline enactment are provided by the PROforma technology which is described in detail elsewhere. Solo is a communications infrastructure that supports the delivery of PROforma services over the Internet using a web browser. The PROforma-Solo technology brings together techniques from knowledge engineering and artificial intelligence with software engineering and the Internet to flexibly support decision making and patient management at the point of care. A variety of clinical applications have been implemented and are briefly described. "
Department of Health. Referral guidelines for suspected cancer. London: DoH, 2000.


"The Government White Paper entitled ‘The new NHS – Modern, Dependable’ guaranteed that everyone with suspected cancer will be able to see a specialist within two weeks of their GP deciding that they need to be seen urgently and requesting an appointment. ...
The aim of these guidelines is to facilitate appropriate referral between primary and secondary care for patients whom a GP suspects may have cancer. The guidelines should help GPs to identify those patients who are most likely to have cancer and who therefore require urgent assessment by a specialist. Equally it is hoped that the guidelines will help GPs to identify patients who are unlikely to have cancer and who may appropriately be observed in a primary care setting or who may require non-urgent referral to a hospital... "

contact links
John Fox
Advanced Computation Laboratory
Cancer Research UK, London
 bullet  Advanced Computation Laboratory  bullet  Cancer Research UK  bullet  InferMed Ltd.
Advanced Computation Laboratory, CR-UK and InferMed Ltd.
Entry on OpenClinical: 5 November 2001
Last main update: 8 November 2001; 01 April 2005
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