IHS Health IT Modernization Focuses on Interoperability Best Practices

The Indian Health Service (IHS) has begun a multi-year health IT modernization initiative to replace its homegrown EHR platform with a private vendor solution.

The IHS is an agency of the Department of Health and Human Services (HHS) responsible for providing healthcare services to 2.6 million members of 574 federally recognized tribes across the country.

At the 2022 virtual ONC annual meeting on April 13, Howard Hays, MD, chief medical information officer for IHS, discussed the agency's impetus for its health IT modernization effort.

Hays emphasized that IHS and its federal partners have been ahead of the rest of the industry in terms of health IT for decades. In 1984, IHS developed its homegrown RPMS EHR system in partnership with the VA.

Significant advances in health IT since then prompted IHS to modernize its platform, Hays said.

"Even though the RPMS EHR is a certified system and has remained a certified system since the beginning of the meaningful use era, the continuously evolving technology and regulatory environment is increasingly challenging," he said. "The IHS is a healthcare organization. We're not by nature a development shop."

"Fortunately, the health IT industry has caught up, and we know that there are modern, capable EHR solutions out there that can be leveraged to truly modernize health IT infrastructure in the IHS," Hays said. "We have an outdated technology stack that's very challenging to support. It's distributed in hundreds of databases around the country, resulting in little interoperability between them."

Hays noted that IHS is looking forward to implementing a modernized technology architecture with better interfaces for providers and patients and true interoperability with partners on different systems.

"This will be a transformational effort that we believe will be a huge leap forward in helping the IHS accomplish our mission," Hays said.

He emphasized that the new enterprise system will promote standardization, best practices, and a governance structure driven by end-users.

"At the IHS, we're serious about a governance approach that will proactively engage subject matter experts across the IHS tribal and urban environment to work with the vendor on system build and workflow configuration as well as an enterprise system governance," Hays noted.

IHS is currently working on business process modeling and best practice alignment to help RPMS users prepare for the eventual transition to a different system.

"We have no illusions that it'll be easy, but we're determined to do as much as possible upfront in program planning and organizational change management to smooth that move," Hays explained.

During the fiscal year 2022 to 2023, IHS will work on acquisition planning and solicitation evaluation processes for the overall EHR procurement and the organizational change management support that the agency will need, Hays said. After that, IHS will begin work on system build, configuration, and testing.

Hays said that the agency plans to deploy the new EHR system to initial sites in the late fiscal year 2024 or 2025, with a multi-year phased rollout plan.

He emphasized the importance of partnerships with self-governance tribes and urban Indian organizations for the IHS health IT modernization project.

While the IHS directly manages many hospitals and clinics, tribes and tribal organizations who have executed self-governance contracts or contacts with the federal government provide most of the care in Indian upcountry, Hays explained. There are also several clinics run by urban Indian organizations, referred to as the IHS Tribal and Urban partnership (ITU).

"Many of these organizations use the IHS EHR solution, and many others use a variety of commercial EHR products," Hays said. "Whatever options they've chosen, it's extremely important that they be part of the modernization initiative. We share patients with each other and with other government partners and the private sector, so interoperability and care coordination are key."

Hays noted the significance of the ongoing Federal Electronic Health Record Modernization (FEHRM) project for IHS.

"IHS cares so much about what the FEHRM is doing," he said. "There are so many American Indian and Alaskan native people serving with distinction in the armed forces that we share tens of thousands of veterans in patients with the VA."

"While IHS is pursuing a different path than the FEHRM to modernization in partnership with tribes and urban Indian organizations, we value our continued engagement with the FEHRM colleagues who are generously sharing artifacts, methods, experiences, and lessons learned," he added.