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The Challenges of EHR Adoption in Native American Communities

March 3, 2013
by Gabriel Perna
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Leaders in national Native American healthcare community are facing a tremendous challenge in trying to get Indian Health Service (IHS), tribal, and urban health facilities to not only adopt electronic health records (EHR), but get them meaningful use certified under the Health Information Technology for Economic and Clinical Health (HITECH) Act as well.

The National Indian Health Board’s (NIHB) HITECH Program, with funding from the Office of the National Coordinator for Health IT (ONC), established the NIHB American Indian/Alaska Native National Regional Extension Center (AI/AN National REC) to help spur along this process. Tom Kauley, the AI/AN National HITECH consultant for the REC, spoke at the HIMSS13 Native American pre-conference symposium, discussing how far along the REC has gotten in getting providers to sign up and indicating some of the aforementioned challenges.

The AI/AN National REC, as Kauley explained to the crowd, has a “phenomenal undertaking.” Unlike RECs in most states, which deal with local providers, the AI/AN National REC serves providers in 34 states. The REC has been able to sign up nearly 3,000 primary care providers (2,988 to be exact) to receive its EHR and meaningful use services.  

REC has surpassed its goal in this regard, and Kauley credits its partnership with several “sub-recipients” including the Alaska Native Tribal Health Consortium (ANTHC), the California Rural Indian Health Board (CRIHB), the Northwest Portland Area Indian Health Board (NPIHB), and the United South and Eastern Tribes (USET) in this effort.

“These are the ‘boots on the ground’ teams, the ones that led us to sign up 2,988 providers and deliver the services that we are giving at this point,” Kauley said. He also credited the IHS, saying the organizations aligned on EHR deployment strategies. The IHS’ RPMS EHR is the majority system for most Native American healthcare organizations, even those outside the IHS, but some use commercial vendors such as Cerner and NextGen.

Despite its success in getting people to sign up with the REC and go live with an EHR, only 15 percent (396 providers) of the tribal organizations have certified under meaningful use, Kauley reported. Furthermore, time is running out. In April of 2014, the ONC-funded REC program ends, and as Kauley said to the crowd, someone else will have to continue the work they have started.

Through the money the REC has received from this program, it has invested health IT-related initiatives. This includes a Native American ePatient initiative and setting up a health IT work training program at colleges in Native American communities. Training was one of the most prominent obstacles Kauley mentioned during the symposium. In addition to the various training challenges, he talked of the need for improved software configuration processes and onsite meaningful use specialists as well.

Still, the brunt of the work remains. The Native American pre-conference symposium was the first of its kind at HIMSS, having been added to the lineup in December. Speakers not only gave an overview of the Native American health IT landscape, in terms of EHR adoption and meaningful use certification, but also opened it up for discussion among the attendees on best practices and how to proceed. Many of the organizations at the symposium belonged to tribal and Alaskan native healthcare organizations.

“The thing that is very important to me is relationship building. Whether it’s with vendors, tribal health organizations, or the tribes themselves, or any state reps, all of these will be sources of support for these tribes going forward,” Kauley said.