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.
