HIMSS24 Native American Health IT Symposium: 'Many nations, one record'

From left, Robert Coffey, health informatics IT manager for the Iowa Tribe Division of Health; Evan Dunne, senior government relations specialist for HIMSS; Tom Leary, senior vice president and head of government relations at HIMSS; and Krystal Schramm, data strategy administrator, Michigan Department of Health and Human Services. Leary and Dunne wear blankets given as thanks for their work with the National Indian Health Board.

Photo: Susan Morse/HFN

ORLANDO - For the first time, the Indian Health Service has a contract to install a new electronic health record connecting tribal communities across 37 states.

The initiative was a massive undertaking involving the National Indian Health Board, tribal groups, states and the federal government, with the help of HIMSS.

All of the stakeholders were needed because tribal governance is unique and involves more than connecting numerous hospitals across a health system.

HIMSS' involvement ramped up after Robert Coffey, health informatics IT manager for the Iowa Tribe Division of Health, approached Tom Leary, senior vice president and head of government relations at HIMSS.

"Robert came to us years ago and said, 'Let's do this,'" Leary said at the Native American Health IT Symposium at HIMSS24.

Tribes represent the oldest governments in the United States and are recognized in the Constitution, said those who spoke during the symposium.

Federal law gives tribes sovereignty and any regulations come from the U.S. government. State law can have no force in Indian Country, they said.

One challenge is that states control the public health data of tribal citizens.

They've tried to get the data directly, but can't, according to Dr. Meghan O'Connell, medical epidemiologist for the Great Plains Tribal Leaders Health Board and Cassandra Fonseca, epidemiologist with the Turtle Mountain Band of Chippewa Public Health Department.

It took two years for the first tribe to have access to data, O'Connell said. They were awarded five grants using data from the past couple of years. The data was not timely.

Sarah Sevoyna of the Centers for Disease Control and Prevention, said tribes are getting raw data.

Fonseca said true data sovereignty is having control and access to the right data within their populations.

The other issue, one too familiar to health systems, is funding.

Under the Indian Self Determination and Education Assistance Act of 1975, over half of the Indian Health Service's budget is controlled by tribes.

But funding for IHS is about 56% of need, said Carrie Field, policy analyst for the National Indian Health Board, the nonprofit national voice for tribal health priorities. Most comes through third-party revenue, for example, that from Medicare and Medicaid. Medicare, on average, spends $15,000 per person in the United States, but for Native Americans that amount is $4,100, Field said.

Native Americans have poorer health outcomes than the rest of the U.S. population, Field said. Life expectancy is much lower. COVID-19 had a dramatic impact on the country. The nation's population lost 2.7 years of life expectancy because of the pandemic, but non-Hispanic American Indian and Alaska Native populations lost 6.6 years, she said.

The roots driving health inequities goes back to colonization, which caused a massive disruption and disconnection, Field said.

Health issues among Native Americans – and speakers included native Alaskan populations in their discussion – involve social determinants of health not often talked about, among the needs for healthy food, transportation and housing.

There's historical trauma, loss of culture, loss of language, access to ceremonies and traditional healing, according to A.C. Locklear, federal relations director of the National Indian Health Board.

WHAT'S THE IMPACT?

Last year, at HIMSS23, Locklear, representing the 574 recognized tribes, talked before a standing-room-only crowd of federal, state and tribal leaders to advocate for all things health.

It was then that the partnership with HIMSS was revealed as a way to network for innovative solutions. Locklear said they had partnered with HIMSS to found the Native American Indigenous Peoples Community.

"We don't get the perspective of those outside solving issues," he said during a HIMSSTV interview.

How health solutions have generally worked is a one-size-fits-all solution that hasn't worked.

"So we often find ourselves having to fit into a box after it's already been made and developed," Lockear said at HIMSS23. "Or having to find solutions that weren't really made or created for our communities."

What's needed, Locklear said, is healthcare modernization.

Interoperability is a challenge for any health system. The Indian Health Service is hampered by having a vast area over 37 states tied to a 40-year old management system of the U.S. Department of Veterans Affairs that is about to be replaced.

The Indian Health Service Resource and Patient Management System – or RPMS – is a decentralized integrated solution for management of both clinical and administrative information.

"The need for healthcare modernization is apparent," said Benjamin Koshy, CISO of IHS, speaking at the HIMSS24 symposium.

Modernization is happening. The IHS put out proposals for a new electronic health record and awarded a contract to General Dynamics Technology, which will be integrating Oracle Health technology.

The buy-and-build phase is happening now and is scheduled to be operational by 2025, according to Andrea Scott, deputy CIO for the IHS. The contract is in place for 10 years.

The new EHR will handle everything from patient registration to insurance billing. But data modernization is not just about technology, it's about workforce and other factors, said Linda Roe, acting director of Division of Detect and Monitor for the CDC.

Said Donnie Parish, former chief information officer of Cherokee Nation Health Services who is now vice president of strategic operations at General Dynamics' information technology division: "Many nations, one record."

Email the writer: SMorse@himss.org