Bespoke Surgical Institute Deep Health Clinical Analysis Technology Platform

Centre to the capture, storage, processing and analysis of Patient Personal Data and medical history is a practice management technology platform known as Bespoke Surgical Institute Deep Health (BSIDH). A Patient Data Master File (PDMF) is created on BSIDH which serves as a Single Electronic Health Record (SEHR). The system serves multiple purposes which include the SEHR and the analyses of anonymised patient data such as clinical diagnoses and co-morbidities, using advanced Artificial Intelligence algorithms to determine Value Based Medical outcomes, also known as Value Based Care (VBC). VBC cannot be achieved without the processing and analysis of anonymised patient personal (demographic) and medical data.

Only Healthcare Practitioners licensed to use BSIDH can access patient data, but cannot randomly or ad-hoc access a PMDF that is not their own Patient or, that has not been directly referred to them by the primary Specialist for a second, professional opinion or a diagnoses in another area of surgical expertise.

Infrastructure of a typical small to medium size surgical practice

This will consist of, at a minimum, a practice Receptionist, an Administration expert, a Patient Care Associate and a Finance / Billing expert including the Specialist. In large surgical practices there will be multiple people performing these functions. For reasons of annual leave, maternity leave, sick leave and vacancies, a single person can perform more than one role in a practice.

Patient Process Flow through a Medical Practice

The Patient data is provided at first visit (consult). Patient data is captured electronically on the BSIDH Practice Management System. This can be achieved in one of three ways – The Patient can:

1. visit the practice’s web page, book a consultation and in the comfort of their own home, provide their personal data, medical history and submit any supporting documents such as ID, GP referral letter, medical aid details and medical reports/tests,
2. arrive at the practice and provide the same information as point i), but using an electronic tablet connected to the BSIDH system via wifi. In this instance, the Receptionist will request the supporting documentation and scan it into the BSIDH system or,
3. provide the same information as above but in the traditional manner of completing a form with pen and paper

In any of the three processes set out above, the Medical Receptionist will be the first to view and access the data to check for accuracy and completeness before confirming the consult in the BSIDH Practice Management System and creating the SEHR Patient Data Master File (PDMF) in BSIDH.

If the Patient has no medical aid cover, the consultation fee is paid upfront and payment can be done via cash or credit card. The Patient's data is used (processed) by the practice’s Medical Receptionist to complete the payment transaction. An invoice is provided for the service fee.

Next User is the Specialist who accesses the PMDF on the BSIDH system prior to consultation. After consult, the Specialist will update the Patient medical history and capture the clinical notes on BSIDH, based on their clinical diagnoses. He/she will record the ICD10 code (for Medical Aid) and the treatment protocol including the procedure codes (Not all treatment protocols require a surgical intervention or hospital admission). After updating the Patient records, the Specialist closes the PMDF.

Patient Care Associate

The Patient Care Associate accesses the PDMF to view the Specialist’s treatment/procedure instructions and acts on them accordingly. The Patient Care Associate will update the PMDF with relevant data related to acting on the Specialist’s instructions such as dates and times (E.g Hospital Admission). The Patient Care Associate will add the Patient to the Specialist’s theatre list.

Practice Administrator

The Practice Administrator will access the PDMF to arrange any tests the Specialist requires including providing the Patient with referral notes to see other medical specialists or Allied Healthcare Workers such as Dieticians, Physiotherapist, or other surgical specialists. The Practice Administrator may also provide the patient with supporting documentation for the Patient’s medical aid to obtain pre-hospital authorisation in the event of a procedure requiring hospitalisation.

Finance/Accounting Department

Second to last, the Finance/Accounting Department will access the PMDF to complete the billing process by checking that all ICD10 codes and procedure codes have been correctly captured and then submit the Surgeon’s account to the Patient’s medical aid (if applicable), for payment.

BSIDH System

Lastly, as BSIDH is a third-party service provider to the medical practice, the patient data is stored, processed, and analysed within the secure confines of the BSIDH system. No external or unaffiliated parties have access to any practice or patient records within the BSIDH cloud environment.

Sharing of data to Third Party Service Providers

Third Party Service Providers

The Patient's personal and medical data is shared across four different Third Party Service Providers platforms at any given time:

1. In need, the Specialist will compile a medical report of his/her conclusions and send this report back to the referring GP for his/her practice records and/or,

2. The Patient's personal and medical data will be shared with multi-disciplinary medical teams such as Dieticians, Physios, and other surgical specialists who will access the PMDF directly from the BSIDH PMDF and/or,

3. The practice Finance/Accounts Admin will send the patient's personal data relating to the consult and cost of treatment to the Patient's medical aid (where applicable). It must be noted that the majority of Specialist Surgeons utilize a medical billing system such as Vericlaim/GoodX (or similar) who in turn process the data for onwards submission to the Patient's medical aid for reimbursement. Vericlaim/GoodX (or similar) is a Third-Party intermediary between the surgical practice and the medical aid, and the medical practice is not responsible for what Vericlaim/GoodX (or similar) does with the Patient data once the Surgeon's account has been submitted for payment, and/or,

4. The Bespoke Surgical Institute Deep Health system is a software system that receives and analyses clinical data. The software system is provided by a technology Third Party called Data4 (Pty) Ltd for which the medical practice pays a monthly license fee. A Service Level Agreement exists between Data4 (Pty) Ltd and BSIDH and, between BSIDH and their Customer (the surgical practice). Included in the respective SLA's is each party's obligations and responsibilities in terms of protection of personal information in accordance with POPI and PIA.

Bespoke Surgical Institute Deep Health Technology Platform

Value Based Care: Principle and processes

Centre to the capture, storage, processing, and analysis of Patient Personal Data and medical history is a practice management technology platform titled Bespoke Surgical Institute Deep Health (BSIDH). A Patient Data Master File (PDMF) is created on BSIDH, which serves as a Single Electronic Health Record (SEHR) for system Users of BSIDH. The system serves multiple purposes, which include the SEHR and the analyses of anonymized patient data such as clinical diagnoses, pathology, histology, and co-morbidities.

BSIDH uses advanced Artificial Intelligence algorithms to determine Value Based Medical outcomes, also known as Value Based Care (VBC). VBC cannot be achieved without the processing and analysis of anonymized patient personal (demographic) and medical data.

Only Healthcare Practitioners licensed to use BSIDH can access patient data but cannot randomly or ad-hoc access a PDMF that is not their own Patient or that has not been directly referred to them by the primary Specialist for a second or professional opinion, or a diagnosis in another area of surgical expertise.

Infrastructure of a typical small to medium size surgical practice

Roles and Functions

This will consist of, at a minimum, a practice Receptionist, an Administration expert, a Patient Care Associate, and a Finance/Billing expert including the Specialist. In large surgical practices, there will be multiple people performing these functions. For reasons of annual leave, maternity leave, sick leave, and vacancies, a single person can perform more than one role in a practice.

Patient Process Flow through a Medical Practice

Data Capture

The Patient data is provided at first visit (consult). Patient data is captured electronically on the BSIDH System. This can be achieved in one of three ways – The Patient can:

1. Visit the practice’s web page, book a consultation and in the comfort of their own home, provide their personal data, medical history, and submit any supporting documents such as ID, GP referral letter, medical aid details, and medical reports/tests.

2. Arrive at the practice and provide the same information as point i), but using an electronic tablet connected to the BSIDH system via Wi-Fi. In this instance, the receptionist will request the supporting documentation and scan it into the BSIDH system.

3. Provide the same information as above but in the traditional manner of completing a form with pen and paper.

In any of the three processes set out above, the Medical Receptionist will be the first to view and access the data to check for accuracy and completeness before confirming the consult in the BSIDH Practice Management System and creating the SEHR Patient Data Master File (PDMF) in BSIDH.

Payment and Invoice

If the Patient has no medical aid cover, the consultation fee is paid upfront and payment can be done via cash or credit card. The Patient's data is used (processed) by the practice’s Medical Receptionist to complete the payment transaction. An invoice is provided for the service fee.

Next User is the Specialist who accesses the PMDF on the BSIDH system prior to consultation. After the consult, the Specialist will update the Patient's medical history and capture the clinical notes on BSIDH, based on their clinical diagnoses. He/she will record the ICD10 code (for Medical Aid) and the treatment protocol including the procedure codes (Not all treatment protocols require a surgical intervention or hospital admission). After updating the Patient records, the Specialist closes the PMDF.

Patient Care Associate

The Patient Care Associate accesses the PDMF to view the Specialist's treatment/procedure instructions and acts on them accordingly. The Patient Care Associate will update the PMDF with relevant data related to acting on the Specialist's instructions such as dates and times (E.g Hospital Admission). The Patient Care Associate will add the Patient to the Specialist's theatre list.

Practice Administrator

The Practice Administrator will access the PDMF to arrange any tests the Specialist requires, including providing the Patient with referral notes to see other medical specialists such as Dieticians, Physiotherapists, or other surgical specialists. The Practice Administrator may also provide the patient with supporting documentation for the Patient's medical aid to obtain pre-hospital authorization in the event of a procedure requiring hospitalization.

Finance/Accounting Department

Second to last, the Finance/Accounting Department will access the PMDF to complete the billing process by checking that all ICD10 codes and procedure codes have been correctly captured and then submit the Surgeon's account to the Patient's medical aid (if applicable) for payment.

BSIDH as a Third Party Service Provider

Lastly, as BSIDH is a third-party service provider to the medical practice, the patient data is stored, processed, and analyzed here.

The Patient's personal and medical data is shared across four different Third Party Service Providers platforms at any given time:

1. In need, the Specialist will compile a medical report of their conclusions and send this report back to the referring GP for his/her practice records and/or.

2. The Patient's personal and medical data will be shared with multi-disciplinary medical teams such as Dieticians, Physios, and other surgical specialists who will access the PMDF directly from the BSIDH PMDF and/or.

3. The practice Finance/Accounts Admin will send the patient's personal data relating to the consult and cost of treatment to the Patient's medical aid (where applicable). It must be noted that the greater majority of Specialist Surgeons utilize a medical billing system known as Vericlaim (or similar) who in turn process the data for onwards submission to the Patient's medical aid for reimbursement. Vericlaim (or similar) is a Third Party intermediary between the medial practice and the medical aid, and the medical practice is not responsible for what Vericlaim (or similar) does with the Patient data once the Surgeon's account has been submitted for payment, and/or.

4. The Bespoke Surgical Institute Deep Health system is a practice management software system provided by a technology Third Party called Data4 (Pty) Ltd for which the medical practice pays a monthly license fee. A Service Level Agreement is in place between Data4 (Pty) Ltd and BSIDH and, between BSIDH and their Customer (the medical practice). Included in the two SLA's is each party's obligations and responsibilities in terms of protection of personal information in accordance with POPI and PIA.