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Indian Health Service Seeking Input on Modernizing its Health IT Systems

December 22, 2017
by Heather Landi
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The Indian Health Service (IHS), an agency within the U.S. Department of Health and Human Services (HHS), issued a request for information (RFI) as part of the agency’s health information technology modernization effort.

According to the RFI, which is not a request for proposal, the agency is looking for information to assess industry innovations and capabilities that might best address IHS’s emerging enterprise healthcare delivery and modernization needs. The RFI can be accessed here. Responses will be accepted until Feb. 1, 2018 at 5 pm.

IHS is responsible for providing federal health services to American Indians and Alaska Natives, and is the principal federal health care provider and health advocate for American Indian / Alaska Natives. The IHS provides a comprehensive health service delivery system for approximately 2.2 million American Indians and Alaska Natives who belong to 567 federally recognized tribes across 36 states.

IHS developed and currently uses a comprehensive integrated government-off-the-shelf (GOTS) health information system-of-systems, the Resource and Patient Management System (RPMS), which supports a broad range of clinical and business functions at IHS federal, tribal and urban hospitals and clinics across the United States.

According to the agency, the RPMS electronic health record system is a distant “cousin” to both the Veterans Health Information Systems and Technology Architecture (VistA) in use at the Veterans Administration, and the Composite Health Care System (CHCS) used in DoD's Defense Health Administration (DHA), having been derived from the same legacy system and sharing many of the same infrastructure and business applications.

The RPMS is certified as a complete electronic health record (EHR) for inpatient and ambulatory settings according to the 2014 version certification criteria published by the Office of the National Coordinator for Health Information Technology (ONC). In recent years, the system has been extended to include a personal health record system (PHR), direct secure messaging, a health information exchange (HIE) service, master patient index (MPI), and supporting middleware services.

The IHS HIT environment further expands across the 567 sovereign nations to include implementation in federal, tribal and urban healthcare facilities and programs. This includes a need for the IHS HIT system to interact with multiple non-RPMS independently deployed commercial-off-the-shelf (COTS) EHRs, “making the larger environment for operation highly decentralized, highly rural, and, at times, low or limited connectivity similar to DoD's theater,” the agency stated.

“Over time, the architecture and complexity of IHS health IT systems, as well as their criticality to health care operations, have become one of the many catalysts for IHS to re-evaluate its current approach to software development and deliverance of health IT services to American Indians and Alaska Natives stakeholders,” the agency stated in the RFI.

The agency said its objective is to modernize, augment, or replace RPMS legacy health IT systems, including, but not limited to, its clinical, administrative, financial and HIT infrastructure. “This project will address the current state of IHS health IT, where multiple legacy systems and disparate data stores, developed over four-plus decades, are in need of modernization to ensure and enable sustainability, flexibility, intra/interoperability, patient data federation, population health, and clinical quality measures, toward improved continuity of care,” the agency stated.

Further, IHS stated that the RFI project objective is researching both the clinical and technical approaches and required to deliver an end-to-end suite of next generation solutions with modularized software components that modernize the IHS health IT platform. “Given the diversity of the types and sizes of healthcare facilities across IHS, their varying degrees of connectivity/bandwidth, a ‘one-size-fits-all' COTS EHR approach is likely neither functionally nor economically feasible. This RFI seeks to discover ‘art-of-the-possible' practical COTS solutions (or a combination of COTS solutions) that holistically address IHS needs,” the agency stated.


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