Louis Valenti

If you are an avid reader of our website blog, or are subscribed to our Evolution newsletter, you would remember that back in August we shone a light on a community partnership that Best Practice Software is engaged in with the Yotkom Medical Centre in Uganda.

Today we’re doing something similar – looking at one of the Best Practice Software community partners who is doing incredible work in and around their community, and this one is a little closer to home.

For the past eleven years, Best Practice Software has been involved in an ongoing community partnership with the Matthew Talbot Primary Health Clinic and hostel, located in Woolloomooloo, Sydney. The Matthew Talbot Primary Health Clinic is a Practice that exists to support homeless men in and around the Woolloomooloo locality. For many years, the area has been a hotspot for homeless activity, with around 100 men living in the available crisis accommodation. The clinic’s patients sleep rough or reside locally in unstable, unreliable accommodation.

The clinic is a non-government organisation run by the St Vincent de Paul Society. Their staff consists of their nursing team, a general practitioner, two psychiatrists, an optometrist, and a roster of visiting clinicians and allied health professionals. Nurse Manager, Julie Smith, stresses the importance of the work that the clinic performs.

“The homeless are not served well by mainstream healthcare services. Typically, they die 25 years before an average Australian. They experience higher rates of mental illness, metabolic disease, chronic illness, and cancer. Accessing healthcare is difficult. We provide advocacy and break down those barriers to receiving a service wherever we can.”

The clinic offers several essential and preventive health services including specialist clinics in smoking cessation, metabolic health, Hepatitis C, and chronic disease management. A point of pride for the clinic is their work in assisting patients with their NDIS funding applications, of which they have been involved in nearly 100. Of these 100, not a single application has been knocked back, meaning that once housed, the patients are able to access lifelong help and support, which in-turn sustains their tenancies and is instrumental in preventing their relapse into homelessness. For these people, these successful applications mean that their homelessness is effectively ended.

Julie explains that the core ethos behind the Matthew Talbot Primary Healthy Clinic is to help those who have trouble helping themselves.

“Supporting and advocating on behalf of people who have difficulty assisting themselves is an important way that we can create and sustain safer and healthier communities. In our hostel, we have a substantial Case Management team who provide comprehensive social welfare services. We partner with them every day and we are instrumental in providing the treating doctors with reports and supportive letters that are crucial elements in obtaining the right benefits or access to housing services.”

To further assist those who are impacted by homelessness, in addition to the medical support and advocacy for housing, the Matthew Talbot Primary Health Clinic also has an onsite learning centre. The centre welcomes those struggling with homelessness, and the wider community.

“It’s a place where you can learn, gain qualifications, meet people, make new friends and obtain assistance.”

The centre’s COMPEER program, which is an initiative backed by Vinnies, is a program that matches community members with people who have a mental illness, but who would benefit from having regular friendships within the community. The centre also provides supportive services for refugees and homeless families, and they run programs which keep homeless children connected to education, which is something that many displaced children struggle with.

While the clinic does offer medical support services, the entire initiative is so much more, aiding with a holistic approach to health, both for individuals and the wider community. Health is very much connected to all aspects of homelessness and being able to assist those in need by considering all aspects of where they may be struggling is crucial to long-term success.

As part of the community partnership agreement, Best Practice Software proudly provides the Matthew Talbot Primary Health Clinic with significantly discounted Bp Premier licences, which benefits the clinic’s staff, but more importantly, allows the clinic to provide, in many cases, lifesaving care and assistance to its patients and the wider community.

Here at Best Practice Software, we are proud to be an integral part of the work that all our customers are undertaking. Though it is especially important that we take steps to assist those who are helping the most vulnerable in our communities, Best Practice Software is particularly proud to have maintained such an important and valuable community partnership with the Matthew Talbot Primary Health Clinic and look forward to continued partnership.

To find out more about the Matthew Talbot Primary Health Clinic, visit their section of the St Vincent de Paul website.

If you are involved with a charitable or non-profit cause, you believe may qualify for Best Practice Software’s Community Partnership program, and can get in touch with us here.

Prescribing medication by its active ingredient will become mandatory from February 2021. This change is part of the government’s 2018-2019 Electronic Prescribing Budget initiative that was legislated in 2019 under the National Health (Pharmaceutical Benefits) Amendment (Active Ingredient Prescribing) Regulations 2019. The aim of this regulation is to improve patient understanding of the medications they take in addition to promoting the uptake of generic and biosimilar medicines that would support a long term viable and sustainable market for these medications in Australia.

The regulation mandates the inclusion of the active ingredients on all PBS and RPBS prescriptions with the exception of:

• Handwritten prescriptions
• Paper-based medication charts in residential aged care settings
• Medications with four or more active ingredients
• Vaccines
• Custom preparations and prescriptions generated through a free text function within prescribing software
• Over the counter items
• Non-medicinal items such as dressings and food supplements
• Medications determined by the Secretary for practicality and safety reasons

Brand names can be included in the prescription if it is considered to be clinically necessary by the prescriber; however, the active ingredient must be listed first as per the regulation. Furthermore, software is prohibited from automatically including the brand name by default. It is therefore up to the prescriber to include the brand name on the prescription.

Why is this change being implemented?

There are numerous benefits to prescribing by active ingredient rather than brand name. First, generic prescribing enables patients to identify the pharmaceutically active ingredient (the international nonproprietary name) of their drug and thereby have a better understanding about the medications they take.

Second, it will reduce the risk of patients accidentally taking the same medication as a result of a prescribing or dispensing error due to being unaware that the brand name is not a unique identifier of their medication.

Third, it will allow the dispensation of any suitable equivalent generic should their brand of medication not be available at the pharmacy and subsequently reduce delays in supplying medication to the patient.

It is envisaged this change will increase the uptake of generic and biosimilar products which would reduce the out-of-pocket cost to the patient and the PBS.

How might this change the way I prescribe medications?

From a prescriber’s perspective, there are some changes in our workflow. When prescribing a new medication, we can still search by brand name or the active ingredient.

Prescribing a new medication by brand name

If we wish the patient to have a specific brand, then we have to check the “Print brand name on scripts” check-box and un-check the “Allow brand substitution” check box. This will convey to the pharmacist that the brand name on the script is what should be dispensed and brand substitution is not permitted.

Prescribing a new medication by active ingredient name

If we are satisfied that there is no clinical need for the patient to be on a particular brand of medication then we can search and select the drug by the active ingredient name. The options to “Print brand name on scripts” and “Allow brand substitution” will not be selectable as it is superfluous information since we have chosen to prescribe a generic medication.

Providing a prescription for a patient’s existing medication by brand

During the roll out of the software update for active ingredient prescribing, if a patient’s medication has previously been declared as not allowing brand substitution, then it will be set to “Print brand name on scripts”. This is because a prescriber has previously decided and recorded that the patient must be on the recorded brand of medication. In such cases the brand name will be printed on the script and the workflow for the doctor will not change.

However, if “Allow Brand Substitution” is checked (meaning that a generic brand can be dispensed), then the “Print brand name on scripts” will not be flagged. This is because, it has not previously been declared that the patient must be on that brand of medication. As per the regulation, software vendors cannot default to printing brand name on scripts in such cases. This may potentially become an issue to doctors who have, for example, previously prescribed “Micardis”, but have declared that brand substitution is permitted. In these cases, the brand “Micardis” will not be printed on the script and therefore the patient will be dispensed a generic Telmisartan rather than Micardis.

Providing a prescription for a patient’s existing medication by active ingredient

This scenario should not change the workflow of the doctor as the active ingredient will be printed.

How might this change affect my patients?

It is very important that we have a discussion with our patients regarding the upcoming changes and how it can affect their medications. This is especially if they are taking brand medications and we wish them to continue to do so.

Below are some examples of a typical prescription showing branded medication, and the same prescription showing only the active ingredient.

If you’re like us, you may have noticed that over time software has progressively become simpler and easier to use. But have you ever stopped to consider why?

Historically, software development followed a top-down design, starting with a general concept then working towards specific needs afterwards. Recently though, companies have started to adopt a bottom-up philosophy, instead starting with, and focusing on, the specific needs of users and developing a solution to meet those needs. In short, software developers have started to adopt a principle known as user centred design.

This approach is core to how we develop at Best Practice Software; it’s how we came to be; we are designed by a Doctor, for Doctors.

A great software experience can only happen with a thorough understanding of the people using the product.

As the name implies, user centred design ensures that our users are at the heart of software we create. By involving users early and often within our development process, we know our design and development decisions are based on the needs and wants of the people who use our software.

User experience designers are the voice of the customer throughout the software development process. We gather knowledge about our user base and test throughout development to verify our assumptions. Software can become cumbersome and frustrating to use without comprehensive testing and input from users.

A core principle is that our products must be simple, logical, and understandable to all our users. We hold regular discussions with a range of customers to ensure we’re supporting practitioners from various disciplines. We began development of our next-generation, cloud-based product after extensive customer discussions and workshops. The brief of these sessions was simple; empathise, connect, and understand the needs of all who work in a busy practice, and what they desire in a cloud-based solution.

There are so many roles within a modern Practice, and we recognise that simply having a list of Practice roles doesn’t mean we know everything about Practices and their staff. Everyone has different life experiences, so two people working in the same role will have different ways of performing similar tasks. Understanding this is key to user centred design, as well-designed software needs to cater to the needs and ability of both of these groups of users.

This is one of the many challenges User Experience (UX) designers face. By talking with people, learning their workflows, pain-points, and daily tasks we begin to get an understanding of what they need to perform their job, and how we can help them achieve that.

A person is so much more unique and complex than their job.

To truly understand our customers and follow the principles of user centred design, our software must support the person, not just perform tasks they need to do. Getting to know the person beyond the keyboard doesn’t come from having a discussion, it comes from the shared experience. A significant, and enjoyable part of being a UX designer is venturing into the real world and visiting our users in their Practices; we observe, we ask questions, we share, we empathise to better understand our customers.

“What is a good day for you?”, “what happens on a bad day?”, and, “what makes those days good/bad?” might seem like odd questions to ask people, but they’re incredibly valuable for a few reasons:

• These stories give us better insight into the environment as a whole
• We learn about their frustrations, and what causes them
• We learn what makes people happy (after all – the goal of a UX designer is to help people and make their lives easier through clever software design!)
• They provide a window into our users’ worlds

“Show us how you last performed that task” turns that window into a door. We can learn to understand why that task is needed, how that task fits into a persons’ day, what information they had or did not have, where that information came from, whether their current method caused any frustration or interruption, providing significant context and life detail.

Only by gathering and merging these different perspectives of our customers are we able to develop the understanding and empathy necessary to design software which supports people.

Our first task when designing user-centred software is to create maps and workflows of the problems we wish to solve. These provide us with a solid foundation for our designs. Layout, interactions, and the ‘meat’ of the designs all follow once we have a solid understanding of the people we’re supporting.

How to be person-first, the next steps: prototype testing, goal setting, and testing again!

The medical industry is evolving, and the needs of the people working in it are complex. It’s imperative that we deliver functionality that is needed and will improve the lives of the people using our software. So, UX designers test throughout the product development process.

Testing and user centred design go together, as through this we ensure we don’t make assumptions, which ultimately reduces the need for rework.

Reducing reworking is important. We verify that our designs will stand up to real-world use before ‘code hits paper’ by testing and simulating real-world scenarios. Observing customers using paper prototypes exposes the strengths and weaknesses in proposed workflows. To the UX designer, paper prototypes are fantastic tools which cut to the heart of the task, testing the workflow without any distractions.

Development uses an agile approach which is well-suited to regular iterative test and improvement rounds. We run small regular sessions to have customers demonstrate how they perform tasks. This feedback loop helps to check our assumptions, confirm we’re aligned with our customers, and are providing valuable solutions to solve their task-related challenges.

Even when our software has been released into the wild, we recognise that there is always room to improve. We employ a diverse range of tactics to get feedback which is fed back into development:

• Repeating our, “show us how you perform this task”, tests
• Visiting Practices and observing how they are using our now-released software
• Talking with support and collecting user feedback
• Reading forums, emails and other online comments

As a UX designer, it’s a joy to know that we’re making a difference in people’s lives. We relish the opportunity to talk with those who use our software, and to hear if there are areas where we can make a difference (and if there are any areas in which we already have!). That’s the beauty of user centred design.

Authored by:

Gareth Chainey & Rachel Hunt
User Experience Designers at Best Practice Software