Name: Toby

Bio: As Allscripts Chief Medical Officer, International, Toby helps establish long-term clinical strategy and short-term priorities for Allscripts solutions. Additionally, he is responsible for executive-level and physician sales support. He is also the single point of accountability for customer experience, business performance and solutions roadmap and the forward looking strategy of the clinical solutions for International Markets. He is also the Patient Safety Officer for Allscripts. Previously, Toby was Medical Director of Information Technology at The Methodist Hospital (Houston, TX), a long-time Allscripts client, and Vice President of Medical Informatics at Physia Corporation. Prior to these positions, Toby has had a long career in private practice as an Infectious Disease physician.

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    Global Healthcare Megatrends: Technical landscape

    May 15th, 2014

    There are more than 7 billion people on the planet today. Our growing global population has triggered some of the biggest healthcare challenges we’ll ever face. Listening to clients in Australia, Canada, Singapore, United Kingdom and United States, I believe many of these issues are universal. This is the fourth post in a five-part series that explores the clinical, population health, financial, regulatory and technical challenges we share as a global healthcare community.

    Once they move from paper to electronic, healthcare organizations aren’t looking back. Both providers and patients are embracing technology as never before:

    Electronic Medical Record (EMR) adoption steadily rising. A recent whitepaper estimates continued improvements around the world. It estimates Australia to be among the leaders at a 78% adoption rate, while the United States has the highest projected growth rate to 62%.

    Patients are more receptive to the benefits of technology. A recent global study finds that patient attitude toward healthcare technology is overwhelmingly positive. Eight out of 10 respondents are willing to anonymously share personal health data to lower healthcare costs.

    We’ll continue to see more and more IT systems worldwide, which generates universal questions. Are they effectively sharing data? Can we improve interfaces and messaging? How do we get to a single virtual patient record?

    Because, as discussed in my earlier clinical and population health management posts, caregivers are taking care of patients that may move in and out of their population or country. Yet they are still responsible for providing the best care possible for that patient.

    Rising demand for qualified healthcare IT candidates

    According to the World Health Organization, there is a global healthcare workforce shortage of about 7.2 million workers. While this report focuses more on clinicians, the shortage is also prevalent in the healthcare IT workforce – from programmers to managers to senior leadership. A recent U.S. survey found that 2 out of 3 healthcare Chief Information Officers reported staff shortages.

    Healthcare organizations are competing for qualified candidates. More and more organizations recognize the importance of having an IT leader with vision.

    Availability anytime, anywhere

    We are becoming an increasing mobile world. Walk down the street in any country – including developing nations – and you’ll see people constantly using their smartphones. People use them in all kinds of innovative ways to work, play, learn and live.

    Mobile devices won’t replace complex work, but they are a disruptive technology in health care. Organizations around the world are pursing better ways to incorporate mobility.

    As we become more reliant on electronic systems in health care, it also becomes increasingly important to have highly available, redundant systems in place. It’s inconvenient to lose an Internet connection when you’re looking for directions to a restaurant; it’s potentially life-threatening to a clinician looking for information about a patient’s medication.

    Many costly initiatives are underway to ensure reliable systems. For example, the Singapore Ministry of Health mandated high availability, redundant systems in all of the country’s clusters (i.e., health systems) by the end of 2014. These efforts may be in the background, they are a vital part of implementation.

    What are the top technical issues that your healthcare organization is facing today?

    Editor’s Note: Dr. Samo’s other posts address Global Healthcare Megatrends inincluding clinicalpopulation healthfinancial and regulatory.

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    Global Healthcare Megatrends: Regulatory requirements

    May 8th, 2014

    There are more than 7 billion people on the planet today. Our growing global population has triggered some of the biggest healthcare challenges we’ll ever face. Listening to clients in Australia, Canada, Singapore, United Kingdom and United States, I believe many of these issues are universal. This is the fourth post in a five-part series that explores the clinical, population health, financial, regulatory and technical challenges we share as a global healthcare community.

    Governments play an important role in standardizing healthcare systems around the world. They regulate three primary areas:

    1)      Reimbursement

    Governments regulate healthcare because it is a significant portion of the global economy. Australia, Canada and the United Kingdom spend about 8-11% of their Gross Domestic Products (GDPs) on health care.

    The United States outpaces all other countries by spending a whopping 17.9% of its GDP on health care. Unfortunately this spend does not result in better outcomes. Many countries are trying to incentivize better outcomes with new reimbursement models (insert link to Financial models post).

    These swiftly evolving and significant markets require government oversight. Especially for developed countries with private insurance companies. To ensure quality and protect patients against things such as bogus insurance policies.

    2)      Quality measures

    Government agencies strive for better care through a series of quality measures. Some items are mandatory – such as Meaningful Use in the United States. Others are voluntary best practices – such as National Institute for Health and Care Excellence (NICE) in England.

    The more quality measure entities there are, the more opportunity there is for overlapping regulation from one agency to another. All have developed their metrics with the best of intentions, but the complexity can be challenging.

    Governments around the world are looking to harmonize these quality measures. Singapore, for example, is looking to standardize a national drug database. These are Herculean efforts to determine how to share and standardize information.

    3)      Certification

    Governments around the world are backing healthcare IT and Electronic Medical Record (EMR) initiatives. The United States and United Kingdom top the list with US$19 billion and US$12 billion respectively.

    It stands to reason that governments want to certify solutions that are capable of managing the complex healthcare environment. Vendors have devoted a lot of research and development resources toward these certification goals, especially over the last couple of years.

    Some would argue that spending this amount of effort on government certification has a negative impact on innovations in usability and new features. It is certainly a challenge to balance the many priorities competing for attention.

    Regulatory environments vary in terms of their formality, structure and centralization. But they all have the best intentions to provide better patient care for better outcomes.

    One of the great challenges being encountered by the healthcare industry is ensuring appropriate quality of care while not inhibiting innovation.  Too much regulation can divert financial and human resources away from other innovative and vital development and adoption efforts.

    How are regulatory requirements affecting your organization?

    Editor’s Note: In Dr. Samo’s next blog post, he’ll describe the global technical landscape of Healthcare IT. Previous posts covered clinical challengespopulation health and financial models.

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    Global Healthcare Megatrends: Financial models

    May 1st, 2014

    There are more than 7 billion people on the planet today. Our growing global population has triggered some of the biggest healthcare challenges we’ll ever face. Listening to clients in Australia, Canada, Singapore, United Kingdom and United States, I believe many of these issues are universal. This is the third post in a five-part series that explores the clinical, population health, financial, regulatory and technical challenges we share as a global healthcare community.

    Healthcare costs are rising around the world. Financial pressure may be the most uniform challenge we face as a global healthcare community. Every country is trying to find ways to deliver better care at a lower cost.

    Reimbursement models differ by country

    Each country has a different way of funding health care. For example, Canada has a single-payer system. Physicians bill the national health insurance plan for services rendered. England’s publicly funded healthcare system, National Health Service (NHS), provides most health care in that country.

    In Germany, insurance companies must provide a minimum base coverage without profit. They can only make profit through add-on services. The United States does not have universal coverage, although the Affordable Care Act is heading us in that direction.

    Every country is wrestling with different ways of covering the costs of health care. The global industry continues to try new reimbursement models with varying degrees of success.

    Capitated care models didn’t work in the 1990s

    New reimbursement models aren’t so new. About 20 years ago, several countries tried variations of capitated care models. In these payment arrangements, physicians received a set amount for each enrolled person based on his age, occupation and other factors.  Whether or not the person sought care did not affect these payments.

    The goal of capitated care models was similar to the goal of today’s value-based care models: to change the incentives. Even then we understood that fee-for-service models – where providers are paid for every service – encourage volume of care, not necessarily quality of care.

    Capitated care models failed in the 1990s because we didn’t have enough IT capability. We couldn’t monitor the work to make sure it was efficient. We were not able to make sure patients were receiving the care they needed. We simply didn’t have the analytics to ensure success.

    Today’s reimbursement models have a far better chance of success, because we have greater IT capabilities than ever before.

    Success is still a moving target

    What will work best? For example, in the United States, will hospitals own ambulatory? Or will ambulatory sites hold the contract for population health? Both of these models are playing out and it is still unclear. My guess is that in the United States, where market forces can play a greater role, there will be multiple solutions.

    There is more central control in countries like Australia, England and Canada. Governments in those countries have more control over the financial structure of health care.

    In your experience, are financial models evolving fast enough? Too fast? What are the signs that we have efficient reimbursement models?

    Editor’s Note: In Dr. Samo’s next blog post, he’ll describe regulatory environments. Previous posts covered clinical challenges and population health.

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    Global Healthcare Megatrends: Population Health Management

    April 24th, 2014

    There are more than 7 billion people on the planet today. Our growing global population has triggered some of the biggest healthcare challenges we’ll ever face. Listening to clients in Australia, Canada, Singapore, United Kingdom and United States, I believe many of these issues are universal. This post is one of a five-part series that explores the clinical, population health, financial, regulatory and technical challenges we share as a global healthcare community.

    What should we call it?

    There is a concept emerging in healthcare that – despite its universal nature – does not have a common, global name. Called “population health management” in the United States, it’s an approach many healthcare organizations are taking to improve outcomes for groups of patients in their community.

    In Canada, people often call it “chronic disease management.” Others may refer to it as community health. What you call it may be different, but the core concepts are the same.

    An approach for every group of patients

    What is the population? If I am the minister of health of a nation, it’s the entire country. If I am the CEO of a healthcare organization I may be responsible for tens of thousands of lives in my region.  If I am a primary care provider, my population may be 1,000 patients. Regardless of population size, the goal is the same: deliver quality care to the entire population.

    That care includes everything from wellness to chronic disease management, from acute care to prevention. Healthcare has focused on patients with chronic disease, because these are the highest risk, highest cost patients. But a true population health strategy helps people maintain good health, too.

    Providers around the world recognize that to properly manage any patient group, they need information and insight. They need to connect to all of the electronic medical records (EMRs)* in their communities, to glean everything they can about the population they are managing.

    This includes data about the population regardless of where that information originated.  For instance, I need to know that one of my patients went to the Emergency Room even if is outside of my hospital system.

    Engaging patients in their own care

    To have good outcomes, we must involve patients in their own care. That involvement will only happen with consistent communication, using all of the tools available to us.

    One of the avenues that is very popular outside the United States is text messaging – or Short Message Service (SMS). Caregivers use it to remind diabetic patients to make follow-up appointments or remind maternity patients to take their vitamins. This form of communication is cheap, which is good for developing countries.

    Caregivers around the world are turning to patient portals to communicate with patients. But there are distinct cultural differences as to how countries view data ownership. For instance, U.S. caregivers are more likely to say that the data belongs to the patient. However caregivers in other countries are more hesitant. They want to make sure patients understand the data and maintain some control over it.

    Our best defense against pandemics

    Remember the SARS outbreak? As we live in an increasingly mobile world, health issues in one region may rapidly impact geographies on the other side of the world.  Therefore, rapid recognition of new diseases or the spread of known illness is vital.  Real-time analysis of patient populations can lead to syndromic surveillance and early identification of disease trends within a community.

    Given the sweeping implications of these challenges, it’s understandable that no one has mastered population health management. There is one aspect to these strategies that everyone agrees is key to success: the human factor. Working together person to person – not just provider to patient – will make all the difference.

    What’s your preferred term for population health management? What do you think are keys to success?

    * Electronic Patient Record (EPR) is another term for Electronic Medical Record (EMR) or Electronic Health Record (EHR).

    Editor’s Note: In Dr. Samo’s next blog post, he’ll discuss the financial challenges we share in global healthcare. In his previous blog post, he discussed clinical challenges.

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    Global Healthcare Megatrends: Clinical challenges

    April 17th, 2014

    There are more than 7 billion people on the planet today. Our growing global population has triggered some of the biggest healthcare challenges we’ll ever face. Listening to clients in Australia, Canada, Singapore, United Kingdom and United States, I believe many of these issues are universal. This post is the first of a five-part series that explores the clinical, population health, financial, regulatory and technical challenges we share as a global healthcare community.

    Caring for more patients than ever before

    Worldwide healthcare providers are seeing more patients than ever before. In part, because we’re living longer. In developed nations, there has been a huge increase in life expectancy over the last 50 years, and experts believe the trend will continue.

    For example, U.S. citizens had a life expectancy of 68.2 years in 1950, which jumped to 76.6 years in 2000, and is expected to reach 83.9 years by 2050. Not only does that mean caregivers have more patients overall, but these patients are aging and require more health care.

    Other cultural and economic factors contribute to an increasing number of patients. As middle classes expand in some nations, they seek more health care, more often. Countries that adopt universal health care models will also increase the patient population.

    This growing number of patients heightens another global challenge: a shortage of primary care providers.

    Providing the right caregiver at the right time

    With more patients, the healthcare industry needs more caregivers. Several countries are employing “physician extender” positions to handle and coordinate routine care.  These staff additions free the physician to provide expert care. Physicians can then practice at the top of their licensure, which is a better use of resources.

    It also helps with clinician satisfaction as they are focusing their time on the patients that need their help the most.   However, in some cultures this approach is more of a challenge, as patients may insist on seeing only the physician.

    There is also an increasing types of sites of care.  No longer will a patient only be seen in the physician’s office.  They may also receive care in pharmacies, schools, offices and grocery stores.

    We must remember that quality clinical care is not just that patients can see any caregiver.  It’s that people receive the right level of care, no matter where they are.

    Driving towards a single patient record

    Most countries we work in are all large enough that choosing a single electronic medical record (EMR)* to facilitate data sharing is simply not an option. So everyone in the world is looking for ways to connect a virtual single patient record.

    Even as EMRs gain traction in developed countries, we still struggle to communicate between organizations. Patient data does not easily flow among caregivers.  New technologies are now appearing in the realm of Healthcare Information Technology to standardize and connect various systems.  This technology will be at the hub of future healthcare delivery facilitating the movement of information between the many stakeholders of healthcare at the point of care.

    Many cultural factors affect healthcare communications worldwide, including language. There are more than 6,900 languages spoken on this planet. Roughly 5% of the world’s population speaks English as a first language, which takes third place to Mandarin and Spanish. This variety affects the single patient record on a most basic level: How do we manage patient data in different languages?

    Measuring to ensure best practices

    Many countries have identified important clinical measures. For example, it might be simple rates of immunization among children and influenza vaccine among adults. Or it could be more complicated measures of chronic diseases, such as regular HbA1c evaluations for diabetic patients.

    Some countries are ahead in this process. Most developed countries have reporting requirements aims at improving quality of care.  These is a movement towards setting up parameters that result in rewards, similar to Meaningful Use in the United States. Because it’s not just about “checking the box” by ordering a certain test – it’s about improving outcomes.

    As we look at all of these clinical requirements, it’s clear that proper use of EMRs can make a difference. There is still a lot of work to be done, and specific challenges to address in each region. But I’m encouraged by the progress I see globally.

    Do these clinical challenges resonate in your part of the world? What other aspects would you add?

     

    * Electronic Patient Record (EPR) is another term for Electronic Medical Record (EMR) or Electronic Health Record (EHR).

    Editor’s Note: In Dr. Samo’s next blog post, he’ll describe the challenges of population health management.

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    Building a more global acute solution

    February 6th, 2014

    Allscripts released an updated version of our acute Electronic Health Record (EHR)*, Sunrise™ Version 14.1 this week. We made a lot of enhancements, especially to the ambulatory and emergency department pieces.

    As Allscripts grows to meet the needs of the global healthcare market, people have asked me: What does Sunrise 14.1 do for clients outside the United States? It will bring new benefits to all of our clients – no matter where in the world they are.

    Clinical needs are more similar than different

    On the clinical side of Sunrise 14.1, we put a lot of effort into the ambulatory and emergency department capabilities. We relied heavily on client clinical advisory groups to shape these enhancements.

    This release reflects an open development process, with more regular input from end users. We specifically sought input from clients both inside and outside the United States.

    We’ve found that healthcare needs are pretty similar across the board.  Everyone is working to do things such as manage chronic disease, coordinate care, engage patients and lower costs.

    Two features especially for clients outside the United States

    That being said, there are some differences as to how each region approaches these goals. We designed Sunrise 14.1 with a couple of features that are of particular interest outside the United States:

    Sunrise Access Manager – includes more support for requirements outside the United States, including Waitlists and Referral Management.  In several countries – such as Australia, the United Kingdom, Canada – care providers put patients who need other services on a Waitlist. Governments monitor these lists closely to make sure patients don’t wait too long for care, and Sunrise 14.1 better supports reporting capabilities for organizations.

    Drug formulary databases – improves utilization of clinical decision support databases to help address the needs of markets in Australia, the United Kingdom, Canada and Asia. Being able to rapidly integrate this content helps global healthcare organizations access updated drug information.

    These capabilities, while developed for the international market initially, support the universal concepts of improved care coordination, access to real-time data at the point of care, and meeting regulatory requirements.

    Flexible enough to stretch from the U.S.A. to South Australia

    Here’s proof that we’re building an adaptable solution that works worldwide. In addition to helping clients manage clinical information, we also help them with financial data. We built Sunrise Financial Manager from scratch. It was the first new revenue cycle management solution on the market in quite a long time.

    We initially built it to meet needs we saw in the United States. But our first client was in South Australia, proving that the system is flexible enough to adapt in different geographies.

    As the Sunrise platform evolves, we’ll continue to build an adaptable solution to meet global healthcare needs.

     

    * Editor’s Note: Electronic Health Record (EHR) is another term for Electronic Medical Record (EMR) or Electronic Patient Record (EPR), which is a more common term outside the United States.

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    Improving Public Health with EHRs

    October 31st, 2012

    Often when we talk about the benefits of Electronic Health Records (EHRs), the focus is on bettering individual patient outcomes. Increasingly, however, stakeholders have been paying increasing attention to the potential benefits EHRs can offer when dealing with public health issues. That’s why Allscripts is taking two important steps to help our clients manage the recent rash of fungal meningitis infections related to tainted steroid injectables.

    The Center for Disease Control posted a list of facilities known to have received the tainted medications. First, Allscripts is comparing this list against our database of clients.  We will be contacting these clients to provide any assistance they might need to identify the individual patients that received intra-spinal steroid injections since May to determine if they are at risk of infection. This proactive step can offer critical benefit to the affected patients, as fungal meningitis can take weeks to cause the patient to experience symptoms.

    Second, Allscripts is preparing a free Medical Logic Module (MLM) for clients using Allscripts Sunrise Clinical Manager specifically responsive to this public health need. The MLM notifies the provider in the Emergency Department if a patient has complaints documented in the Triage Note that might be consistent with these infections. Specifically, the notification reminds the provider to consider fungal infection as the cause of the patient’s problems.

    EHRs provide all types of benefits to not only providers and patients individually but in also helping manage this type of public health issue in a proactive manner. We have clients who’ve used similar processes in the past to head off meningitis outbreaks in their community and identify possible e coli sufferers. Allscripts provided similar support with the recent H1N1 outbreak and will continue to do so when needed in the future to help protect the patients’ health.

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