Health Affairs: Closing the Health Disparity Gap for American Indians and Alaska Natives Through Health IT Modernization

“Since its founding in 1955, the Indian Health Service (IHS) has provided a comprehensive health service delivery system to approximately 2.56 million American Indians and Alaska Natives who belong to 573 federally recognized tribes in 37 states. The agency’s mission and vision are to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives (AI/AN) to the highest level, while building healthy communities and quality health care systems through strong partnerships and culturally responsive practices. To aid its mission, the IHS has historically relied on its electronic health record (EHR) system, the Resource and Patient Management System (RPMS), for its clinical, financial, and administrative needs. Initially developed specifically for the IHS, years of inattention and underfunding have left the RPMS unusable by current technological standards, making it difficult to provide continuous, consistent care to the already marginalized AI/AN community.”

“Between June 2017 and May 2018, both the Department of Defense (DoD) and Department of Veteran Affairs (VA) elected to move to commercial off-the-shelf solutions to increase interoperability and meet the increasing requirements for modernized health information technology (IT) systems. In May 2018, the VA made a decision to replace its legacy EHR system, VistA, with a commercial product that was developed by Cerner, the same corporation chosen by the DoD. This decision significantly impacts the IHS, whose own EHR has historically benefited from and been dependent upon VistA development for its core health IT applications.”

“This decision also highlights the historical and ongoing disparities, both fiscal and health-related, between the veteran population and the AI/AN population. While the VA has been appropriated $1.6 billion to fund its transition to the Cerner EHR, the IHS is poised to receive significantly less—a proposed appropriation of $25 million for fiscal year (FY) 2020 to begin evaluating and updating its health IT system—despite providing care to a population equal to 27 percent of the VA. The $1.6 billion for the VA is an initial appropriation on what is believed to be a final cost of more than $10 billion.”

“In fact, until FY 2020, there was no budget line item for IHS health IT at all. Because of the extensive work needed to bring the RPMS up to minimum modern health IT standards, the proposed amount is inadequate to meet the Unites States’ responsibility for providing health care to tribal nations…” Read the full blog post here.

Source: Closing The Health Disparity Gap For American Indians And Alaska Natives Through Health IT Modernization – By Theresa Cullen, Matthew A. Demaree, and Shannon Effler, January 27, 2020. Health Affairs.

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