Best Practice Software

Louis Valenti

Medicinal Cannabis Prescribing – Simpler and More Accessible Than Ever

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In Australia, all doctors and nurse practitioners can legally prescribe medicinal cannabis to their patients with specific medical conditions through the Therapeutic Goods Administration (TGA) Special Access Scheme. To date, there have been over 220 conditions approved by the TGA. Recently there have been significant improvements to the application process when prescribing medical cannabis to improve patient access and reduce the administrative burden on you as the prescriber.

The below information has been taken from the TGA website:

“If you determine that an ‘unapproved’ medicinal cannabis product is clinically suitable for your patient, there are four pathways through which your patient can access the product with your prescription.”

Authorised Prescriber - 'Established History of Use' Pathway

Medical practitioners can apply to become Authorised Prescribers of specified medicinal cannabis products without the need for approval from a Human Research Ethics Committee or endorsement from a specialist college.

Medicinal cannabis products and indications deemed by the TGA to have established history of use are specified in the list of medicines with an established history of use.

Authorised Prescriber - Standard Pathway

Medical practitioners can apply to become Authorised Prescribers of medicinal cannabis products not included in the list of medicines with an established history of use via the standard pathway. This pathway requires approval from a Human Research Ethics Committee, or endorsement from a specialist college before applying to the TGA.

SAS Category A Notification Pathway

Medicinal cannabis products supplied via the SAS Category A pathway must be imported on a patient-by-patient basis with permission from the Office of Drug Control (ODC). 

SAS Category B Application Pathway

The SAS Category B pathway is an application pathway available to prescribing healthcare practitioners including Medical Practitioners and Nurse Practitioners. When applying to access an unapproved medicinal cannabis product on behalf of a patient under the SAS Category B pathway, prescribers must provide a clinical justification. The justification should include the seriousness of the patient’s condition, consideration for the use of medicines that are included in the ARTG and the potential risks and benefits of using the proposed unapproved medicine.

There are no restrictions on the medical conditions for which a prescriber may apply via the SAS to access an unapproved medicinal cannabis product for their patient, provided the prescriber has the appropriate knowledge on the condition being treated and on the medicinal cannabis product they wish to prescribe.

Reporting

MedReleaf Authorised Prescriber Now Available in the Bp Premier Reporting Tool

The MedReleaf Authorised Prescriber 6-Monthly Report is to support prescribing doctors who are authorised prescribers for unregistered medical cannabis products. Authorised prescribers for unregistered medical cannabis products need to report the number of new patients commenced on treatment, and number of patients continued on treatment (for longer than 6 months), for each product to the Therapeutic Goods Administration. 

This report takes the stress out of keeping track of patient numbers throughout the reporting period. A simple report generation saves the doctor and clinic ample administrative work.

To learn more on the TGA Reporting Tool please visit: MedReleaf 6 monthly TGA reporting

Learning

MedReleaf Prescriber Program

MedReleaf Australia’s prescriber program is available to all doctors, providing access to training and education for the doctor to confidently assess, advise, prescribe and treat patients with medical cannabis. 

Peer-to-peer workshops, educational webinars and further clinical material are available through registering to access MedReleaf’s online training and education portal, available here.

medical cannabis prescribing prescriber program flyer

The following article was submitted by Bp Software Silver Partner MedReleaf. You can view their partner profile here. 

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Prevention is Better Than Cure – My Journey With NCSR Integration

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Contributed by guest author Dana Tse of Campsie Medical Practice in Campsie, NSW.

When it comes to cervical cancer, Australia is fortunate enough to have the lowest mortality rate, and second lowest incidence rate in the world. While these are encouraging statistics, the success of our cervical screening program is heavily dependent upon the recruitment of women.

Higher rates of participation in cervical screening means that more women with precancerous abnormalities can be detected and treated sooner, which is necessary to achieve lower incidence and mortality from cervical cancer.

Cervical Screening Rates In Your Practice

What are the cervical cancer screening rates in your practice? More importantly, how do they compare to other practices in your PHN or the national average?

What, if any, have you found are the limitations in improving screening rates within your practice? Can you articulate the barriers to cervical screening in your practice? Is it perhaps a lack of patient education around the importance of cervical screening? Are there cultural barriers in place?

Is Preventative Healthcare Part of Your Practice's Workflow?

Nationally, cervical cancer rates are declining. Some drivers behind this include the widely available HPV vaccination, the option for cervical cancer screening self-collection, and the initiative to offer cervical screenings every 5 years. However, even with all the above, our national rate of screening is less than 50%; and I tend to be a glass half empty sort of person!

At our practice in Campsie, less than half of our female population were involved in cervical screening. We averaged approximately 30% for our PHN, compared to the national average of around 40%.

So naturally the question came to mind – what were some of the barriers that our women patients were facing? We decided to embark on a quality improvement activity with NPS MedicineWise Learning to ascertain how we could improve these rates.

The most welcomed upgrade and recently added feature in Bp Premier Saffron was the NCSR integration – or National Cancer Screening Register. Instead of having our nurses call and be on hold with the NCSR, we can now readily access information through Bp Premier. In fact, we’re able to do everything related to cervical screening directly within Bp Premier; from the utilities function, to searching the NCSR hub for most recent screening dates, results and even to check when women were next due, or if they were overdue and required a recall.

We could finally update our database to reflect our true cervical screening rates and actively recall women who were due for screening. This was particularly important post-lockdowns, where ‘less important’ things like screening may not have been front of mind. I believe our cervical screenings rates are now higher than before, due to information previously being missing, incomplete or out of date.

Bp Software provides several SQL queries that have proven useful for us in accomplishing this task.

NCSR Integration - Where To From Here?

Quality improvement is something that exists on a timeline. It can’t be set and forget. As for our practice’s approach:

  • We plan to revisit our cervical screening every 6 months to capture any data that is missing
  • We plan to include cancer screening records for all new patients when they meet with our nurses
  • We would like to tackle bowel screening rates
  • We look forward to the NCSR integration with Breast Screen
  • We would like to see NCSR reminders in Bp Premier generated as a list, without having to enter the reminders ourselves

We are fortunate and privileged to live in a country that offers free screening for prevention of these cancers, most of which have great treatments if identified early.

As the adage goes; prevention is better than cure.

Authored by:

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Dana Tse
Practice Manager at Campsie Medical Practice

Dana has previously contributed an article to the Bp Newsroom on Effective Practice Management.

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Concerned about PRODA? – A Message from Services Australia

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The following is a direct statement provided to Best Practice Software from Services Australia.

Services Australia (the agency) is pleased to be working with the Medical Software Industry Association (MSIA) to ensure their members, and more broadly the healthcare software industry developers, have the correct information available for you and your customers.

Concerns have been raised about the changes to the way healthcare locations transmit claims and payments with the Medicare (including AIR and DVA), PBS and Aged Care programs. We want to assure you that the considerable effort you have put into developing and transitioning to web services and PRODA is not in vain.

Confusion About Services Offered by Provider Digital Access (PRODA)

PRODA is an online authentication system that verifies an organisation or individuals’ identity. It is used by multiple programs and services to ensure the right person is accessing the right services. Once authentication is verified through PRODA, the user is passed to the services they are already registered for. Users do not have to register more than once for PRODA.

The services that use PRODA to authenticate are not limited to healthcare programs, and include a range of services from Student Services, Child Care and eInvoicing.

eInvoicing is not for Medicare, PBS or Aged Care claims and payments. eInvoicing is a program that allows government departments to speed up the way they invoice and pay for goods and services (moving away from sending invoices). It is used for government contracts and payments between government departments.

Other Concerns Identified

Sharing of information: PRODA is used for authentication services for many programs, Once authenticated, no details of your secure transactions with linked services are shared outside that program.

Web services: Moving Medicare, Aged Care and PBS claims and payments to web services is part of the Health Delivery Modernisation Budget Initiative to remove adaptors and the significant technical debt and the log4j vulnerabilities associated with them. Claims are assessed and processed in the same way, regardless of the technology the transmission is submitted through.

Authenticating of behalf of customer: Software developers are able to continue to offer their customers the ability to authenticate on their behalf or have their customers (i.e the site) authenticate themselves.

Organisation structures: There is no requirement for Medicare, Aged Care and PBS healthcare locations, including shared GP practices, to set up an entirely new business structure for claims and payments.

Medicare claiming using a PRODA account: Healthcare providers can use their patient management system and web services/PRODA organisation account to claim for Medicare.  The PRODA organisation account is linked to the healthcare provider’s Minor ID or multiple Minor IDs.

A provider may choose to submit claims authenticated by their own PRODA account for the practice location they are servicing from. Alternatively, if there are a number of providers servicing from a location, one provider may submit claims on behalf of other providers. This model requires consent from the other servicing providers.

Re-signing up to PRODA: A user is not required to re-sign up to PRODA. A PRODA user only needs to register once and can use this account to link to multiple services. Signing up to PRODA does not request or confirm tax requirements. The organisation set up for submitting claims to Medicare is not for tax purposes.

Important Information for 13 March 2022

Please know that we understand the large amount of pressure the healthcare industry is under. We appreciate your significant efforts in supporting your customers to either transition to web services or to ensure their renewed PKI certificates are installed.

We’ve already let you know that we will not be turning off adaptor technology on 13 March 2022. If your customers are having trouble transmitting claims online from midday on 13 March 2022, it will be because they have not installed their renewed PKI certificate.

The agency is ready to assist you in monitoring your customers’ progress in installing their renewed certificates and to confirm any that may be at risk of not having their certificate installed in time.

In the weeks after 13 March 2022, we will contact developers and healthcare locations that are still transmitting on adaptors and have not requested and been approved for additional time.

For More Information

You can find out more about linking PRODA services here.

For eLearning, simulations and guides about PRODA click here.

You can find out more about eInvoicing here.

If you still can’t find the information you need, please contact us here.

We’ll work with you to provide the right information to your customers.

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Have You Upgraded to Medicare Web Services? The Clock is Ticking!

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Have you upgraded to Medicare Web Services yet?

The 19th of June is only weeks away and if you’re not using Medicare Web Services-compatible software by then, Online Claiming and Eclipse billing will stop working for you. The team here at Bp Software is here to break down the process for you into more manageable, bite-sized pieces. So, bookmark this post, set aside a few minutes each day, and make a start because how do you eat an elephant? One bite at a time.

Step 1

If this article comes as a shock to you, and you weren’t aware of this mandatory change, please click here for an overview of Medicare Web Services, and the impact on your practice. 

Step 2

If you do not have one already, click here to register an individual account in PRODA. Services Australia steps and our Knowledge Base can help you navigate the registration process.

Step 3

If you do not have one already, register your organisation by logging into your PRODA account, selecting organisations then registering new organisation. Again, Services Australia steps and our Knowledge Base break it down nicely.

Ask the question first… Is your organisation already registered? Who set up the organisation? Who in the practice will be adding and managing your B2B device? If you haven’t had that conversation yet, now is the time. Perhaps your principal doctor originally set it up, but you, as the practice manager, will be the one managing your B2B device. You won’t be able to do that if you’re not delegated the right authority in PRODA.

Step 4

Link to Medicare Online. You’re going to need to grab some information from your system first before you jump back into PRODA, so if you’re a Bp Premier user click here, or a Bp VIP.net user, click here.

Step 5

Add or manage other members of your organisation in PRODA. If you’re the person who’ll perform functions on behalf of your organisation, you need to ensure you’re added by your PRODA RA number. Click here for more information.

Step 6

This one is exclusive to multi-location practices. Make sure you register your practice locations as subsidiary organisations in PRODA by following these steps.

Step 7

Register your B2B device. For Bp Premier users, you’ll need Saffron SP2 or later. Click here for the steps. For Bp VIP.net users, you’ll need Topaz SP1, which is on its way.  

upgraded to medicare web services quote

What's Next?

After your PRODA set up is done, you’ll need to upgrade your software. If you’re a Bp Premier user, you can do this now by upgrading to the most recently released version of Bp Premier. It’s really simple to upgrade, you just need to ensure you’re running at least Indigo SP1 and have the February 2022 data update installed. To see just how straight forward it is, check out this short demonstration:

How To Upgrade Your Version of Bp Premier on Vimeo.

If you’re a Bp VIP.net user, your Medicare Web Services compatible version is currently being worked on and will be available to you soon. In the interim, in order to be adequately prepared to upgrade when it’s ready, we strongly recommend you complete the PRODA preparation steps.

If you get stuck at any point with PRODA, Services Australia can give you a hand and for anything system related, our support teams are standing by to assist. If you don’t prepare and upgrade by June 19th, Online Claiming and Eclipse billing will stop working for you, and you’ll need to manually process your claims.

Please don’t delay and remember, how do you eat an Elephant? One bite at a time.

Authored by:

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Suzi Eley
Training & Deployment Leader at Best Practice Software

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Identifying and Responding to Substance Abuse Disorders: The ASSIST

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The ASSIST is a World Health Organisation endorsed screening and brief intervention framework, designed to help clinicians identify and respond to substance use disorders. ASSIST screens for all drugs, legal and illegal, and stratifies risk for each substance into low, moderate and high levels.

ASSIST Screen 1

ASSIST has several advantages over other screening tools. First, ASSIST covers all drugs, including legal drugs like alcohol or tobacco, and illegal drugs like cannabis, methamphetamine or opioids (and more). Importantly, ASSIST is also able to identify use of non-medical use of prescription drugs. The benefit therefore, over other screening tools, is that ASSIST can also capture polydrug use which is an increasingly common occurrence in primary health settings.

How Does ASSIST Connect to Primary Health?

By providing primary healthcare clinicians with the tools to manage low to moderate risk substance use disorders in-clinic, the ASSIST also has the capacity to reduce the burden of unnecessary referrals to specialist alcohol and other drug (AOD) services. The ASSIST triages risk for the patient into low, moderate or high risk for each substance, and connects that stratification to an appropriate intervention. For low and moderate risk clients, a purpose-built brief intervention is appropriate. 

Therefore, these patients can and should be managed by the primary health clinician rather than being referred to specialist services.

For high-risk cases however, an ASSIST score can also be used as the basis of a referral to specialist AOD service for further assessment or treatment. Only those at high-risk are candidates (those who score 27+ on a given drug) to be referred to specialist AOD services for assessment and treatment if required.  

We have therefore actively encouraged the primary healthcare sector to use the ASSIST to identify those who are at high risk of dependence, and respond by sending only those individuals for further specialist AOD assessment.  

Currently, some specialist AOD services require an ASSIST assessment as part of the referral process. Having an awareness of the ASSIST and how it connects primary and specialist AOD services will be an important feature of the prevention of substance use disorders moving forward.

A new ASSIST word processing template is now available for use within Bp Premier.

The ASSIST program was developed by Associate Professor Robert Ali (MBBS, FAChAM, FAFPHM) and Dr Matthew Stevens (PhD) from the University of Adelaide. 

The full summary of the ASSIST program is available to read here.

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Saffron SP3 & Medicare Web Services Have Arrived!

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In recent times, Medicare Web Services and the requirement for your practice to transition to this new technology within your software has certainly been a very popular topic of discussion.  Team Bp are very excited to have recently released our newest version of Bp Premier, Saffron SP3 containing some exciting new features, and most importantly, bringing all of the functionality required for your practice to be fully compliant with, and connected to Medicare Web Services technology to continue your connection to functions like Medicare Claiming, and the Australian Immunisation Register in Bp Premier.

It is critical that you are aware that your practice has until Sunday June 19th 2022 to install your upgrade to Saffron SP3, and complete your connection to Medicare Web Services via PRODA. This date is sure to approach rapidly, so if your practice has not yet installed Saffron SP3 it is vital that you plan now for your practice to do so as soon as possible.  If you’re not sure where to start, the best place to begin is our Enablement Material for Medicare Web Services page – here you can follow all the steps to get your PRODA account in order to be fully prepared for your upgrade.

What functions in Bp Premier rely on Medicare Web Services? These are:

  • Medicare Bulk Bill Claiming, and private Patient Claiming functionality
  • Patient eligibility verifications for Medicare and DVA
  • The Australian Immunisation Register (AIR) for transmitting patient vaccination data.

If your practice has not completed your upgrade to Saffron SP3 before June 19th, you will be impacted significantly, and be unable to access any of the functions listed in Bp Premier – this means not being able to verify patient eligibility, not being able to transmit AIR notifications, and also no ability to for Medicare to receive payment claims from your practice.

Medicare Web Services is certainly an essential reason for you to complete your upgrade, but Saffron SP3 also contains some very exciting new features alongside this critical change. In Saffron SP3, there is brand new AIR functionality built directly into the patient record, new cancer screening preventative health warnings, new Medicare claiming functionality, and more! You can find all of the information available on our Knowledge Base (click ‘Help’ then ‘Online’ in Bp Premier to access), or watch our free Masterclass webinar that was recently held here.

In summary, what are the key points that you need to be aware of in relation to Medicare Web Services?

  • You must upgrade to Bp Premier Saffron SP3 by Sunday June 19th 2022
  • If you haven’t upgrade by June 19th, you’ll be unable to access any Medicare and AIR functions in Bp Premier
  • Saffron SP3 also contains exciting new features, like AIR access directly within the patient record
  • Access our Knowledge Base for step-by-step instructions on all things Medicare Web Services, and to see the full list of new features.
    • If you haven’t visited the Knowledge Base before, click ‘Help’, then ‘Online’ from within Bp Premier to head directly there.

As always, help is available! If you need assistance with anything related to Saffron SP3, Medicare Web Services, or any other enquiries, our Support team are available via phone or email, so please get in touch!

Authored by:

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Bec Bland
Training & Deployment Leader at Best Practice Software

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Changes to Image Based Prescribing

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From 1st April, 2022, prescribers may continue to fax or email digital images of paper prescriptions to the pharmacy of the patient’s choice. However, the prescriber must now send the original paper prescription to the pharmacy. The original temporary exemption that was in place from March 2020 did not require a paper copy of the prescription to be sent to the pharmacy (unless an S8 or S4 medication), we can now confirm that this is ending on March 31, 2022.

For practices using our Bp Premier product, ePrescribing is available and will ensure that an electronic version of the prescription can be provided to the patient, without the need to supply a paper copy of the prescription to the patient or pharmacy. Further information regarding ePrescribing for Bp Premier can be accessed here.

For practices using our Bp VIP.net product, we are expecting that ePrescribing will become available before the end of 2022. Until then, prescriptions that are faxed or emailed to a pharmacy will require a paper copy or the original prescription to be sent.

Authored by:

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Jessica White
Head of Commercial and Government at Best Practice Software

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NASH Certificates – It’s Time to Renew!

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National Authentication Service for Health (NASH) Certificates are issued by Services Australia to your Practice to securely access and share information using digital health systems.  NASH Certificates for many practices in Australia will expire on or before 13th March 2022 as Services Australia upgrade the certificate security.

What Purpose do NASH Certificates Serve?

In your Best Practice Software product, your NASH Certificate is used to support the following functions:

  • My Health Record
  • Electronic Prescribing with eRx
  • Healthcare Identifiers (HI) service for both eligibility and validation checks

These certificates expire every two years, and a current NASH certificate is required to continue to use the functions listed above. Previously, the HI Service, and eRx both used your Practice’s Medicare Site Certificate for these secure communications instead, however both services now require the use of your NASH certificate.

Updating Your NASH Certificate

If your certificate is due to expire on or before 13th March 2022, you can renew this now, there is no need to wait until the expiry date.  You can request and download a renewed NASH Certificate for your Practice through Healthcare Professions Online Services (HPOS), and install this into your software. Doing so ensures that My Health Record, prescribing with eRx, and HI lookups will continue to function in your Practice without interruption.

To request an updated NASH Certificate, your practice’s nominated Organisation Maintenance Officer needs to log onto the HPOS portal through your practice’s PRODA account and request an updated certificate.  The Australian Digital Health Agency have provided several resources to assist with requesting your new Certificate, including:

Once you have renewed your NASH Certificate, you can then install this into your software to continue your access to My Health Record, prescribing with eRx, and the HI service. 

Need Extra Assistance?

Not sure what to do in your software? Help is available on our Knowledge Base! Simply log in to your software, open the ‘Help’ menu, and click ‘Online’ to be taken to the relevant Knowledge Base to find step-by-step instructions to guide you through this process. As always, the Bp Support team are here to help as well, and you can contact us on 1300 401 111 for assistance.

Authored by:

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Bec Bland
Training & Deployment Leader at Best Practice Software

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Moving to Medicare Web Services – Is Your Practice Prepared?

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Please note that this article is for our Australian customers.

As you are aware, Services Australia is upgrading the current technology used by practice management software, to connect to critical digital health services such as Medicare/DVA Claiming, Eclipse and the Australian Immunisation Register. This new technology is referred to as Medicare Web Services (MWS).

A number of our products currently connect to Services Australia via a Medicare Client Adaptor, which utilises a Medicare PKI certificate also known as a site certificate. As per the new requirements, practice management software vendors will be replacing this Medicare PKI certificate method with a Provider Digital Access (PRODA) account, which will lead to the replacement of the current Medicare Client Adaptor technology.

What does this mean for your Practice?

For Bp Premier Customers:

  • We expect Saffron SP3 to be available towards the end of February 2022. This is the version of Bp Premier that contains all MWS changes needed to meet transition dates. We recommend that your Practice upgrades as soon as this is made available.

  • Prior to upgrading to Saffron SP3, you must ensure that your have registered and configured your PRODA account. If this is not completed prior to the upgrade being applied, your Practice will not be able to access any Services Australia business functions.

  • Bp Premier customers have also been granted a 3-month extension by Services Australia and now have until 19 June 2022 to upgrade to Saffron SP3. To take advantage of this extension, your Practice must ensure that they have received a new PKI Certificate and that this is installed and configured for existing Medicare functionality to continue to function after the original cut off date of 13 March 2022.

For Bp VIP.net Customers:

  • We expect the next version of Bp VIP.net to be made available in April 2022. This is the version of Bp VIP.net that contains MWS changes needed to meet transition dates. We recommend that your Practice upgrades as soon as this is made available.

  • Due to some of the complexities involved in implementing these important changes, we will not meet the original March 13 2022 deadline and have successfully obtained an extension to this date on behalf of all of our Bp VIP.net customers. As a Bp VIP.net customer, this means that your Practice will now have an additional 3 months to transition to our final Medicare Web Services enabled build. The new date for your transition deadline is now Sunday the 19th of June, 2022.

  • To take advantage of this extension, your Practice must ensure that they have received a new PKI Certificate and that this is installed and configured for existing Medicare functionality to continue to function after the original cut-off date of 13 March 2022.

  • Prior to upgrading to the Bp VIP.net release containing MWS functionality, you must ensure that you have registered and configured your PRODA account. If this is not completed prior to the upgrade being applied, your Practice will not be able to access any Services Australia business functions.

For Bp Allied Customers:

  • The next version of Bp Allied, V7 SP2, is due for release towards the end of February 2022.

  • This release will contain the changes needed to support the new MWS requirements.

  • As we leverage a third-party API to connect to Services Australia functionality, all Practices must apply the V7 SP2 update prior to the 12th of March 2022 to ensure that they can continue to access Services Australia business functions.

Moving to Medicare Web Services - what support is available?

  • Access your Bp Knowledgebase to review the steps required to register and configure your PRODA account, along with accessing other supporting information about Medicare Web Services such as renewing and configuring your PKI Certificate.

  • Review the Enablement Material our fantastic Training Team has put together to support our Practices through this change.

  • For Bp Premier users, register for our upcoming Saffron SP3 Masterclass Series here. Classes begin from the 23rd of February 2022!

  • For Bp VIP.net customers, keep an eye out for our planned April Masterclass Series.

  • Send our team an email if you have any questions or require any further information!

Authored by:

Jessica White Author Blog Picture

Jessica White
Head of Commercial and Government at Best Practice Software

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The New Generation of Practice Management Systems – From Interoperability to AI

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Early practice management systems (PMS) were born out of the need to provide better continuity of care for patients and more efficient operations for a GP/practice, both of which contribute to the improved quality and safety of care delivery. They have created significant and perhaps intangible benefits to individuals and society over the last several decades.

The new technology enablers, however, make it possible to transform PMS into more federated, better connected, and evidence-based systems by leveraging the emerging interoperability standards and Artificial Intelligence (AI) technologies.  This will make the new generation of PMS even more central to primary care systems within the overall healthcare care continuum.

This will enable future generations of Best Practice Software to bring many new benefits to patients, practitioners, and the community at large – contributing to a ‘more sophisticated and connected community healthcare management’, as mentioned in a recent Wild Health article.

Technology Enablers

The technology enablers include web-based and cloud infrastructure, now being used as the basis for the next generation of Best Practice Software, referred to internally as Titanium.

When used in conjunction with new interoperability standards such as HL7 FHIR®, cloud technology adds new mechanisms to the way various parties in the delivery of healthcare are connected, including support for patient engagement.

Through the cloud, AI solutions can be built leveraging huge amounts of data created by clinicians, including as part of collaboration with other clinicians, and in some cases, generated by medical devices. Such solutions can provide new insights to the clinicians and support new models of clinician-patient collaborations, with added emphasis on preventative and personalized health.

The Added Value of Interoperability

Architecting for interoperability adds dynamic and evolvable aspects to the way health systems of the future are connected, typically using APIs over cloud. This allows constructing and managing flexible event-driven clinical workflows supporting multiple participants, including hospitals, Aged Care facilities, community health centres, and patients.  This is not currently possible using HL7 v2 messaging integration approaches.

The emerging HL7 FHIR® standard provides a common information model for representing digital health data (the so called FHIR Resource entities) and API interfaces, both of which support building interoperable and connected digital health systems, and many international vendors are now embracing it.  In some cases, this is in response to regulatory requirements, such as the US Office of National Coordinator (ONC) cure act Final Rule.  This rule was designed to give patients and their healthcare providers secure access to health information. It also aims to increase innovation and competition by fostering an ecosystem of applications to provide patients with more choices in their healthcare, in part through the standardized API interfaces.

Best Practice Software recognizes the many benefits that the FHIR® standard can bring in the context of cloud technologies and is currently establishing a long term FHIR® adoption roadmap as part of its strategic direction.

The Added Value of AI

In general, AI is a collection of interrelated technologies used to solve problems autonomously and perform tasks to achieve defined objectives without explicit guidance from a human being. AI adds value through automating many tasks typically involving human actions and decision making.

Examples of AI use in healthcare are in the interpretation of medical images, e.g., X-rays and MRI scans, in the personalized treatment of patients based on their medical history and genetics, and in the optimization of clinical workflows.

A key component of AI is machine learning (ML), whereby computers ‘learn’ without being explicitly programmed, making use of the large amount of clinical data collected over time (aka training data) and applying advanced computational reasoning techniques. This can be in the form of:

  1. statistical machine learning searching for a predictive function from the training data
  2. reinforcement learning approaches constructing AI algorithms with “rewards” or “penalties” based on their problem-solving performance, inspired by control theory approaches
  3. deep learning solutions based on the use of artificial neural networks.

Other AI applications are in natural language processing, computer vision, used in many clinical image processing applications, and robotics. Another area of use in health is knowledge representation, particularly used to document clinical knowledge in a computable form such as SNOMED-CT clinical terminology.

Many rule-based Clinical Decision Support (CDS) systems can also be regarded as a form of AI.  Best Practice Software has included since its initial release CDSs aimed at helping clinicians to provide safer and more personalized healthcare. For example, when prescribing, background checks are made for potential allergies, drug interactions, contra-indications etc.  The use of new AI approaches can add another level to CDS, leveraging data-based solutions, contributing to better evidence-based healthcare provision.

Best Practice Software is currently looking at AI technologies for its future products to advance the creation of learning health systems for primary health providers as part of connected health ecosystems. The aim is to support more effective, evidence-based, and personalized clinical care and adaptable clinical workflows, as well as more efficient administrative operations of practices, based on the large volumes of historic data that has been collected. Possibilities include analysis of previous investigations of patients to support predictive clinical actions, text mining of correspondence with specialists, hospitals, and other clinicians, to help better decision making in case of similar future symptoms and so on.

While interoperability delivers more connected and event-driven care, analytics and AI provide augmented decision making for clinicians.

Establishing Trust for Providers and Consumers - Guidance for Developers

An important consideration when discussing AI technologies is to ensure that clinicians trust the decisions that are made as a result of the use of the AI system. This is often referred to as an explainability problem, which requires mechanisms to support clinicians in understanding how AI systems make decisions.

There is a further element of trust, whereby that learning health systems need to ensure that personal and societal confidence in IT systems is preserved in the presence of the data proliferation and sharing. To this end special care needs to be taken to express rules related to privacy, policy and ethics.  These concerns were discussed at more length in the paper delivered by Best Practice Software at the recent AI in Healthcare workshop in Oct 2021, and highlighted next.

One way to create trust is to develop “explainable” AI, where developers can present the underlying basis for decision-making in a way that is understandable to humans and can demonstrate that the system is working as expected by clinicians.

Another part of the guidance for developers is related to the problem of expressing computable expressions of policies, such as obligations, permissions, accountability, responsibility, and delegation. These expressions can be implemented in code as part of any digital health application, including the AI solutions. For example, they can be used to encode rules associated with privacy consent, governing the rules of access to personal healthcare information, or with research consent, governing the rules of clinical research. 

Computable expressions of policies are also important when one needs to express responsibilities associated with passing of healthcare data between providers, taking into account various legal constraints such as data ownership or custodianship or regulatory constraints associated with privacy.

AI brings its own set of policy issues such as how one can go about specifying ‘responsibility’ of AI applications, e.g. in the case of safety concerns, is this a responsibility of the AI developer, the IT staff involved in deploying the system or of the users of the system such as the clinicians.

These are issues which are currently yet to be addressed as part of legal systems, but the computable policy framework should be a required prerequisite when building scalable AI in any healthcare organization.

Co-authored by:

New Generation of Practice Management Systems Author Headshots

Dr Frank Pyefinch
CEO at Best Practice Software
&
Dr Zoran Milosevic
Interoperability and AI Consultant at Best Practice Software

Footnote

The paper presented at the AI in Healthcare Workshop is available upon request. If you would like to obtain a copy, please contact Dr Zoran Milosevic here.

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