Health:  An  Amazing  Challenge  for    

Informa4on  Architecture  Junkies  

Cradle  to  Grave  

1928 1/Doctor Visit

5/Hospital Stay

1929 $6 / Year of

Hospital Care

1982 DRGs

Introduced as way to manage

costs

2013 •  ACA (October) •  ACO •  Full Capitation •  ICD 10

Current  Macro  IA  Trends  •  Explosion  of  new  informa0on  from  EMR  and  only  about  half  are  at  Stage  II  MU  

•  Shi=ing  and  Evapora0on  of  Pa0ents  •  Care  Management  is  Rapidly  Changing  •  You  have  to  Care  for  Community,  Not  Just  Pa0ents  (I  think  this  makes  it  easier,  not  harder  for  IA)  

Our  Shared  Language  •  Hierarchy  of  Data:  Figure  out  what  goes  where  and  why  and  what  you  should  do  first  

•  Taxonomy,  First  Not  Last  – Cross  Walks  

•  Curated  Views,  Last  (you  need  experience)  •  Interface  Engines,  Connec0ng  to  the  world  

–  (SeeBeyond,  CloverLeaf)  

The  Importance  of  Place  as    New  Informa4on  Parameter  

ShiF  in  Who  is  Paying  for  What  

Diseases  are  Growing,  Declining,  and  Being  Eliminated  ALL  at  the  same  4me  

What  Needs  to  be  Captured  NOW!  

Hospitaliza4ons  -­‐  40,692,505  (.13)    Outpa4ent  -­‐  96,404,868  (.308)    Emergency  Dept  -­‐  136,176,760  (.4355)    Physician  Office  Visits  -­‐  1,045,262,266  (3.343)  

US  Healthcare  Efficiency  Index  

Health  Expenditure  Projec4ons  

0  500  1000  1500  2000  2500  3000  3500  4000  4500  5000  

2004  2005  2006  2007  2008  2009  2010  2011  2012  2013  2014  2015  2016  2017  2018  2019  

Na4onal  Health  Expenditures  Billions  

US  Health  Expenditures  

Hospital  Care,  827.3  

Physician  and  Clinical  Srvc,  556.1  

Other  Prof  Services,  74.6  

Dental  Services,  111.8  

Other  Personal  Health  Care,  90.3  

Home  Health  Care,  82.8  

Nursing  Home  Care,  156.2  

Prescrip4on  Drugs,  274.5  

Other  Medical  Products,  70.9  

DME,  28.1  

Other  Non-­‐DME,  42.8  

Insurance,  189.5  

Public  Health,  84.6  

Research,  54.2  

Structures,  130  

2011  

The  Real  Physician  Story  •  985,375  Total  Physicians  •  752,572  Pa0ent  Care  Focused  •  125,928  Inac0ve  •  64,153  Not  Classified  •  9,458  Unspecified  Physician  Specialty  •  432  Address  Unknown  

Transac0ons  =  Fluidity  

How  are  we  going  to  track  health?  

PHR  à  EHR  à  EMR  

Coding  MDC  Major  Diagnos4c  Codes    DRG  Diagnos4c  Related  Groupings    ICD9  à  ICD10  2014  –  Interna4onal  Classifica4on  of  Diseases    HCPCS  –  Healthcare  Common  Procedural  Coding  System    CPT4  –  Clinical  Procedural  Terminology    SnowMed  -­‐  Systema4zed  Nomenclature  of  Medicine    

Quality  Mafers  

The  Uninsured  Nearly 50 Million Uninsured and Growing

Before you count your chickens,

understand how the egg

is made