The Early Referrals Application (ERA) is an interactive decision support tool to support General Practitioners in identifying those patients with suspected cancer that should be referred under the 2-week standard outlined by the Department of Health's "Referral Guidelines for Suspected Cancer".

ERA is intended to be used within the consultation so the workflow has been designed to be as simple as possible. During a typical user session (from first accessing ERA to making the referral) just four web pages will be encountered. The figure below illustrates the ERA workflow in terms of the web pages encountered by the user, with the central flow being the optimum route. These pages are clear and concise as the user must read and comprehend their content within the environment of the consultation. It also ensures that minimal time is spent interacting with ERA rather than the patient.

ERA workflowERA workflow

The design of the web pages has been influenced by the published guidelines, particularly with respect to the referral proformas. Where possible we have implemented the referral proformas' look and feel but, obviously, we have had to change some aspects to make the forms as computer friendly as possible and to collect information not represented on the referral proformas but necessary to make the decisions.


ERA was piloted by the NHS Information Authority. For the pilot, ERA was integrated with the EMIS Practice Management System prior to implementation within two NHS Trusts (Leicester and Southampton). The system was used by around ten GP practices and sixty GPs.

The project involved stakeholders from Cancer Research UK, Department of Health (DoH), National Health Service (NHS), NHS Information Authority (NHSIA), Cancer Action Team (CAT), Leicester Health Authority, Southampton Health Authority, University Hospitals of Leicester, University Hospitals of Southampton, EMIS and InferMed Ltd.

Further information

ERA brochure

ERA demonstration