ERA In detail
ERA models the referral guidelines for suspected cancer (Department of Health web site).
- The ERA top-level plan contains 12 sub-plans, each supporting a referral decision for a different cancer type (breast cancers, colorectal cancers, gynaecological cancers, haematological cancers, head and neck cancers, lung cancers, neurological cancers, paediatric cancers, sarcoma cancers, skin cancers, upper gastrointestinal cancers and urological cancers).
Each plan has an event trigger, which means it can be triggered by the end-user at any point in the process.
- The Introduction action displays the list of cancer types as hyperlinks. Each hyperlink triggers the corresponding event trigger, thus invoking the appropriate sub-plan.
- The structure of the referral decision workflows in each cancer plan is similar; it’s the details that change from plan to plan.
- Looking at the breast cancer plan, the workflow begins with a Clinical information plan that gathers the relevant patient information; next is a Referral decision that determines whether an early referral is justified; finally, one of three referral actions informs the end-user of the appropriate action.
- In the breast cancer plan, the clinical information plan consists of three enquiries:
The Patient details enquiry collects data about the patient’s age and gender.
The Breast problem enquiry collects data about tissue changes, skin changes, nipple changes and presence and type of pain.
The More on discharge enquiry only runs if nipple changes include discharge: it collects data about features of the discharge.
- Equipped with clinical data, the workflow proceeds to the Referral decision. In the breast cancer plan, the decision has three candidates: Two week referral, Non urgent referral and No referral.
The arguments for the Two week referral candidate are:
- Nipple retraction or distortion
- Eczema
- Skin distortion
- Skin nodule
- Skin ulceration
- Discrete lump in a woman over 30
According to the recommendation rule of this candidate, if any of these arguments are true, a two-week referral is recommended.
The arguments for the Non urgent referral candidate are:
- Asymmetrical nodularity
- Intractable pain
- Nipple discharge in a patient over 50
- Large volume, bilateral nipple discharge
- Bloodstained nipple discharge
- Abscess
- Cyst
- Discrete lump in a patient under 30
According to the recommendation rule of this candidate, if any of these arguments are true and if there is no support for a two-week referral, a non-urgent referral is recommended.
The No referral candidate has no arguments. Instead, its recommendation rule states that if a two-week referral and a non-urgent referral are not supported, no referral is recommended.
- The referral decision is followed by one of three tasks, each with a precondition:
- The Non Two week referral action runs only if the result of the decision is Two week referral
- The Non urgent referral action runs only if the result of the decision is Non urgent referral
- The No two week referral action runs only if the result of the decision is No referral
The referral tasks advise the end-user of the appropriate action.
If you have installed the Tallis Toolset, you can find this sample in the World > Samples folder in the ACL Web Repository.
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