Development of a cloud-based application for the Fracture Liaison Service model of care.
The aims of this study are to develop a cloud-based application of the Fracture Liaison Service for practitioners to coordinate the care of osteoporotic patients after suffering primary fractures and provide a performance feedback portal for practitioners to determine quality of care. The application provides continuity of care, improved patient outcomes, and reduced medical costs.


BACKGROUND
The purpose of this study is to describe the content development and functionality of a cloud-based application to broadly deploy the Fracture Liaison Service (FLS) to coordinate post-fracture care for osteoporotic patients.


METHODS
The Bone Health Collaborative developed the FLS application in 2013 to support practitioners' access to information and management of patients and provide a feedback portal for practitioners to track their performance in providing quality care. A five-step protocol (identify, inform, initiate, investigate, and iterate) organized osteoporotic post-fracture care-related tasks and timelines for the application. A range of descriptive data about the patient, their medical condition, therapies and care, and current providers can be collected. Seven quality of care measures from the National Quality Forum, The Joint Commission, and the Centers for Medicare and Medicaid Services can be tracked through the application.


RESULTS
There are five functional areas including home, tasks, measures, improvement, and data. The home, tasks, and data pages are used to enter patient information and coordinate care using the five-step protocol. Measures and improvement pages are used to enter quality measures and provide practitioners with continuous performance feedback. The application resides within a portal, running on a multitenant, private cloud-based Avedis enterprise registry platform. All data are encrypted in transit and users access the application using a password from any common web browser.


CONCLUSIONS
The application could spread the FLS model of care across the US health care system, provide continuity of care, effectively manage osteoporotic patients, improve outcomes, and reduce medical costs.
Johns Hopkins Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, 750 E. Pratt Street, 15th floor, Baltimore, MD, 21202, USA.
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Holzmueller
CECity, 285 Waterfront Drive, Homestead, PA, 15120, USA.
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Karp
National Bone Health Alliance, 1150 17th Street, NW, Suite 850, Washington, DC, 20036, USA.
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Zeldow
National Bone Health Alliance, 1150 17th Street, NW, Suite 850, Washington, DC, 20036, USA.
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DB
Lee
Johns Hopkins Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, 750 E. Pratt Street, 15th floor, Baltimore, MD, 21202, USA. dthomps1@jhmi.edu.|School of Nursing and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. dthomps1@jhmi.edu.
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Thompson
D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D000067917:Cloud Computing; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D000070516:Intersectoral Collaboration; D017146:Models, Organizational; D010024:Osteoporosis / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D055502:Secondary Prevention / Q000458:organization & administration / Q000592:standards; D014481:United States
D050071:Bone Density Conservation Agents
Cloud-based application; FLS; Fracture Liaison Service; Osteoporosis; Post-fracture