MK Javaid Norman Collisson Lecturer in Metabolic Bone Disease, University of Oxford

1. Elfin project- improving patient safety, experience and outcomes for secondary fracture prevention- an update MK Javaid Norman Collisson Lecturer in Metabolic Bone Disease, University of Oxford Hon Consultant Rheumatologist, Nuffield Orthopaedic Centre Lead Clinician for FRiSCy

2. Regional status: How big is the problem? 175 360 500 560 375 400 160 4260 hip fractures ~12,800 non-hip fragility fractures 600 380 610 140

3. Fracture Reduction in South Central PolicY group AIM: Every patient with a fragility fracture over the age of 50yr in South Central is: • Identified • Assessed • Treated effectively for at least five years for both bone and falls health A network of every bone clinician/ Nurse Fracture Liaison Service > Fracture Prevention Service

4. Finding them all… Complete assessment See patient while in trauma Re-fracture reduction Start Monitoring Commitment to ongoing Patient support Critical First Impression Face to face

5. Hip fracture ward patient Wrist fracture clinic patient Pelvic fracture Medical patient Spine fracture General patient OVER 75 years UNDER 75 years Assess & Treat DXA Falls & Generations Game Care Home Assess & Treat Dementia Recommend to Patient and GP Renal Care Monitor for 5 years

6. 2,481 patient assessed 1,257 referred for DXA 545 monitored x0.5 Band7, x3 Band6 (+1 maternity leave), x1.5Band4 Oxford FPS 11 2011 -11 2012

7. Information streams

8. Datahub assist

9. electronic fracture prevention patient support programme Elfin

10. INPUT OUTPUT DATABASE Assessment Letter to GP Data input once Letter to Patient Effective nurse use Output many times GP letter Referrals & Requests Audit & reporting Patient information Patient recall

11. NON Adherence NON response/ re-fracture Patient Safety Adverse events Active Systematic Monitoring: Therapeutic Tailoring Effective fracture reduction

13. Patient Experience Patient Information Prescription:

14. Interfaces

15. Product • Features • Standards • Systems • Performance Milestones Scoping exercise to develop product features, milestones and costs To develop, test and implement in Oxfordshire To implement in South Central hospitals To engage extra-regional stakeholders for implementation

16. Stakeholders: Clinician Specialist nurse/ Administrator NHS IT and Data protection Patient and 3rd Sector Commissioner/ reporting

17. Data dictionary – complete • Data entry forms –3rd round beta testing • Output to GP and patient letter – 2nd round of beta testing • Export – completed basic, next anonymised • Linkage to patient registration, appointments and labs – in progress in Oxford • Scheduling – completed • Platforms – memory stick, laptop, server, integrated • Written in xml • Open source no licence or user fees • Phase I sites selected and programmer found

24. PHASE I

25. PHASE II

26. PHASE III

27. PHASE IV

28. PHASE V

29. Next phase • Complete beta testing in Oxford • Extend throughout S Central phase II - IV • Link with National Osteoporosis Society • National and international availability phase V

30. Evaluation • User usage • Reduced in NHS administration costs • Audit • Research

31. Questions?