Best Practice hints at a transformational plan

10 minute read

Best Practice is returning to the idea of building a cloud version of its market-dominant GP practice management software in Australia, and it hasn’t just got GPs in its sights.

In a cheeky press release last week, our largest GP PMS vendor, Best Practice, gave its strongest indication in years that it will build a cloud version of its Australian market-dominant, but currently server-bound, GP software Best Practice Premiere.

However, its plans seem to be much bigger than just building a local GP cloud PMS based on Premiere. The company is also intent on developing a single cloud platform that encompasses GPs, allied health and specialists, with some links into emerging cloud-based aged care platforms.

Best Practice’s product suite includes allied, GP and specialist applications in Australia and New Zealand.

The press release, titled Introducing BP Omni, was mostly announcing the beta launch of BP’s first Saas clinical software product in New Zealand, which has been built, initially at least, for the allied health market.

But the marketing team at BP added an all-important segue to its announcement:

“Further development of features and integrations will see BP Omni [initially an allied health cloud platform] become available to other allied health disciplines, general practitioners, and specialists both within New Zealand and Australia in the future,” the statement read.

When contacted for clarification, BP Chief Product Officer, Danielle Bancroft, confirmed that Omi was the beginning of a much bigger plan BP had in play to build a single cloud platform to service GPs, allied professionals and specialists.

It will also connect into evolving cloud platforms in aged care such as those being developed by Telstra Health.

Ms Bancroft told The Medical Republic that a major pillar of the plan was the Halo Connect project which is aimed at creating a common FHIR-based API platform which could be used by all the current application integrations into the server bound BP Premiere product, to talk to the cloud version of BP when it became available.

In this way, all of BP’s integrators, and its BP Premiere customers would potentially have a much smoother path to transitioning to the cloud, said Bancroft.

BP is a major shareholder of Halo Connect.

Bancroft would not give a date when a cloud version of BP catering to allied professionals, specialists and GPs might be available in Australia, but she gave a clear indication that the program of work in the company was in a firm line from the New Zealand Omni allied health launch all the way through to a version of the software that serves each sector on one cloud based platform.

Omni, according to the BP press release, is the new name for project Titanium, the original project undertaken by BP more than five years ago to develop a cloud version of the BP Premier product in Australia.

BP originally launched its Titanium program, in part to respond to new cloud-based competitors who were emerging in the market after 2016.

At this time its major GP competitor Medical Director was in the early stages of launching its cloud product called Helix, and to two independent new businesses, MediRecords and Clinic to Cloud, had built ground-up cloud PMS systems for general practices and specialists respectively.

Genie, which dominated the specialist sector soon started developing its own cloud product for that market, known as Gentu.

Clinic to Cloud pursued the specialist market in a play against major incumbent Genie Solutions, but once Genie launched its own cloud version several years ago with an integration platform strategy like the one being pursued now by BP with Halo Connect, Clinic to Clouds growth slowed significantly.

Not long after, the company started experiencing financial issues and slowed down its development program.

The Gentu platform allowed Genie customers to stay on their old server product if they wished and transition to the cloud product when it suited them. It also provided an easy way for product integrations to talk to the new cloud product without having to build out completely new cloud-architected versions of their applications.

Building a cloud product for specialists was in theory easier than building one for GPs because the number of integrations required was a lot less than in the GP market, which had a lot more interfaces with the health system to deal with. The specialist products also required less overall in functionality for their clients.

MediRecords launched its cloud-based PMS as early as 2016, but together with Helix it became apparent within two years that both products were launched too far ahead of a market in which no major application integrations – especially vital integrations like payments and secure messaging – were built to talk to cloud systems (payments via Medicare are now all cloud enabled).

For both MediRecords and Helix, the number of integrations using old server bound technology meant that to meet the integration functionality that was being delivered by the server versions of BP and Medical Director each would have to build bespoke and backwards facing integrations into old technology at a crippling expense.

As a result, GPs did not adopt either product in significant numbers and the major server bound incumbent products of Medical Director and BP continued to dominate the market.

This dynamic was reinforced by factors such as state governments contracting long-term with secure messaging vendors to help create hospital connectivity to the old server-bound GP technology and the federal government doing the same thing for data contracts with PHNs and for the delivery of data for GP QPIP.

MediRecords pivoted its business model and product development and started developing and selling its platform successfully into environments where there was a business model being pursued which focussed significantly on delivering care virtually through the cloud. It ended up securing major contracts with the Queensland government, the Department of Defence, rapidly growing private groups delivering alternative virtual care models such as Doctors on Demand and My Emergency Doctor, and several LHDs seeking to establish virtual ED and outpatient services.

Telstra, which bought Medical Director for $340m in late 2021, did not pivot with MediRecords into the emerging virtual care provider space. Instead, it planned on using Helix as a basis for launching into the UK GP sector via contracts with various regional NHS funded primary care organisations.

In the meantime, BP pursued a strategy of market share acquisition and dominance in Australia over its main traditional rival Medical Director by offering highly competitive pricing, a simpler UI and focusing a lot on customer service.

Recent survey data coming out of some key PHNs in Australia suggest that BP might have a built its share of the GP PMS market in the past few years to more than 65%, with Medical Director down to as little as 25% or less overall.

When Medical Director was acquired by private equity firm Affinity in March 2016 for $155m, it was estimated that it had a share equal to BP at the time – something like 45%.

If BP’s market position is actually this dominant, then its plan to build out its New Zealand allied health Omni platform into a platform serving allied, specialist and GPs might be perfectly timed.

Despite most GP owners not really seeing the value in a cloud product so far, from a marketing perspective it’s an ideal time to be telling all their GP customers that the cloud version is coming anyway.

Both GPs and hospital networks are not funded to make their systems connect properly in the current ecosystem so no matter how much talk there is about building out secure messaging networks from hospitals to GPs for things like eReferrals, the focus of each group is not on getting connectivity between sectors right.

GPs don’t have the time or money to worry about the problem, and it is not a priority for hospitals either at the end of the day given their funding regime.

Although cloud products offer GPs more security, will connect much better in a modern system to other providers to share data, and, after getting rid of all their hardware and maintenance contracts to run such hardware, might end up cheaper to run, owners don’t want any hassle with integrations that don’t work properly or don’t connect to the cloud yet.

They also don’t want the hassle and time of having to switch over systems and teach their doctors a new system, potentially with new UIs and processes.

But the current federal government and the Department of Health and Aged Care (DoHAC) are sending clear signals to the market that this situation won’t be tolerated much longer across the broader health ecosystem.

DoHAC has told software vendors like BP and Medical Director (Telstra Health) that it is working on introducing legislation which will have similar carrot and stick features to the US 21st Century Cures Act legislation, which eventually transformed most of the US medical software platform sector to being FHIR and open API based in that country, with a goal of ensuring that patient data would be shared seamlessly and securely across the web.

BP’s timing in the plan it has outlined to build an all-encompassing primary, specialist and allied are product, feels like it is being in part driven to align with government’s emerging new position on healthcare data sharing in Australia. It knows it is eventually going to be forced in some way to a more interoperable offering by the government.

BP probably also now sees the inevitability that all healthcare systems around the world are moving to cloud-based system data sharing.

DoHAC has indicated it will take 12 months to two years before it introduces legislation.

Based on BP’s loose timetable, and the amount of work it still needs to do to get a cloud product up in general practice in Australia, it sounds like it is aiming to have something in market in Australia by 2025.

That timetable would be helped a lot if Halo Connect can have a transitional API platform interface up for all those applications that can’t afford initially to rearchitect their products for the cloud.

Both align to the government’s timetable.

If all this happens, then transformation in healthcare data sharing across the entire Australian healthcare system will likely commence in earnest.

The government will have mandated it both for software vendors, and possibly more importantly, providers themselves, the dominant market player in Australia will be offering its customers a path to cloud, and via Halo Connect a smoother means to make that transition.

And almost certainly, the 100-pound gorilla in digital health that is Telstra health will respond by building out its Helix product to meet the new BP offering head on.

In this circumstance, some significant changes to the market are likely to start occurring.

One of the most significant would be that the secure messaging sector, dominated today by Healthlink (owned by Irish group ClanWilliam), New Zealand based Bpac and Queensland based Medical Objects, would understand that while their business models would not disappear overnight, the end was coming.

The ideal future system state would be that all the major medical platform software in Australia from GP, specialist and allied care patient management products to hospital EMRs to pathology systems, would all be FHIR, and open API enabled to share data across the web securely, as is currently the case in the US.

If that state can be reached in Australia, secure messaging will not be a technology anyone uses. Neither would the fax.

Theoretically most major hospitals would be connected far more seamlessly to the primary care sector for vital information sharing of discharge information and eReferrals and if BP and Telstra get products up for allied and aged care then they would be better connected to community and aged care as well.

If all this is to happen the federal government will need to put equal pressure on the hospital sector to comply with new legislation for modern data sharing protocols and standards as much as they are starting to put that pressure on our major primary care software vendors.

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