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

3. AIM: Every patient with a fragility fracture over the age of 50yr in South Central is: 1.Identified 2.Assessed 3.Treated effectively for at least five years for both bone and falls health A network of every bone clinician/ Nurse Fracture Reduction in South Central PolicY group Fracture Liaison Service > Fracture Prevention Service

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

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

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

7. Information streams

8. Datahub assist

9. ELFIN electronic fracture prevention patient support programme

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

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

13. Patient Information Prescription: Patient Experience

14. Interfaces

15. Product Features Standards Systems Performance Milestones 1.Scoping exercise to develop product features, milestones and costs 2.To develop, test and implement in Oxfordshire 3.To implement in South Central hospitals 4.To engage extra-regional stakeholders for implementation

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

17. a.Data dictionary – complete b.Data entry forms –3 rd round beta testing c.Output to GP and patient letter – 2 nd round of beta testing d.Export – completed basic, next anonymised e.Linkage to patient registration, appointments and labs – in progress in Oxford f.Scheduling – completed g.Platforms – memory stick, laptop, server, integrated h.Written in xml i.Open source no licence or user fees j.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?