IAANMP: Journal article review

Research article reviews featured in the IAANMP advanced practice supplement highlight the important role of evidence-based practice in advancing clinical excellence and improving patient outcomes.

These reviews provide insightful analysis and appraisal of contemporary research across diverse healthcare specialties, translating scientific findings into practical knowledge for advanced clinical decision-making.

By engaging with current literature and evaluating emerging evidence, ANMPs contribute to the continuous development of advanced practice in Ireland, fostering a culture of research-informed care and professional leadership within the IAANMP community.

In this edition, the journal article ‘The development and implementation of a digital platform in a fracture liaison service’ is reviewed by Leena Rodrigues, RANP (fracture liaison service) at St Vincent’s University Hospital.

‘THE DEVELOPMENT AND IMPLEMENTATION OF A DIGITAL PLATFORM IN A FRACTURE LIAISON SERVICE’

Authors:  Conlon B, O’Brien H, Clarke V.
Reference: Conlon B, O’Brien H, Clarke V. The development and implementation of a digital platform in a fracture liaison service. Arch Osteoporos. 2025 Jan 8;20(1):7. doi: 10.1007/s11657-024-01491-3. PMID: 39775166.
Published Date: 8 January 2025. Published in Achieves of Osteoporosis, Volume 20, January 2025. Available at: https://pubmed.ncbi.nlm.nih.gov/39775166/.
Journal article review author: Leena Rodrigues, RANP (fracture liaison service), MSc (advanced practice nursing), MSc (clinical practice), RNP, Grad dip (critical care nursing), RGN.

Introduction and study rationale

In their article, Conlon et al (2025) highlight that fragility fractures, caused by low-impact trauma due to weakened bones in people over the age of 50, are a serious but often under-recognised health problem.

Around 23 per cent of women worldwide are affected, yet many fractures go undiagnosed or un-noticed. Nearly one-in-five people who experience a fragility fracture will suffer another within two years, highlighting the importance of identifying at-risk individuals early and providing timely treatment to prevent future fractures.

Barriers to effective management include poor symptom awareness, lack of physician referral, and the absence of a dedicated specialty to manage this patient cohort.

The authors highlight that care following a first fragility fracture is often inadequate. Many healthcare systems struggle to identify fractures promptly and coordinate treatment effectively, leaving patients at risk of breaking another bone. They point to fracture liaison services (FLS) as the internationally recognised model for addressing this issue.

These services offer a structured approach, including patient identification, bone health assessment, starting treatment, and ongoing follow-up. Early identification, they note, is key to creating an efficient, effective, and fair service.

Additionally, the key performance indicators (KPIs) developed by Javaid and colleagues provide a useful framework for monitoring and improving secondary fracture prevention services, helping ensure care is more consistent and effective worldwide.

In Ireland, the authors highlight several major challenges in managing fragility fractures. A national survey in 2021 found that the country’s 10 FLS sites were under-resourced and lacked standardised procedures. In 2022, nine sites contributed data to the National FLS Database (FLS-DB), yet identification rates remained low, with only about a third of expected fragility fractures being captured.

At their own hospital, fewer than 10 per cent of patients with potential fragility fractures were identified, largely due to limited time and the absence of a consistent approach. Much of the work depended on manual record reviews and referrals, and the lack of electronic patient records made it difficult to confirm diagnosis and enter data efficiently.

In addition, manually anonymising data for the national database was time-consuming and prone to errors. These issues highlight the urgent need for better digital systems and more efficient, streamlined ways to identify and monitor patients at risk.

The authors point out that digital technology has emerged to be a powerful and innovative solution internationally for identifying, treating, and monitoring patients within FLS. They note that this approach fits well with Ireland’s Digital Health Strategic Implementation Plan 2023-2027, which aims to use data-driven, digitally connected services to improve care and empower patients to take a more active role in their treatment.

To address gaps in patient identification and data management, the authors developed a digital platform designed to streamline the FLS workflow.

The system supports patient identification, documentation of clinical care episodes, monitoring of treatment adherence, and secure integration with the National FLS-DB, while ensuring compliance with data protection regulations. Support from organisations was secured through a business case and committee approval, providing the funding and infrastructure needed to implement the digital solution effectively.

Methods

Conlan et al ensured transparency, efficiency, and compliance with national financial regulations and followed a competitive tender process in line with HSE guidelines. The contract was awarded to Openmedical, a digital healthcare company, to develop a platform that met the requirements of FLS.

Identification and patient data capture

The authors adapted the hospital’s existing eTrauma digital platform to include an FLS module. To ensure all patients with fragility fractures were identified – age, mechanism of injury, and fracture site were set as mandatory fields.

Once a patient was identified, their information was automatically transferred to the FLS platform, giving staff real-time visibility of new cases and greatly reducing the manual work previously needed for patient identification. The authors note that this time-saving feature allows clinicians to focus more on patient care rather than case finding.

The platform also includes a colour-coded dashboard to show patient status at a glance – purple for those awaiting assessment, yellow for patients currently under treatment, and green for those who have been discharged. This visual system makes it easier to prioritise workflow and get an overview of all cases.

A shared electronic health record was introduced that was both user-friendly and comprehensive.
It captured a wide range of information, including patient demographics, clinical history, medication use, osteoporosis risk factors, previous treatments, FRAX (fracture risk assessment tool) scores, mobility status, and diagnostic results. This system made it easier to carry out bone health and falls assessments while also ensuring that all data requirements for the National FLS-DB were met.

KPIs and compliance monitoring: Conlon et al explain that the digital platform was upgraded to automatically identify, extract, and anonymise data for the National FLS-DB. This improvement made it possible to transfer data securely while reducing the errors that often occur with manual entry.

Since the system is cloud-based and uses two-factor authentication, it also provides safe and compliant remote access in line with both European and national data protection standards.

The system also allowed for continuous monitoring of patients’ progress against the 11 national KPIs. Automatic alerts were triggered if key targets, such as completing a bone health assessment within 90 days, were not met.

To monitor treatment adherence, digital questionnaires were sent to patients via SMS at four and 12 months after their assessment, and clinicians were notified if follow-up action was required.

Results

Within five months of implementation, the platform identified 545 patients who likely had fragility fractures, capturing around 87 per cent of the estimated cases based on the internationally accepted 5:1 non-hip ratio. The smooth integration between the eTrauma and FLS systems made patient identification and data transfer much more efficient.

During the same period, nearly 200 patients (37 per cent of those identified) were assessed and treated through the FLS platform in this single RANP-led service, representing a significant increase in service capacity.

The platform’s real-time monitoring, colour-coded tracking, KPI alerts, and automated adherence reminders all helped enhance patient safety, improve clinical oversight, and maintain continuity of care. In addition, anonymised data from 162 patients were successfully uploaded to the National FLS Database, demonstrating the platform’s ability to support compliant data integration and national reporting.

Implications for practice, policy, and research

This work highlights the clear benefits of digital innovation in FLS, particularly in overcoming case finding and manual data handling. In practice, digitalisation can free up clinicians to spend more time on patient care, while also supporting audit and quality improvement processes locally and nationally.

For policymakers, Conlon et al offer a proof of concept that could guide national strategies for integrating digital solutions into secondary fracture prevention. Standardisation and interoperability across hospital systems are essential for such platforms to be expanded at regional and national level.

From a research perspective, future studies should focus on linking digital FLS platforms with patient outcomes and cost-effectiveness analysis. Also, evaluating the role of digital tools in supporting patient engagement and treatment adherence would be beneficial.

Conclusion

Conlon et al provide a strong example of how digital health innovation can improve fracture liaison services. Their digital platform significantly increased patient identification rates (from 10 to 87 per cent) and reduced the burden of manual administrative work, leading to more efficient service delivery and better-quality data.

Although wider adoption and long-term outcomes still need to be explored, this study offers a practical model for integrating digital tools into FLS systems and represents an important step in improving service efficiency and secondary fracture prevention.