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L. Philip Caillouet PhD FHIMSS Louisiana Center for Health Informatics

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 PhD FHIMSS Louisiana Center for Health Informatics The University of Louisiana at Lafayette October 12, 2011.

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L. Philip Caillouet PhD FHIMSS Louisiana Center for Health Informatics

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  1. Louisiana HIMSSFall 2011 Education Session: Advancing Health IT in Acadiana and Beyond EHR & HIE:Essential Enablers for an Information Intensive Industry L. Philip Caillouet PhD FHIMSS Louisiana Center for Health Informatics The University of Louisiana at LafayetteOctober 12, 2011

  2. “Information Intensive” Healthcare has two underlying processes: a. the provision of care b. gathering information to facilitate the provision of care in the future

  3. Once Upon a Time ... … things were simple ...

  4. Healthcare Information: Simple Beginnings The Doctor-Patient Relationship Physicians Patients

  5. The Hypothetico-Deductive Approachfrom Biomedical Informatics, Shortliffe & Cimino editors, Springer, 2006.

  6. Healthcare Information: Post-World War II Wage & Price Freezes; Government Subsidies Equip. Mfrs. Hospitals Suppliers Employers, Unions, & Assns. Physicians Workers Insurers

  7. Healthcare Information: The Great Society Medicare & Medicaid Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Physicians Citizens Insurers

  8. Healthcare Information: Corporate Self-Insurance The Bottom Line Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Physicians ASO TPAs Enrollees Insurers

  9. Healthcare Information: Rise of the HMO, PPO, & IPA Wellness, Not Illness Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Physicians ASO TPAs Network & Care Mgrs. Members Insurers

  10. Healthcare Information: Direct Contracting & Data Services Who Has Data Wins Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Data Services PHOs Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Physicians IPAs ASO TPAs Covered Lives Network & Care Mgrs. Insurers

  11. Healthcare Information: Cost Sharing Sharing = “You Pay” Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Data Services PHOs Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Physicians IPAs ASO TPAs Network & Care Mgrs. Consumers Credit Bureaus Claims Assistance Financial Services Insurers

  12. Healthcare Information: Supply-Side Economics Technology & Cash Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Data Services PHOs Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Drug Mfrs. Physicians Pharm. Benefit Mgrs. IPAs ASO TPAs Marginal Units Network & Care Mgrs. Credit Bureaus Claims Assistance Financial Services Insurers

  13. Healthcare Information: Vertically Integrated Health Systems “Hospitals” to “Systems” Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Data Services PHOs Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Drug Mfrs. Physicians Pharm. Benefit Mgrs. IPAs ASO TPAs Network & Care Mgrs. Populations Credit Bureaus Claims Assistance Financial Services Insurers

  14. Healthcare Information: A State of Confusion!?! Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Data Services PHOs Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Drug Mfrs. Physicians Pharm. Benefit Mgrs. IPAs Us! ASO TPAs Network & Care Mgrs. Credit Bureaus Claims Assistance Financial Services Insurers

  15. Will We Live Happily Ever After? Enter Healthcare Reform andHealth Insurance Reform … one more time ...

  16. So … Will We Live Happily Ever After? Accountable Care Organizations? Coordinated Care Networks? National Health Information Infrastructure? Meaningful Use? ???

  17. “Essential Enabler”

  18. Healthcare Information: Order from Chaos? Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Data Services Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Drug Mfrs. Physicians Pharm. Benefit Mgrs. ASO TPAs Network & Care Mgrs. Credit Bureaus Claims Assistance Financial Services Color Key: Clinical (specific) Clinical (summary) Financial Administrative Patients Insurers

  19. Questions, Comments,or Suggestions? <caillouet@louisiana.edu> Learn more at http://lchi.louisiana.edu

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