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Using automation to improve the triage and referral management pathway

Find out about new provider functionality in the NHS e-Referral Service API.

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Introduction

Most referrals sent to secondary care must be reviewed and assessed by a clinician.

In cases where the assessment is heavily guideline driven, without clinical intervention, there is a rationale to automate the process.

For example, a referral is automatically accepted into a receiving service if the fixed criteria is met. The patient must:

  • be of a certain age and sex
  • live in a specific demographic
  • show specific health indicators in blood pressure, obesity and smoking

This referral process can be automated, resulting in faster processing and reduction of administrative burden.

Solution and impact

Our API endpoints can be used via our supported authentication modes:

  1. User-restricted.
  2. Application-restricted (unattended).

Historically, the latter has been restricted to retrieving information in a read-only context.

We have amending this authentication mode to allow our API to write back data to e-RS. This function is currently restricted to recording a triage outcome (A028).

This can be where referrals are awaiting review and are:

  • sent into a triage service
  • deferred into a directly bookable service because of appointment slot unavailability

There is no impact to partners already using this endpoint.

Partners can continue to use this functionality via the user-restricted access mode.

Integration opportunities

If you believe your users would benefit from automating triage outcomes, there are a number of guidelines to consider:

  1. Organisation readiness.
  2. Workflow automation.

1. Organisational readiness

Introducing automation, changes the risk profile for an organisation.

Automated processes can access and modify data on a large scale, greatly increasing the risk of malfunctions, errors, or malicious use.

Your organisation must:

  • assess if your current risk management, including any clinical implications, support the additional risks
  • get approval from the organisation's Chief Information Officer and Caldicott Guardian
  • assign a senior responsible person who will be responsible for all the automated actions

2. Workflow automation

When implementing an automated triage referral process, follow the checklist to meet our requirements.

Checklist
  • Submit your use case to the e-RS FHIR API Partners team for review
  • Keep an audit log
  • Consider how you will evidence your automated solution via the audit log
  • Plan how you will continuously monitor all automated processes
  • Establish an exception monitoring process to manage failures
  • Undertake a clinical risk assessment as per the DCB0160 standard

Use case review

Our e-RS FHIR API integration panel will review your use case for approval. This may take up to 20 working days, depending on the backlog.

You must:

  • ensure your automated workflow does not include clinical decision making
  • document each automated workflow including workflow diagrams
  • assess the risks of each workflow, with approval of the referral criteria by clinicians
  • review your proposed process with any connected 3rd parties to ensure there are no downstream risks

It is best to engage the team early in your software design to ensure any feedback can be incorporated.

Find out more

If you need further information, please reply to our dedicated thread on the developer community.

Last edited: 3 April 2025 10:50 am