Cancer patients often face delays and fragmented care due to limited access to multidisciplinary expertise, especially outside major cities. Tumour board consultations can be logistically difficult, and many patients lack timely second opinions or personalized guidance. As a result, wealthier patients seek care abroad, deepening inequities.
To ensure equitable access to multidisciplinary oncology expertise and evidence-based clinical guidance, Shemha Health launched PrOPA (Precision Oncology Patient Advice) in 2023 as a secure, AI-driven tele-oncology platform. It allows structured case submissions, virtual tumour board reviews and integrated decision support. Initial uptake was bolstered by national digital health strategies and strong professional engagement, particularly through the Bulgarian Joint Cancer Network (BJCN).
PrOPA functions as an advanced tele-oncology system designed to facilitate multidisciplinary collaboration by virtually connecting over 20 oncology specialists spanning all major clinical domains. Central to the platform is the AI–Ambient Patient-Clinical Intelligence (APCI) module, an standalone large language model–based clinical decision support engine enhanced by a modified GRADE approach (grading of recommendations assessment, development and evaluation) for clinical practice implementation. This module integrates patient-specific clinical data with evidence from international medical literature to generate guideline-aligned diagnostic and treatment recommendations. The platform serves as a virtual multidisciplinary tumour board, enabling timely, equitable and evidence-based oncology decision-making regardless of geographical location.
The AI-ambient patient-clinical intelligence (APCI) system is the clinical reasoning core of the PrOPA tele-oncology platform, designed to assist practicing oncologists, multidisciplinary tumour boards (MDTs), and oncology institutions. It operates using structured PICO-based (population, intervention, comparator, outcome) clinical questions and parameterized evidence datasets curated from systematic reviews in global medical literature. APCI analyzes patient-specific clinical metadata – such as tumour type, disease stage and comorbidities – against an extensive library of international guidelines and scientific evidence, generating real-time, evidence-based diagnostic insights and personalized treatment pathways.
Patients or their treating physicians can securely upload structured or unstructured medical records to the PrOPA platform, or have data automatically extracted from hospital health information systems. This creates a structured digital case file, which is then assigned to a lead consultant responsible for convening an MDT, including surgical oncologists, radiologists, medical oncologists and others, to collaboratively develop clinical recommendations. The platform integrates video conferencing, secure messaging and scheduling tools, enabling timely, virtual MDT consultations while ensuring compliance, consistency and quality in decision-making across care settings.
Since its launch in Bulgaria, PrOPA has been scientifically piloted under a formal clinical validation protocol and is now undergoing multicenter evaluation in Cyprus, Portugal, India and beyond. Its performance is benchmarked against real-world MDT decisions using anonymized patient data, ensuring the highest standards of evidence-based oncology support.
Enablers: Important enablers included strong support from the oncology community and innovators (Governance). A particularly influential element was the active engagement of the oncology specialist network behind BJCN, who not only served as consulting experts on the PrOPA platform but also helped raise visibility by presenting it at a BJCN educational event focused on the future of tele-oncology. This significantly boosted awareness among healthcare professionals. The COVID-19 pandemic also played a role, as it had already normalized virtual consultations for both doctors and patients, lowering adoption barriers. On the technical side, the prevalence of high-speed internet and smartphones in Bulgaria made the telehealth infrastructure feasible. Moreover, alignment with national and EU digital health priorities (the 2023 MoU on tele-oncology and the EBCP’s push for digital care) creating an environment receptive to PrOPA’s value.
Barriers: The implementation faced a set of multifaceted challenges. Integrating the platform into existing healthcare workflows necessitated a shift in clinical culture, with initial skepticism from some healthcare professionals regarding the reliability of AI-generated recommendations and a general reluctance to transition from traditional in-person consultations to telemedical formats (Resources). From a regulatory perspective, the initiative necessitated ethical and legal adaptations, underpinned by a transparent technical framework to ensure full compliance with data protection regulations (Governance) as well as the synchronization between the EU MDR and the EU AI Act. Furthermore, reimbursement mechanisms for virtual oncology consultations or upcoming AI-driven ambient instruments for informative clinical decision remain underdeveloped, as such services are not yet systematically covered by insurers, posing a barrier to wider adoption and scalability (Funding).
PrOPA has received formal endorsements from the BJCN and has been well received by the Organization of European Cancer Institutes (OECI) and the European School of Oncology.
Next-generation platforms like PrOPA, functioning as advanced clinical decision support systems, enable predictive modelling of treatment outcomes and the integration of genomic data for truly personalized oncology care. With CE marking and regulatory approval, PrOPA can be formally adopted into healthcare systems supporting the transition toward value-based cancer care. Interest is growing in deploying PrOPA for regional tumour boards, allowing smaller hospitals to consult centralized experts, enhancing access and equity. This AI-powered, GRADE-enhanced system offers strong cross-border scalability and reinforces multidisciplinary collaboration by embedding standardized, evidence-based methodologies into comprehensive cancer infrastructures. This ensures global impact in precision oncology, particularly in underserved regions facing workforce shortages and limited access to experienced oncology specialists.
Lessons learned: The PrOPA platform illustrates how innovation can streamline and personalize patient care pathways while enhancing consistency, transparency and quality in oncology services. It further highlights that success relies heavily on strong engagement from trusted national oncology organizations, like BJCN, which helped establish credibility and foster professional adoption. At the same time, the case underscores how lagging legal and reimbursement frameworks can hinder full integration if they do not evolve in step with digital oncology models. Aligned with the EU Cancer Mission’s vision of equitable knowledge exchange and standardized care, platforms like PrOPA are well-positioned to become foundational components of future oncology care pathways.
