Frank & Lorraine Pyefinch of Best Practice Software are two iconic and down to earth players in the Australian Practice Management System game.
Dr Frank Pyefinch is not only founder of Best Practice, but also originally the founder of Medical Director - the number 1 and 2 practice management systems for Australian GPs today, and have been for many years.
As CEO of Best Practice, Frank brings with him a long and proud history working as a busy GP, and Lorraine as a registered nurse - so together they understand first hand the challenges and needs of the medical community when it comes to software and technology.
[02:07] Genie was first created because Frank doesn’t like Mac
[02:45] The first PMS in Australia (Medical Director) was created by Frank because the poisons act changed in Australia allowing typed scripts, which included computer generated ones.
[06:38] The break-even point for MD back in the early 90s was 200 sites. This seemed an ambitious goal at the time. Today Best Practice Software has over 4500 sites.
[06:49] The name “Medical Director” came from Lorraine looking through Job Classifieds in Aus Doc magazine, and liking the attributes of a ‘Medical Director’.
[07:58] The original Medical Director logo was created by Lorraine with the kids etch-a-sketch in the back of the family car
[08:30] The first copy of Medical Director was sold on it’s launch at the AMA’s annual computer day conference in 1992.
[09:00] In 1994/95 advertisements started to be inserted into the Medical Director software, which subsidised the program heavily.
[09:30] In 1999 Medical Director was sold to Health Communication Network (HCN). Frank and Lorraine went to HCN with the business.
[10:30] Frank and Lorraine left HCN in 2003 as they were dissatisfied with the increasingly intrusive advertising being placed in MD to raise revenue. They sat out their exclusion period in their contract, and during that time Frank went back to being a GP in Bundaberg while writing Best Practice.
[12:00] There were no standards for medical software at that time. If there were, it’s likely the product would never have been built.
[14:00] Frank and Lorraine have seen Medical Software evolve from a text mode dos interface, to a graphical user interface, to the introduction of tables and touch screens. Now seeing a bigger emphasis on communication, and also now a shift to the cloud, which is driving the development of their Titanium product to be released next year.
[15:07] Frank still does some programming in Best Practice even today, because he enjoys it.
[17:34] Some of the government brain waves aren’t clearly thought out, such as the PHN’s collecting data for the QI Pip.
[18:55] The biggest cause of support issues for Best Practice are Medicare claims not reconciling due to the archaic nature of the Medicare adapter. BP is hoping Medicare shift to web services before BP release Titanium so they don’t need to integrate with legacy technology in the cloud.
[21:15] During the roll out of the then PCHR, now My Health Record, during the Royal Review, Frank and Lorraine provided the suggestion that Doctors should be remunerated for uploading summaries to My Health Record as it was additional admin work they were not being paid for.
[26:51] The BP Partner Program has been launched in order to give partners more controlled access to the BP database so they don’t need to hack their way in, and only get access to what they need - protecting the partner, the patient, the practice and BP.
[31:10] Pathology requests in PMS systems is standardised as SNP and QML, two competitors came together in the early 90’s came to the PMS providers and standardised the format of the forms, which set a format for future pathology vendors. This didn’t happen with radiology which is all over the place
[33:30] The ADHA is making strides towards their goal of interoperability, for example with secure messaging, although is Secure Messaging the best way to go about it, perhaps web services for a central repository would be a more modern way to go about it.
[35:30] Titanium has not been released yet due to the sheer amount of work to build 30 years of product development from scratch into the cloud. The business was also distracted by recent acquisitions which expanded their reach into Allied and NZ markets. Ultimately all products will be rolled into Titanium their cloud product.
[40:15] BP are soon releasing their patient app, they see it as a future direction for practices wanting to engage more with patients
[44:50] A big consideration for BP in rolling out the patient app was the potential risk of needing to support millions of patients using the app - shifting from a B2B approach to B2C.
[00:00:00] Pete: [00:00:00] Welcome to Talking HealthTech. My name is Peter Birch, and this is a podcast of conversations with doctors, developers, and decision makers that are playing in the Australian HealthTech scene today.
[00:00:12] With me today are two very iconic and extremely down to earth players in the Australian Practice Management System game. I'm talking about none other than Frank and Lorraine Pyefinch of Best Practice Software.
[00:00:23] Dr. Frank Pyefinch is not only founder of Best Practice. But he's also originally the founder of Medical Director, the number one and two Practice Management Systems for Australian GP's today, and they both have been for many years. Dr. Frank Pyefinch is CEO of Best Practice and he brings with him a long and proud history of working as a busy GP and Lorraine as a registered nurse, so together they understand firsthand the challenges and needs of the medical community when it comes to software and technology. Best Practice has dominated the market for a long time as the first choice for GPs around Australia when it comes to selecting a PMS, and I look forward to [00:01:00] finding out why in my conversation with both of you, Frank and Lorraine how you doing?
[00:01:03] Frank: Hi. Well, good.
[00:01:06]Pete: This is a first for me. I'm actually recording from your office. So had taken it out on the road, which is great. But I, I originally thought I was going to go to Bundaberg, but you've got a few offices I see.
[00:01:16] Frank: We moved from Bundaberg about five years ago , and came to Brisbane because our two children had to come down for university and getting them to go back to Bundaberg was quite difficult. So every birthday and Christmas, it was down to Brisbane. After a couple of years, we decided we might as well just move here.
[00:01:35] Lorraine: The main office is still in Bundaberg, so we've got about 65 staff working there. We've got four offices all up, so we've got one here in Brisbane with just over 40 staff and another 9 down in Sydney, and then, over in New Zealand, we've got more than 40 in Hamilton, in the North Island.
[00:01:55] Pete: So I always used to say that Bundaberg was the HealthTech capital of Australia, or the Silicon Valley of [00:02:00] Australian HealthTech.
[00:02:00] Frank: It was certainly in the 90s, , when Paul was still living there and wrote Genie
[00:02:07] Lorraine: We have a funny story about Paul because you see, I clearly remember the night Paul came round to our house. After Frank had first started to show off the original Medical Director, and I remember them sitting in the study and I could hear Paul going "Oh wow, that's really good, Frank". And then he asked Frank the fatal question "does it run on a Mac?" And Frank said, " no, I hate Macs". And so Paul went, "Ya ha!, I'm going to write Medical Director for a Mac!",
[00:02:34] Pete: [00:02:34] As I sit here, I look sponsored by Mac sitting in front of you. Hey, look, so, there's a lot that we can cover off. Obvious question. You guys have a lot of history in this space. So where do you start? How did this all start?
[00:02:44] Frank: [00:02:44] It really started in the late 8 0's , when Lorraine was doing a bachelor of health science at central Queensland uni, and so we had to buy a computer for her to do her course, and I got interested in it. And [00:03:00] started using it for a little database projects at home, like watching the rainfall every day and coding what bottles of wine we had in cupboard and things.
[00:03:11] And around about the same time, in about 1989 the Queensland Government changed the poisons act to allow prescriptions to be typewritten , as opposed to handwritten. And of course, type written also included computer generated. And so I thought this was really neat because I had something like 25 patients in a local nursing home.
[00:03:33] And almost every week I'd get a list of prescription requests for them, and I could sometimes sit for an hour after I'd finished at six o'clock at night writing out prescriptions for the nursing home, and I thought if I could put all these patient's names into a computer, into a database. And then put the drugs in against the names.
[00:03:55] I'd be able to just go through and tag which ones I wanted to print and print them out. [00:04:00] And so I did that and started using it at work.
[00:04:04] Pete: [00:04:04] When was that? There was back in the 80s?
[00:04:06] Frank: [00:04:06] it was about 89 / 90 when I really started.. And then I started using it day to day with my regular patients as well, because once I've written that in, it could write scripts, it didn't have to be restricted to the nursing home patients. So I bought a computer and put it on my desk with a dot matrix printer. And in those days we had to supply our own prescription paper, which I had to get printed and so I started using it for all my patients. Then one of my partners started using it too, and we actually networked it by putting a cable up through the ceiling and down the other side and into his room.
[00:04:43] And so we had a little network of two computers and progressively it just grew from there. And I started putting other things in. I got a list of PBS medications from the pharmacy next door. The pharmacist had written his own computer program for [00:05:00] point of sale, and so he gave me a big list of all the medications with their PBS listings.
[00:05:05] I was able to use that to create pick-lists of drugs and so on. And once I had that, it was possible to use that data in other ways, so I put things like listing allergies, and then I could cross check between the scripts and the allergies and it just grew. And yeah. Progressively, we added more and more things, and over the early 90's, through 90 to about 92 it became what was ultimately Medical Director the first release. And how Medical Director really came about, was that a GP in Narrangbar, which is just North of Brisbane, heard about the fact that I was writing computer generated scripts and he was really keen to do the same. So he contacted me and said. Can I have a look at your program?
[00:05:50] So packaged it up onto a three and a half inch floppy disc and posted it down to him and he put it on and played around with it and said, you got back in touch and said, this is amazing. [00:06:00] This is just what I've been looking for. There's nothing else like it anywhere in Australia. And he said, you should be selling it.
[00:06:06] And I thought, hmm, I'm a GP. I'm not a sales person or a computer expert. It was just a hobby really for my own use. But we had a chat about it and decided..
[00:06:21] Lorraine: [00:06:21] I went to TAFE and did a short course on how to write a business plan because I thought we'd better have a business plan. They were very popular back in the 90s so I wrote that business plan. I remember coming home to Frank one night from TAFE and saying very proudly: "so I've worked out our break even point, we have to have 200 sites to break even. Okay. And Frank said, Oh, that's a bit ambitious, isn't it?
[00:06:43] Pete: [00:06:43] How many sites do you have now?
[00:06:45] Frank: [00:06:45] Four and a half thousand
[00:06:49] Lorraine: [00:06:49] Medical Director was interesting because even the name. We came up with the name, I like to say I named the babies in the family, but we came up with the [00:07:00] name because at the time there were a lot of really gimmicky names, you know,
[00:07:04] Frank: [00:07:04] Medi-mouse.
[00:07:06] Lorraine: [00:07:06] I was actually flicking through Aus Doc magazine and got to the classifieds back. And they had all these ads looking for a Medical Director, and I was reading the attributes of what a Medical Director was, and I thought, yeah, that's actually something, responsible, in charge, reliable, all those sorts of things.
[00:07:32] So I thought, well, that's the kind of this kind of image we thought, something that helps the practice and to make it more efficient, just even handwriting, because there were a lot of concerns about the medication errors and just being able to have a type written prescription, just removed any ambiguity over what of handwritten script might've might have seemed to whoever was dispensing. So that's sort of where it started. The logo, the MD logo, [00:08:00] I was sitting in the back of the car with the kids etch-a-sketch when we were coming back from holidays. Came up with the MD, the original, they don't use that one anymore.
[00:08:10] Pete: [00:08:10] They've still got the name though.
[00:08:12] Frank: [00:08:12] So we started selling it in 1992. And in fact, we had a table at the AMA's annual computer day that they used to have back in those days. And, we were in a corner with a table and we had a printer and we were actually printing scripts on fake sample script paper, and we sold the first one on the day.
[00:08:34] At the at the trade display, and that was September 92 and basically it just took off from there and I think 94 we had passed out 200 site limit to, to break even, and I had to take increasingly longer periods of time away from the practice. And so I ended up in about 94 or 95, we teamed up [00:09:00] with some advertising people down in Sydney, and that's when we started putting the ads into Medical Director, which subsidized the program quite heavily.
[00:09:10] It was never free. People keep telling me that. We used to give it away free, but we never actually did, but it was heavily subsidized by the advertising. And over the period through 95 to 99 we build up to about 1500 sites. I think it was at that time, we sold the business to health communication network and we worked there for four years, but during that time I didn't do any general practice, and by the end of that time I thought we were starting to lose touch with the coal face, and at the same time we thought the product was being pushed in directions that we didn't want to see it going. In that it was being used as a cash cow with increasing amounts of advertising and more intrusive advertising
[00:09:54] Lorraine: [00:09:54] When it was our business, Frank used to have pretty tight editorial control over [00:10:00] where and how many ads appeared, and so it was more of an exclusive spot at the pharmaceuticals paid for and we disagreed with, I think, the way that, that seemed to be a lucrative revenue. stream for for the business and we didn't agree with what
[00:10:17] Pete: [00:10:17] Yeah I mean, you obviously can't do that at all now.
[00:10:20] Frank: [00:10:20] No, no. It went from being the customers, being the doctors, to the customers, being the drug companys, which was not what we wanted to see. So in 2003 we both left and then had a year to sit out in the exclusion period from my contract. And during that time, I went back to general practice 12 hours a week in Bundaberg. And we decided during that period that there was still room for someone to come in and produce a product targeting doctors that had no advertising in it. And so that was why we started working on BP.
[00:10:56] Lorraine: [00:10:56] And by then, our old product Medical Director was the market [00:11:00] dominate...
[00:11:00] Frank: [00:11:00] It had 85% market share at that time.
[00:11:03] Lorraine: [00:11:03] So it was, it had gone in that space of less than 10 years from probably less than 5% of doctors using computers in their surgery to being the norm for the vast majority. So, I mean, ultimately patient safety, by the fact that, prescriptions will legible had improved remarkably in that time.
[00:11:24] Frank: [00:11:24] And I mean, we've added so much allergy checking, interaction, checking disease interaction checking. So there was a lot of patients safety sort of features built into the product. And it actually reached a point where at one point the medical defense people were saying that if you weren't using a computer for prescribing, then you probably weren't practicing to the standard that is expected at the time. So if you had a misadventure due to with the handwritten script, you would probably lose the case.
[00:12:00] [00:12:00] Lorraine: [00:12:00] I suppose we look back on it now, there were no standards for software in Australia at that time. They really aren't now, Frank created the standard, I suppose, he set the bar. If there had been standards in place, it might have actually been more difficult to do what we do. Because the way you look at some of the government mandated work and think, well, we probably wouldn't have designed it like that.
[00:12:27] Frank: [00:12:27] Well, it was very much designed by a clinician, and that's why it, I think took off because the workflows were very intuitive and very natural to the clinicians. Once they started using it, it really improved their efficiency, improve the note-taking, improved patient safety. There was all positives.
[00:12:48] Pete: [00:12:48] It sounds very much designed to solve a problem rather than designed to show off some fancy tech.
[00:12:54] Frank: [00:12:54] Yeah. It was very much from a user and that's when I wasn't working in general [00:13:00] practice during the HCN period. I started to feel that it was losing some of its relevance because it wasn't keeping pace with what clinicians were using.
[00:13:11] And so while we lived in Bundaberg, I always working 10 hours a week. I did that for 10 years until we left in 2014.
[00:13:24] Pete: [00:13:24] So, you know, you, you've built it up to, to what it is today, and your, , there's a lot of people walking around in this, in this office, and you've got other offices as well.
[00:13:31] No doubt. You've. paved the way and kind of set the pace for a lot of people, but you've also had to keep up with we the industry and everything that's happening around it and use a needs and just general advancements in technology. It's a very big question for people with such a vast experience, but what would you say some of the biggest things that have changed in that in that time period, from when you first created the thing to now?
[00:13:54] Frank: [00:13:54] When I first created it, we were using a text mode dos [00:14:00] interface where everything basically was done by typing. There was no mouse. There wa s, none of the sort of touch screens or any of the voice activated stuff that you see today
[00:14:13] Pete: [00:14:13] You didn't say, Hey Siri...
[00:14:15] Frank: [00:14:15] Couldn't do that. Back in 1990. So we've seen it move from that to windows to becoming a graphical user interface. We've seen the introduction of tablets and touch screens and all the rest of it. We've seen much bigger emphasis on communication, which is something that's still evolving with secure messaging and that sort of stuff. Now we're seeing the move to the cloud, which is why we have so many people in the offices that we have. Redeveloping. obviously, for the cloud, it has a whole raft of issues that you didn't have when you had an office based solution. And the security is obviously a major issue. [00:15:00] We've got quite highly paid people working on the design and the architecture to make sure that we get it right. In the old days, I did a lot of the programming. I still do some, but only on the legacy product because I don't understand the new technologies well enough to know that we'd be doing the best job possible.
[00:15:18] Pete: [00:15:18] I didnt think you'd do any programming at all nowadays?
[00:15:21] Frank: [00:15:21] I enjoy it, I love it. That's why I started doing it in the first place was because I really enjoyed it. So yeah, so I still do a bit of work on it. I do have a few special projects. I do a bit of decision support work along with some of the pathology labs. I like to keep working on the actual program, but I'm not doing any work on the cloud version, it's all young guys who have much sharper brains than I do
[00:15:51] Pete: [00:15:51] We will get into cloud in a bit too, because I want to cover off a little bit on that , but just back to the needs of the customers being the doctors, the clinician, general [00:16:00] practice, like today, what do you think of the big things that GPs need a hand wave or, are some of the biggest challenges that they face? Or just generally the environment in which we're in, which is creating challenges for them.
[00:16:14] Lorraine: [00:16:14] think there's certainly been a shift towards more corporatized medicines. So there's a lot of doctors that are working as employees of contractors to do the surgery. We certainly started in an environment when most practitioners owned their own surgery or were in a group practice. So there's changes along there. A lot of them aren't decision makers anymore.
[00:16:35] So, you know, there's a different set of needs for non-practitioner owners. Certainly there's been, there's financial issues in medicine these days. For a long time, there was no increase in Medicare rebates, which meant that , for a good number of years, the income that doctors could generate was limited. those challenges, I think, are always there. This aging, [00:17:00] of doctors
[00:17:01] Frank: [00:17:01] Increasing chronic disease
[00:17:03]Lorraine: [00:17:03] Managing chronic diseases and other thing s, there's more emphasis on, it'd be interesting to see how PHNs go with that. There's still a lot of question marks around data security
[00:17:15] Pete: [00:17:15] That's all linked to the QIP isn't it?
[00:17:18] QI Pip Yeah
[00:17:20] Lorraine: [00:17:20] QI Pip Yeah. I mean, a lot of it hasn't been clearly articulated, so, you know, it's a bit of a work in progress.
[00:17:28] Frank: [00:17:28] I mean, government often come up with brain waves that aren't clearly thought out, and we've seen it with the QI PIP where they using the PHNs to collect the data.
[00:17:45] So there's a lot of, not distrust of the PHNs, but not all GPs are willing to give the PHNs data, whereas they'd be more inclined to upload it to a central repository that was directly managed [00:18:00] say by the department of health or, or someone like
[00:18:02] Pete: [00:18:02] that
[00:18:03] I mean the funding model in Medicare and everything around that space.
[00:18:07] Is there any thoughts you've got around, any progressions that have been made, particularly around technology? There's a lot of people that have thoughts on how Medicare is supporting the changing needs of patients or clinicians or the way that healthcare is delivered. Is that impacting you in any way?
[00:18:21] Frank: [00:18:21] Medicare itself is really just an insurance organization. So the claiming we have automated within Best Practice as best we can, it is all done through a little, what they call an add that to. Which is quite old and it's not even, I don't think it's been upgraded for four or five years now. So they're not terribly forward moving. They have been talking for some time, the adapter has a lot of issues and we've had to do some pretty tricky programming to get the Medicare claims to reconcile at times. And it's one of our biggest [00:19:00] support issues and that we have from practices is. W wanting to know how they can get the Medicare to add up between what they've claimed that they've actually received. They have been talking for years about replacing the adapter with web services, which is a much more modern way of transmitting data to and from Medicare, but it hasn't happened yet. We're hoping that it will happen in time for our cloud program because we don't really want to implement the adapt to in our modern program because talking to those sort of legacy products is actually quite difficult sometimes and trouble prone, which is then going to cause us more support issues. So we'd rather they'd move forward, but they've been very slow. Medicare and not pushing anything really. They're very reactive.
[00:19:59] Pete: [00:19:59] What about, [00:20:00] dare I say My Health Record? I think I've, got to a point in this podcast where I haven't asked one question about My Health Record. But I'm gonna ask you guys about My Health Record and, whether it's your take on it or what's needed to increase uptake of it or how that's kind of working , what kind of thoughts have you got around that space?
[00:20:18] Frank: [00:20:18] I personally, as a clinician, was quite keen on the concept of My Health Record was, the original cases involve issues where people were away from home on holiday or whatever and got sick and they full record would be available to a clinician at that location. People were admitted to a hospital and unable to give a history if they were unconscious after a car accident, that sort of thing. The hospitals would be able to look it up, so there's lots of good that clinician could see in it, but the implementation has probably let it down. When they did the, was it the Royce review?
[00:20:58] Lorraine: [00:20:58] Royal. [00:21:00] Richard Royal.
[00:21:01] Frank: [00:21:01] Royal Review about four years ago now, after it had been released for about a year and the uptake was very slow. He, was commissioned to basically write a report saying why was this the case and what could be done to turn it around? And that's when they renamed it from PCHR to my My Health Record. Like that was gonna make a big difference. That as part of his report, he interviewed a lot of people who were involved with it, including us. And. We gave him some suggestions for increasing uptake. And our biggest suggestion was that the GPs get paid an extra item number for curating the online health record, because it does take a couple of minutes at the end of a consultation to check that the health summary, shared health summaries up to date and accurate, and then to upload it.
[00:21:55] And if you see 40 patients a day and you put an extra two minutes onto every [00:22:00] consultation, that's 80 minutes a day of unpaid work. And at the time, the health minister. Well, I think it was Nicola Roxon said that while it might push the level B consultation to a level C, and that was fine if that happened, but in most consultations it doesn't. If you've got a 10 minute consultation and you add two minutes, you don't go from a B to a C, you stay a B. So essentially GPS were being asked to do work that they weren't going to be paid for. And in the current climate and the climate at that time, no one had time to do extra work. And the GP is the person who actually has least to benefit from the My Health Record because they have all the data in the desktop system already.
[00:22:40] So curating it and uploading it is of no real value to them personally. So it's good for hospitals, it's good for paramedics, it's good for occasional visiting GPs, if you're visiting somewhere else, but for your own regular GP, that data is already on his system. So being on the, My Health Record is of no [00:23:00] great value.
[00:23:01] So I think, they're not going to get uptake until they can sort that out. Basically. But I mean, it was also flawed in the sense that it was a very document based architecture that they used. So everything that gets uploaded is a like a PDF basically, and that gives it no flexibility. You can't do anything really clever with the data. All you can do is just look at the documents. You can't graph the data pathology results go up and they can't, you can't use that atomize data that you can do with ones that come into your local system. So it's not as flexible or as useful as it probably could have been. And they recognize that and they're in the process of redesigning it, but we'll wait and see what they come up with.
[00:23:49] Lorraine: [00:23:49] I mean, it's always an ongoing challenge with government dealing with new programs and things like that. Often the people that are making these announcements, you know, there's been no design behind it. It makes [00:24:00] it really difficult from a developer's point of view to actually understand what they're trying to achieve and how they're going to get there. And often, there's very little input into, into those specs. So from an industry point of view, I know MSAA spends a lot of time trying to, trying to encourage more discussion with, um, with developers.
[00:24:20] But I mean, we all We also see from a patient's point of view with regard to My Health Record, we think that, for example, our app that we're releasing in the next couple of months, Best Health, you know, that gives the patient a copy of the health summary, all of the key things that they would need to know.
[00:24:35] So if they are on holiday and need to see a doctor, they've got it there anyway. So it's probably more convenient. In that format.
[00:24:42] Frank: [00:24:42] Doesn't help if you're unconscious after a car accident to get into your phone. Yeah. Phone is probably lost in the crash. And, um, even if it wasn't, no one knows you pin
[00:24:57] Pete: [00:24:57] Well, [00:25:00] that's interesting. what about partners? There's all these other vendors that focus on a very niche kind of area and you guys are the central hub for information. Everyone wants to play with you, I guess, because that's how they engage with their target market and also, hopefully leverage some of the information there to ultimately improve patient outcomes. You've had a bit of a ramp up or at least I've seen work on your partner network and focus on that recently, so it seems like it's a big interest for you right now?
[00:25:28] Frank: [00:25:28] It's complicated. We've got something like 300 or 400 people who want to interface to was one way or another, or have or want to, and that was becoming unmanageable for a start. But then also some of the people who already were interfacing, were doing things in a slightly less than perfect way, I'll say. And so as part of the partner network, we've given them more controlled access. [00:26:00] So that they don't need to be, in a sense, hacking the database for their own purposes. We'll give them controlled access to what they need and keep them away from what they don't need. Because if you've got an online appointment booking system, you don't really need to be reading any clinical data at all. And then so the partner program tightened up and standardized things so that it was all much more secure because obviously patient privacy and the privacy act has changed and there's mandatory data breach notification and stuff all became real in the last five years or so. And so we had to make the program keep up with that.
[00:26:41] And as part of that, the tightening up of the security layer has that we've under done in the last couple of releases was necessary.
[00:26:50] Lorraine: [00:26:50] Yeah. I mean, we've always been open to Engaging with, people who have niche products that we don't do. I mean, we stick to our knitting, [00:27:00] we don't think we can be all things to all practices.
[00:27:02] I mean, that's the interesting thing about general practice. They're so diverse and the needs are all very different. the way they run their businesses is all very different. So you can't be all things to all people all the time. Is the old saying, so we don't object to that at all, but, we have to be very confident that we know exactly what those third parties are doing and why, how... Because we are allowing them to access that info. Well, not us, but the practice does, and we've got to do whatever we can as vendor to make sure that our customers don't get themselves into any tricky situations. So the more you can protect the customer from making a mistake, the better.
[00:27:43] Frank: [00:27:43] Yeah. I mean, it's a hard balance. In some ways. We have always looked at the, the data belong to the practice. So we've always given them the ability to access it and allow third parties to access it. But some of the third parties have sort of taken [00:28:00] advantage of that to do things that would never really intended.
[00:28:04] And the practice has not always known what was being done with the data. So as part of our practice partner program, we now have a contract where they have to agree not to use any data for purposes other than
[00:28:18] Lorraine: [00:28:18] other than what has
[00:28:19] Frank: [00:28:19] been signed up for.
[00:28:21] I mean, that's a small protection that it's just a signing a document, but at least we've got something in place. Whereas before we had nothing. And so. t's a difficult balance between giving people access to data and not giving them too much access
[00:28:39] Pete: [00:28:39] Need to find that right balance. so I surprisingly get asked, a fair bit, from, vendors that might have been developing something on how they can integrate with more practice management systems or can integrate better with the Is there, I can put some contact details of the, the partnership program, for best practice in the show notes, if that's would be good to you way.
[00:28:57] Yeah. Easy.
[00:28:58] Lorraine: [00:28:58] I'm surprised they [00:29:00] haven't already spoken to it.
[00:29:01] Pete: [00:29:01] So I think sometimes it's, you know, you get lost in the way and how to do things
[00:29:06] Lorraine: [00:29:06] It's funny. You know, you hear all these. Buzzwords, connectivity and, secure messaging and all that sort of stuff.
[00:29:12]I mean, we look back and over the last, you know, 25 plus years, we've been involved in every single, trial for discharge summaries from hospitals, for example. And a lot of those trials were great. They were so successful, but they never proceeded. the ecosystem for health is quite complex.
[00:29:28] And unless. If you're talking about connectivity and unless you get, a lot of them are big overseas vendors, that have hospital systems and and system administrators within the health department themselves. Unless there's a will there to proceed with that kind of thing. It makes it very difficult.
[00:29:44] And yet there's so much money spent in the public health system, tertiary care, when in actual fact most of the interaction on a day to day basis is in general practice
[00:29:55] Frank: [00:29:55] State based public hospitals seem to forget that general practice [00:30:00] exists basically.
[00:30:02] Yeah ok,
[00:30:02] Pete: [00:30:02] Well
[00:30:03] Lorraine: [00:30:03] it's not the remit, but
[00:30:05] Frank: [00:30:05] it's not, I mean, it's this sort of crazy idea we have of having a federal health system that runs primary care and then a state based system that runs tertiary care.
[00:30:15] And it's different in every state. They use different software, different systems. sometimes in the past, even between the hospitals in one state, they've used different systems and although that is gradually becoming less of an issue. Yeah.
[00:30:30] Lorraine: [00:30:30] I mean, we like to, we like it when there's a national approach and they do it once and everyone uses the same format.
[00:30:37] Frank: [00:30:37] Unfortunately, we're facing the safe script thing for the real time prescription monitoring where every state seems to be going to go at sign way and use a different method for tracking real time prescriptions. Let's
[00:30:51] Pete: [00:30:51] That makes things easy for you...
[00:30:52] Frank: [00:30:52] It doesn't make things easy at all! And it's just typical of the way governments seem to run in this [00:31:00] country.
[00:31:01] Lorraine: [00:31:01] It's really inefficient from that point of view. I look back in the mid nineties two of the largest pathology companies in Queensland, so we had Sullivan Nicolaides and QML, which is Queensland Medical Laboratory. They were really strong competitors, and there was a big divide between them, but they both got together and stumped up some cash and contacted the PMS software vendors, around at the time, including us at Medical Director and, said, we're going to do pathology results. And also we're going to standardize the way that requests are made. And so they came up, to their credit ,with the same format of the form. And then whenever any other lab from any other of the state would contact us, we'd say, this is the format for the form, you've got to use that. And so suddenly pathology, we're all using the same format, and it was so simple. Whereas radiology is all over the shop cause they all still have their own,
[00:31:56] Frank: [00:31:56] particularly in early nineties, most [00:32:00] radiology practices were just sub double digit numbers of radiologists and they didn't have the big conglomerates.
[00:32:08] Whereas the path labs have always been quite large and therefore, and there's not so many of them yet, and so it's easier to get them to come to some agreement.
[00:32:18] Lorraine: [00:32:18] So I suppose after all this experience in the industry, our advice is do at once. Do it well.
[00:32:26] Frank: [00:32:26] Sadly it's not happening though. Real time prescription monitoring is looking like being a bit of a nightmare.
[00:32:32] Lorraine: [00:32:32] And, and also PHNs, you know, they're all wanting data, but they're all ultimately collecting the same sort of data for the federal government. It'd be terrible if all they all decided they wanted it. It in a different format. It's kind of make it. The life of all software vendors, really difficult, you know, where it's the same information really.
[00:32:52] Frank: [00:32:52] We've seen a bit of that in New Zealand with the PHO's collecting data, right? Even
[00:32:58] Lorraine: [00:32:58] though they're all collecting
[00:32:59] Frank: [00:32:59] the same [00:33:00] stuff, but they all have different formats and different ways of transmitting it.
[00:33:05] Lorraine: [00:33:05] And the overhead, from our point of view is quite costly. So you don't want to do that.
[00:33:10] There's no need to do that.
[00:33:11]Pete: [00:33:11] You're talking earlier about Government institutions and associations looking at the ADHA, the Australian Digital Health Agency, and putting it around the other way. what are the things that practice management systems can be doing to be helping the ADHA in their big quest for the big buzzword interoperability.
[00:33:28] Frank: [00:33:28] They have made some, some strides towards that, especially in the last couple of years. And I know Tim Kelsey made secure messaging one of his priorities and we have been involved in the trials that they did one or two years ago which have resulted now in a further round of funding.
[00:33:47] For all of the vendors to implement the new work. And so there is progress being made. I guess my thought though is secure messaging really the best [00:34:00] way to be doing it. And should we be looking to something like the. Prescription exchanges where they use web services to put documents into a central repository, which then can be accessed by different people.
[00:34:13] So say a referral to a specialist rather than going point to point with secure messaging could be sent centrally and then downloaded by the specialist or by one of a group of specialists that the patient decides is the one that they want to go to. Yeah. I mean, secure messaging is coming. But whether it's what we really want, I'm not entirely certain.
[00:34:37] Lorraine: [00:34:37] The directory is always been the sticking point because they were, there was no national directory to make sure you
[00:34:44] Frank: [00:34:44] Every secure messaging company has it's owndirectory, and they didn't communicate. It makes
[00:34:49] Pete: [00:34:49] it hard to, to connect with the whole point. So
[00:34:53] Lorraine: [00:34:53] that's work being You know, I'd done now district that a federated one.
[00:34:58] That's good. That's
[00:34:58] Pete: [00:34:58] Good. Look, lastly, [00:35:00] to wrap things up, I'm looking at what you guys are working on because there's a lot of people out there working at the best practice office here on your new thing coming up and, I'm glad, that you mentioned cloud before because Titanium has been on your website for a long time.
[00:35:14] Frank: [00:35:14] It's
[00:35:14] Pete: [00:35:14] been, there's been a lot
[00:35:15] Frank: [00:35:15] of construction for a long time.
[00:35:18] Pete: [00:35:18] So it's an interesting looking at cloud in practice management land. It's, is that a deliberate strategy from you guys of kind of seeing how things play out or understanding what the market needs, or is it just about building like the right thing for
[00:35:33] Frank: [00:35:33] the market
[00:35:34] I think there are a couple of things. One is that when we started the titanium project, we weren't really designing it for the cloud. We were designing it as a web application, but not specifically as a cloud application. And so about two years into the project, we kind of changed direction of it.
[00:35:53] And as I said, the security and the, sort of concerns in the cloud are quite different to what we [00:36:00] were originally doing. So it changed direction halfway through, but the other issue that's holding it back a bit is the sheeramount of work that needs to be done to be able to fully replace Best Practice. It's a really rich, functional piece of software, which has taken ultimately nearly 30 years to get to where it is if you count the Medical Director time as being a sort of
[00:36:25] Lorraine: [00:36:25] precursor first run.
[00:36:30] Frank: [00:36:30] So just getting that functionality takes time. Unfortunately practices in different ways use every bit of functionality that we've given them because we put it in there for a purpose. And we've seen that the practice needs this or that, and so we've put it in and we can't take it away from them.
[00:36:50] So getting to that level of richness where we can actually move people from BP premiere to Titanium is just taking a long time. We [00:37:00] also, in a way, got distracted a bit when we took over the Houston business and took over vip.net and Ultimately bought BP allied, which used to be called My Practice because there was a lot of catch up work that needed to be done on those products to get them to our level of quality.
[00:37:20] And. We've done that, we've achieved that, but that did divert resources for a couple of years into work that we hadn't originally anticipated doing. And I mean, sure, we gained some resources when we took over Houston, but, it was a bit of a diversion for a time. Ultimately, those products are all going to be replaced by Titanium, so we have to include New Zealand, we have to include Allied all into the Titanium, work load, which again, adds time. So it's, it's just slow.
[00:37:53] Pete: [00:37:53] So that, that'll, that'll cover tran Tas...
[00:37:57] Frank: [00:37:57] yeah.
[00:37:57] Pete: [00:37:57] Yeah.
[00:37:59] Across the [00:38:00] dutch.
[00:38:00] Lorraine: [00:38:00] Yeah,
[00:38:01] Frank: [00:38:01] that's right. I mean, yeah, we pretty,
[00:38:03] Pete: [00:38:03] that's a valeant effort in itself. Just covering to
[00:38:06] Frank: [00:38:06] aim is ultimately to only have one product, but through configuration and preferences and whatnot, we can, make it appeal to GPs,Allied Health and Specialists.
[00:38:18] And we do see that some of the allied health may need a lot less functionality than the GP practices use. So it may be that we actually release a sort of Ttitanium for allied health before we release titanium for GPs.
[00:38:36] Pete: [00:38:36] That's
[00:38:37] Frank: [00:38:37] a
[00:38:41] Pete: [00:38:41] valeant effort in itself just to be able to do, to cover all of those needs.
[00:38:47] It's, it can stretch, you know, many kilometers wide and you only get it a couple of centimeters date in covering all the needs of not just GPS, which like you say, 30 years of, of, of expertise. That's, that's. That's why [00:39:00] you are where you are. Um, but to build it again from scratch and then include specialists in
[00:39:05] Frank: [00:39:05] an allied The other issue is that during the time that we're working on it, we still have to maintain the existing products because they, people are using them.
[00:39:18] Things are changing at have asking for work to be done on the secure messaging and so on. And we can't stop doing that. And so BP premiere is getting richer and titanium is, the workload is getting bigger with every passing day. So. That is also a bit of an issue. Amazing.
[00:39:38] Pete: [00:39:38] Well, look, I, I'm not going to keep you too much longer from all of that work that does need to be done. before we bail, are there any parting thoughts or any kind of final on or things that we didn't cover off?
[00:39:47] Frank: [00:39:47] Um, we didn't talk much about the app. I don't know if
[00:39:51] Pete: [00:39:51] you tell me more about the, Cause you've got a patient app that's is being worked on.
[00:39:56] Frank: [00:39:56] It's actually been out
[00:39:57] Lorraine: [00:39:57] trials for you
[00:39:59] Frank: [00:39:59] for months [00:40:00] in a small number of sites for user testing. And it's proven to be quite popular in those sites. So we're actually looking at a full launch in October, the first release of the app includes It's all about communication between the practice and the patient.
[00:40:22] We see that as being a bit of a future direction and the practices and patients will, um, be more easily able to communicate. So the way we've designed it. For example, um, when a GP checks a result, they can directly from the checking results screen from the inbox, they can send a message to the app, which goes securely, and the patient will get a notification on their phone, but they will have to have the pin numbers and whatnot not to get in and read the message.
[00:40:55] So it's much more secure than SMS. And so we'd be using it for [00:41:00] appointment reminders, we can use it for actual reminders for things like that. cervical screening and what not. We can use it to inform people of their results. We can use it to send documents and in particular health fact sheets, patient education material, appointment reminders.
[00:41:21] Ultimately though, we're aiming to do things like, prescription ordering. So repeat prescriptions. Requests for specialist referrals. If the people don't really need to be seen, if it's a routine annual ophthalmology review or something, and it'll be optional for practices as to how far they take those things, but it gives them the, the option.
[00:41:49] So it's another option in communicating. I mean, people don't want to send letters anymore because it's way more expensive than sending an SMS and the patient app, the [00:42:00] communications costs from it will be much less than even SMS. So it's giving practices a better way of of doing things and a more secure way
[00:42:11] Pete: [00:42:11] Are practices asking for an app because there's a few apps out there that do, I guess a similar thing on the, surface of what you've described.
[00:42:21] Frank: [00:42:21] They do, we think this kind of rolls it all into one easy app. I mean, ultimately it will. Well, it will allow you to make your online appointment through the practices online appointment system. It'll be a kind of, you get a message from the GP to say, I want to talk to you about your results. You can immediately on the same app.
[00:42:46] Make your appointment. And then you get the reminder come into your app a day later. Whenever the picks appointments do, you can check in at the front desk. Again, if the practice don't want everyone to be physically seen by the receptionist. And [00:43:00] some practices insist on that. There are others that use checkin kiosks.
[00:43:04] So this will essentially replace a checking kiosk, cause you can use it, the app to check if you have
[00:43:11] Lorraine: [00:43:11] it doesn't restrict patients from. Seeing more than one practice. And the reality is, is that, you know, a lot of people don't always have, you know, they might have a family GP, but they might also use a, you know, bulk-billing clinic when they go and get a sick certificate or something like that.
[00:43:27] Frank: [00:43:27] some people have one in town, me at work, of course, and then one out the
[00:43:32] Lorraine: [00:43:32] home. So, so if they're using, if those surgeries are using best practice in theoretically, um, the, the patient will be able to register it both, but nominate one as their main one, but then they'll consolidate anything that's been, you know, if, if they've been diagnosed with something at one, it'll actually update their app.
[00:43:52] Frank: [00:43:52] Ultimately, when Titanium finally makes it out into the real world, you could have your physio and your [00:44:00] podiatrist everyone on the way. Can all be in the one app, so you don't need an app for the physio and an app for the ophthalmologist and two apps for the General Practices, which was originally when we were discussing the, the app that was an option was for us to sort of white label it so that the practice could put a sign in logo on the front and every practice could have an app that interfaced.
[00:44:23] But when we thought about it and how people might use it, it made more sense to have just one app with our branding on it. And allow that to have multiple surgeries to connect.
[00:44:35] Pete: [00:44:35] And that'll be a bit of a shift for you too, because if it's going to be something that's, that's patient facing with your branding on it, that's new for you guys to
[00:44:44] Frank: [00:44:44] It's new for us
[00:44:46] I mean, we've discussed at length the issues of supporting patients because in the past we've only ever provided support to. And practices and users. So the implications of having [00:45:00] potentially 12 million people, um, using the app, that won't happen, but even 1 million, it's. If they have a minor problem, it's a lot of support.
[00:45:11] So that's why we did a sort of restricted release before doing the full release and to try and make certain that there's no issues that are going to come back and become an unmanageable problem. And at the moment it's looking good. So we're happy to release it in October
[00:45:31] Pete: [00:45:31] So much happening. A lot of new innovations a lot of, history there too, so much to, to digest. I'll put some links and some information in the show notes of the podcast. Frank and Lorraine, thank you so much for your
[00:45:44] Frank: [00:45:44] Thank you
[00:45:44] Pete: [00:45:44]
[00:45:46] Thanks for listening to talking HealthTech. My name Peter Birch. Go do some stuff on our socials, visit the website, share it with some people and give us a nice review and a five star rating because it all helps to spread the word and get people talking. Until next time I'm outta here.