Louisiana HIMSS Fall 2011 Education Session Advancing Health

Louisiana HIMSS Fall 2011 Education Session: Advancing Health IT in Acadiana and Beyond EHR & HIE: Essential Enablers for an Information Intensive Industry L. Philip Caillouet Ph. D FHIMSS Louisiana Center for Health Informatics The University of Louisiana at Lafayette October 12, 2011 Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 1

“Information Intensive” Healthcare has two underlying processes: a. the provision of care b. gathering information to facilitate the provision of care in the future Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 2

Once Upon a Time. . . … things were simple. . . Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 3

Healthcare Information: Simple Beginnings The Doctor-Patient Relationship Physicians Patients Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 4

The Hypothetico-Deductive Approach from Biomedical Informatics, Shortliffe & Cimino editors, Springer, 2006. Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 5

Equip. Mfrs. Hospitals Healthcare Information: Post-World War II Wage & Price Freezes; Government Subsidies Suppliers Employers, Unions, & Assns. Physicians Workers Insurers Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 6

Healthcare Information: The Great Society Equip. Mfrs. Hospitals Peer Review Orgs. Federal & State Gov’t. Medicare & Medicaid Suppliers Physicians Fiscal Intermediaries Employers, Unions, & Assns. Citizens Insurers Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 7

Healthcare Information: Corporate Self-Insurance Equip. Mfrs. Hospitals Peer Review Orgs. Federal & State Gov’t. The Bottom Line Suppliers Physicians Fiscal Intermediaries ASO TPAs Employers, Unions, & Assns. Enrollees Insurers Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 8

Healthcare Information: Rise of the HMO, PPO, & IPA Equip. Mfrs. Hospitals Peer Review Orgs. Federal & State Gov’t. Wellness, Not Illness Suppliers Physicians Fiscal Intermediaries ASO TPAs Network & Care Mgrs. Employers, Unions, & Assns. Members Insurers Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 9

Healthcare Information: Direct Contracting & Data Services Equip. Mfrs. Hospitals Suppliers Peer Review Orgs. Federal & State Gov’t. Who Has Data Wins Data Services PHOs Physicians Fiscal Intermediaries Employers, Unions, & Assns. IPAs ASO TPAs Network & Care Mgrs. Covered Lives Insurers Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 10

Healthcare Information: Cost Sharing Equip. Mfrs. Hospitals Suppliers Peer Review Orgs. Federal & State Gov’t. Sharing = “You Pay” Data Services PHOs Physicians Fiscal Intermediaries Employers, Unions, & Assns. IPAs ASO TPAs Network & Care Mgrs. Insurers Consumers Financial Services Credit Bureaus Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Claims Assistance Slide 11

Healthcare Information: Supply-Side Economics Equip. Mfrs. Hospitals Suppliers Drug Mfrs. Federal & State Gov’t. Technology & Cash Data Services PHOs Physicians Pharm. Benefit Mgrs. Peer Review Orgs. Fiscal Intermediaries Employers, Unions, & Assns. ASO TPAs Marginal Units IPAs Network & Care Mgrs. Insurers Financial Services Credit Bureaus Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Claims Assistance Slide 12

Healthcare Information: Vertically Integrated Health Systems Equip. Mfrs. Hospitals Suppliers Drug Mfrs. to “Systems” Data Services PHOs Physicians Pharm. Benefit Mgrs. “Hospitals” Federal & State Gov’t. Peer Review Orgs. Fiscal Intermediaries Employers, Unions, & Assns. IPAs ASO TPAs Network & Care Mgrs. Insurers Populations Financial Services Credit Bureaus Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Claims Assistance Slide 13

Healthcare Information: A State of Confusion!? ! Equip. Mfrs. Hospitals Suppliers Drug Mfrs. Federal & State Gov’t. Data Services PHOs Physicians Pharm. Benefit Mgrs. Peer Review Orgs. Fiscal Intermediaries Employers, Unions, & Assns. ASO TPAs Us! IPAs Network & Care Mgrs. Insurers Financial Services Credit Bureaus Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Claims Assistance Slide 14

Will We Live Happily Ever After? Enter Healthcare Reform and Health Insurance Reform … one more time. . . Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 15

Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 16

So … Will We Live Happily Ever After? Accountable Care Organizations? Coordinated Care Networks? National Health Information Infrastructure? Meaningful Use? ? ? ? Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 17

“Essential Enabler” Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 18

Color Key: Clinical (specific) Clinical (summary) Financial Administrative Equip. Mfrs. Healthcare Information: Order from Chaos? Peer Review Orgs. Fiscal Intermediaries Suppliers Federal & State Gov’t. Data Services Hospitals Employers, Unions, & Assns. Patients Drug Mfrs. Claims Assistance Pharm. Benefit Mgrs. Network & Care Mgrs. Insurers ASO TPAs Financial Services Credit Bureaus Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 19

Questions, Comments, or Suggestions? <caillouet@louisiana. edu> Learn more at http: //lchi. louisiana. edu Louisiana Center for Health Informatics at The University of Louisiana at Lafayette Slide 20