Can the health information system of the Indian Health Service be broadly improved? Yes, it can, and it must, say a team of healthcare researchers, in an article published online on April 26 in the Journal of the American Medical Informatics Association (JAMIA). The authors—Theresa Cullen, Jan Flowers, Thomas D. Sequist, Howard Hays, Paul Biondich, and Maia Z. Laing—offer readers a detailed analysis of the IHS’s healthcare information technology landscape, and their recommendations for change.
As the authors write in the JAMIA article, “The Indian Health Service (IHS), an agency of the U.S. Department of Health and Human Services (HHS), provides care to remote and under-resourced communities in the United States. American Indian/Alaska Native (AI/AN) patients have some of the highest morbidity and the mortality of any ethnic group in America.1,2 AI/AN communities have high rates of poverty and social risk. Lack of fiscal and human resources contribute to these statistics; limited effective strategies have been identified to impact these numbers. However, 50 years ago,” the authors write, “these disparities led to an IHS strategic and core commitment to health information technology (HIT) to help improve efficiency and quality. HIT was designed to increase access to care, provide early situational awareness for public health emergencies, and achieve the goal of health equity. Starting in the 1970s, this investment in HIT created support and knowledge for a population health approach to health care—decades before population health was recognized as a critical part of the healthcare delivery cycle in the broader U.S. health system. This perspective reports on the current Resource and Patient Management System (RPMS) evaluation process undertaken to support modernization of RPMS in the pursuit of health equity.”
In their article, the researchers analyze the shortcomings of the current RPMS, including an under-resourced platform; limited wide area and local area network IT infrastructure; a scarcity of a skilled and consistent rural workforce with adequate knowledge of the system; immature interoperability; poor usability; and a variety of implementation concerns.
With a system affecting over 400 facilities serving more than 2.2 million patients across 37 states, they propose a set of governing principles and an intricate program of assessment activities, in their plan for a reformed information system for the Indian Health Service.
In the end, the authors write, “As a public health agency, the IHS has an enormous opportunity to lead the identification and incorporation of what and how data is included, displayed, and utilized in the next generation HIT systems to best achieve health equity. This user and population centered approach envision a new model for HIT within IHS; this model has the potential to move the needle forward on health equity beyond the borders of AI/AN communities,” they write. “We should be watching. Opportunities to adopt IHS achievements in this area as a result of these modernization efforts may drive the larger HIT ecosystem to prioritize health equity as a core mission of HIT.”
