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Indian Well being Service IT Exec Describes Plans for EHR Transition

Jeanette Kompkoff serves because the director of the Division of Well being Info Expertise Modernization and Operations (DHITMO) on the Indian Well being Service (IHS). In a latest interview, carried out by way of e-mail, with Healthcare Innovation, she detailed IHS’ not too long ago introduced plans to transition from a home-grown EHR to Oracle Cerner. 

The IHS, an company within the U.S. Division of Well being & Human Companies, supplies well being providers for roughly 2.8 million American Indians and Alaska Natives who belong to 574 federally acknowledged tribes in 37 states. 

DHITMO, which was established to supervise the Well being IT Modernization Program, sits inside the IHS Workplace of Info Expertise. Because the DHITMO director, Kompkoff supplies oversight and administration of the enterprise digital well being document (EHR) system and its upkeep. She additionally manages the acquisition exercise for quite a few well being IT providers and merchandise that complement the EHR funding and oversees a group of greater than 80 federal and contract IT personnel who help this system’s efforts. 
Kompkoff joined the IHS in 1988 and brings practically 35 years of well being IT implementation experience to the IHS Well being IT Modernization Program. Throughout this time, she created infrastructure necessities, led a number of software program improvement tasks, managed multimillion-dollar IT contracts, and led nationwide groups to implement and handle giant and complicated IT investments, together with the IT modernization effort.
Healthcare Innovation: Are you able to clarify among the the explanation why the IHS is working to switch the Useful resource and Affected person Administration System (RPMS) with a business enterprise well being IT suite?

Kompkoff: Implementation of contemporary expertise is important for IHS to reinforce the person expertise for sufferers and suppliers, centralize the system for fast, responsive help from expertise specialists nationwide, and bolster catastrophe restoration and continuity of care. This modernization goals to reduce system disruptions and streamline entry to affected person information throughout services, granting sufferers better management over their care and offering suppliers with a complete care overview. By transitioning from the RPMS to a business enterprise well being IT suite, IHS is addressing these crucial wants, laying the groundwork for improved well being care supply and operational effectivity.

In listening classes that mentioned findings of the 2018 evaluation of the present state of the company well being IT system, 60 p.c of the Tribal and City Indian Group (UIO) companions had been in settlement that full substitute of RPMS is essentially the most applicable and reasonable modernization resolution. In a complete examine carried out by the U.S. Division of Well being and Human Companies (HHS) between 2018 and 2019, deficiencies within the RPMS expertise used throughout IHS, Tribal and City medical services got here to mild, leading to a powerful advice to switch the system. Highlighted by two crucial stories from the HHS Workplace of Inspector Common, these shortcomings referred to as for instant motion. Compounding the problem, the approaching substitute of the U.S. Division of Veterans Affairs’ VistA system, upon which the IHS has dependencies, underscores the urgency for IHS to transition to a business enterprise well being IT suite, guaranteeing the continued supply of top-tier well being providers. 

HCI: May you give a timeline of what has been executed to this point by way of planning and fascinating with stakeholders — and what the following steps are? As an example, has an RFP course of began? 
Kompkoff: Throughout the Well being IT Modernization Program, the IHS seeks methods to actively share updates with, hearken to, and acquire inputs from companions to construct the enterprise EHR resolution. IHS needs a partnership within the journey to construct the enterprise EHR resolution utilizing governance frameworks that promote collaboration.   
One of many central rules of the IHS Well being IT Modernization is to construct and function the enterprise EHR resolution with our companions, not for them. The Enterprise Collaboration Group will function a discussion board for companions to offer enter relating to the configurations and workflows that the enterprise EHR resolution supplies. Extra alternatives for enter will probably be out there by means of focus teams, with preliminary subjects centered on interoperability, implementation, information administration and analytics.
HCI: What sort of appropriations have there been to this point for this challenge? Is there a projected general price and timeline?  
The IHS Well being IT Modernization Program is a complete, multi-year initiative geared toward updating well being IT programs throughout IHS, Tribal, and City Indian well being care packages, following a transparent timeline from analysis and planning levels in 2018 to 2021, to purchasing and constructing in 2022 to 2024, and eventually coaching, creating, and working from 2025 onwards. Financially, the challenge has a Life Cycle-Price Estimate starting from $4.5 to $6.2 billion to be expended all through a 10-year interval, accounting for the mandatory infrastructure to help an enterprise EHR resolution. The Fiscal 12 months 2024 President’s Funds Request features a request for $913 million for the initiative, with an extra $1.1 billion per yr to be requested for FY2025 by means of FY2029, totaling $5.5 billion over 5 years to offer secure funding to help the deliberate length. Every finances request is topic to annual congressional approval.  
HCI: The Navy Well being System and VA are within the technique of upgrading to a brand new enterprise system from Oracle Cerner. Are there interoperability benefits for IHS to be on the identical system because the navy and VA?

Kompkoff: In November 2023, the Indian Well being Service introduced that Common Dynamics Info Expertise, Inc. will construct, configure, and keep the enterprise digital well being document resolution utilizing Oracle Cerner expertise. The enterprise EHR resolution will probably be shared by each federal and non-federal companions and prioritizes Tribal sovereignty and our collective mission of enhancing the well being standing of American Indian and Alaska Native folks. 

Whereas the VA and DoD efforts and the IHS Well being IT Modernization Program will each use Oracle Cerner expertise, each occasion of an EHR construct is completely different. The IHS enterprise EHR resolution will probably be a special product than the VA and DOD merchandise and it is going to be applied otherwise. IHS has had profitable implementations of comparable merchandise all through Indian Nation and we now have the benefit of gaining classes realized from our federal, Tribal and City companions and can construct the system with our customers. Interoperability will probably be supported utilizing licensed expertise between VA, DOD and business companions.

HCI: What are some components of the IT governance strategy that DHITMO is taking with this challenge?
Kompkoff: IHS is proactively establishing a collaborative governance construction to information the event of an enterprise EHR resolution. The Government Steering Committee will handle federal capabilities, guaranteeing alignment with our objectives. The federally led Enterprise Collaboration Group, supported by IHS informatics, supplies suggestions for the enterprise EHR resolution’s design and configuration. This complete governance strategy, spearheaded by the DHITMO, underscores our dedication to a collaborative and efficient improvement course of for the enterprise EHR resolution. 
HCI: What do you foresee as essentially the most difficult facet of the transition?
Kompkoff: The transition to an enterprise EHR resolution is complicated. We anticipate essentially the most difficult facet to be guaranteeing a easy information migration, aiming to forestall information points resembling information loss, misinterpretation, or mis-mapping fields. To reduce downtime and keep productiveness, we plan to conduct sturdy testing at services previous to go-live. To make sure websites have the right infrastructure, employees, and workflows earlier than implementing the answer, we’re actively incorporating suggestions from our companions throughout Indian Nation. Clear communication and robust management are essential to navigate this transition, stopping misunderstandings and errors, guaranteeing a profitable implementation that aligns with our mission, and serves our sufferers and suppliers effectively. 
HCI: Are there many points associated to information migration from legacy programs? 
Kompkoff: IHS is proactively addressing a number of points associated to information migration from legacy programs to make sure seamless entry to finish data for each sufferers and suppliers within the enterprise EHR resolution. Key challenges embody stopping information loss, avoiding misinterpretation of knowledge, and guaranteeing correct mapping of knowledge fields between the previous and new programs.
HCI: Are some clinics within the system already utilizing another kind of EHR quite than RPMS?  And if that’s the case, will they be allowed to remain on these quite than switching to the brand new system?
Kompkoff: All federally acknowledged Tribal nations and City Indian packages that function their very own EHR can choose into the brand new system at any time or proceed to make use of a system of their alternative. If a Tribal or City program is at present utilizing RPMS, they might want to both undertake the IHS chosen enterprise EHR resolution or pursue a special system of their alternative.  All IHS-operated services could have RPMS changed with the chosen IHS enterprise EHR resolution.
HCI: I learn that the proposed structure includes establishing a brand new database – “4 Instructions Warehouse (4DW)” – in a federal cloud setting. Are you able to describe briefly what 4 Instructions will contain?

Kompkoff: 4 Instructions Warehouse is about to be a central repository in a federal cloud setting, with long-term storage options for complete RPMS information archive and capabilities to include information from a number of EHR options. It allows seamless entry to scientific information for each sufferers and suppliers throughout varied services, boosting visibility into affected person care wants. 

The system facilitates the usage of legacy data with out the necessity for loading the total historical past of affected person healthcare information into the enterprise EHR, and it requires no upkeep of RPMS programs. With sturdy safety controls and a complete information analytics setting, 4DW ensures the safety of affected person information on the IHS-managed platform, streamlining the transition to trendy healthcare options whereas laying the groundwork for superior affected person care optimization. 



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