Realizing Integration:Defragging the Health Care System

Mark D. Fox, MD, PhD, MPHDavid C. Kendrick, MD, MPH

Section of Medicine/Pediatrics

Overview• Framing the issue• Context of health “system” performance• Opportunity for innovation

Disclaimer• Original planned title:Social justice and health information technology• Anchoring lectures process• Challenge to clarify abstruse connection

Social Injustice• Denial or violation of economic,

sociocultural, political, civil or human rights of specific populations or groups in society based on perception of inferiority by those with more power or influence– Often involves stereotypes and stigmatization

Social Injustice 2• Policies or action that adversely affect the

societal conditions in which people can be healthy

• IOM definition of public health:What we, as a society, collectively do to assure the conditions in which people can be healthy

• Populations and groups in first definition are usually especially vulnerable to these forms of social injustice

Shorter Life Expectancy

Real Health Disparities

Longer Life Expectancy

NORTH TULSA

SOUTH TULSA

14 Year difference in Life Expectancy

Across Tulsa County

…And its not because we are not spending enough money on healthcare

The State’s Next Challenge - Securing Primary Care for Expanded Medicaid PopulationsLeighton Ku, Ph.D., M.P.H., Karen Jones, M.S., Peter Shin, Ph.D., M.P.H., Brian Bruen, M.S., and Katherine Hayes, J.D.

http://www.commonwealthfund.org/Maps-and-Data/State-Data-Center/Local-Scorecard.aspx

http://www.commonwealthfund.org/Maps-and-Data/State-Data-Center/Local-Scorecard.aspx

Vulnerable Populations• Tulsa’s primary care safety net• Challenges of access• Fragmentation of care

– By system (SFH, Hillcrest, SJMC, OSU)– By free clinic (Day Center, Sallie, Dream

Center, Bedlam, Good Samaritan)– By provider within those clinics

Bedlam/OU Community Health Experience

• EMR implementation to link diffuse network of clinic operations

• Improve efficiency• Reduce redundancy• Improve safety• Make network more functional