Bone Abstracts

The gap between osteoporosis clinical guidelines and their implementation exists in all countries. The increasing use of computerised patient records offers new opportunities to aide clinical decision making. We have developed a fracture and osteoporosis investigation and treatment clinical decision tool to aide primary care management of osteoporosis. Uniquely, this tool is designed to be integrated with existing patient data software.

Electronic clinical decisions support systems are one of the most promising interventions to improve uptake of guideline-based recommendations in clinical practice. There is solid scientific evidence for their use. A recent systematic review of RCTs found two thirds demonstrating improvement in clinical decision making. Studies have also found several features essential for the optimum use of the tools; automatic provision of the clinical decision tool as part of clinical workflow; recommendation rather than just assessments are provided; decision support is supplied at the time and location of decision making and computer based, rather than paper based, decision support. All these features are incorporated into our tool as well as an audit function to data mine for patients who may require screening for osteoporosis and a fracture risk calculator with specific functions for communicating risk to patients. Uniquely this tool is designed to be incorporated into existing patient data software.

Design of such electronic tools require unique collaborations between clinicians and software development professionals with clinicians providing the detail of clinical decision thought pathways and IT professionals translating this to computer screens. They then need to be tested for acceptability, and feasibility in primary care and, above all, effectiveness, that is, their ability to improve patient health outcomes. We will describe the process required for the development of electronic decision support as well as the unique features of the osteoporosis tool.