1. November 27, 2018

2. Welcome to the November Innovation Webinar
HHS/IHS
Health Information Technology Modernization
Analysis Project
Technical Assessment of RPMS
Theresa Cullen, MD, MS
Associate Director
Global Health Informatics
Regenstrief Institute
Howard Hays, MD, MSPH, FAAFP
Principal Consultant
Hays Health Informatics Consulting, LLC
Opening slide

3. Today’s Webinar Describe HHS/IHS HIT Modernization Analysis Project
Brief background on IHS and HIT in Indian Country
Describe Technical Assessment component
Open Forum discussion among webinar participants on potential for “modernization” of RPMS

4. Project Background
In close collaboration with the Indian Health Service (IHS), the HHS Office of the Chief Technology Officer (OCTO) has funded and awarded a one-year project to study IHS’ options for modernizing its health information technology (HIT) solutions, either by updating the Resource and Patient Management System (RPMS) technology stack, acquiring commercial off-the-shelf (COTS) solutions, or a combination thereof.
This webinar presentation and discussion will focus on one aspect of that project.

5. Stakeholders American Indian / Alaska Native Tribes
Urban Indian Health Programs
IHS/Tribal/Urban facilities and staff
IHS Headquarters Programs, e.g. Diabetes, Behavioral Health, Resource Access, Public Health, Epidemiology, etc.
Health and Human Services Office of the Chief Technology Officer
Office of the National Coordinator for Health Information Technology

6. Contractors Emerging Sun, LLC Regenstrief Institute Pistis, LLC
Multiple expert subcontractors

7. Project Elements Kickoffs with IHS/HHS/ONC
Meetings with IHS, Tribal, Urban stakeholders
Site visits
Data call across I/T/U
Technical Advisory Group
Technical Assessment of Legacy Systems (RPMS)
Community of Practice Model
Analysis of Alternatives
Recommendations to IHS/HHS

8. Indian Health Service
The IHS provides direct and purchased care to American Indian and Alaska Native people (2.2 million lives) from 573 Federally recognized tribes in 37 states.
Authority to provide health care services to Indian people rests in numerous treaties, regulations, and statutes, including the Indian Health Care Improvement Act, permanently reauthorized in 2010 as part of ACA.
IHS Mission – to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.
IHS Funding – $5.5 billion FY 2018 appropriation, plus 3rd party collections ($1.02 billion at IHS sites in FY 2017)

9. Profile: IHS, Tribal and Urban (I/T/U)
25 Hospitals
55 Health Centers
21 Health Stations
Tribal
20 Hospitals
280 Health Centers
62 Health Stations
134 Alaska Village Clinics
Urban
43 Urban Indian Health Programs
100, ,400
50,000-99,999
10,000-49,999
1,713-9,999

10. Resource and Patient Management System (RPMS)
IHS Health Information Solution since 1984
RPMS is an integrated Public Health information system
Composed of over 100 component applications/namespaces
Patient and Population based clinical applications
Patient and Population based practice management applications
Financially-oriented administrative applications
RPMS is in use at all IHS (federally-operated) facilities, as well as most tribally- operated and urban Indian health programs
The RPMS Suite is the only federal government-developed EHR to be certified according to ONC criteria, in 2011 and 2014

11. History of RPMS
IHS Office of Research and Development established in Tucson in 1969
Numerous “firsts” in health IT accomplished by ORD in subsequent decades
RPMS Patient Care Component launched in 1984
Cousin to the VA’s VistA system – RPMS and VistA have evolved together over the years
RPMS and VistA share much of the same infrastructure and some clinical applications such as Radiology, VistA Imaging, and BCMA
RPMS and VistA each contain applications developed in the sister agency
Many VA applications (Laboratory, Pharmacy) have been extensively modified to meet IHS requirements.
IHS developed numerous applications independently of VA to address IHS-specific mission and business needs (child health, public/population health, revenue cycle)
Currently about 20-30% of RPMS code originates in VistA

12. RPMS Application Suites
Clinical Applications
Patient Care Component, Electronic Health Record, Behavioral Health System, Reminders, Pharmacy, Laboratory, BCMA, VistA Imaging, etc.
Population Health and Case Management
Diabetes Management System, HIV Management System, Immunization Tracking, iCare Population Management, etc.
Practice Management Suite
Patient Registration, Scheduling, Third Party Billing, Accounts Receivable, Pharmacy Point of Sale, etc.
Quality Reporting
Clinical Reporting System (GPRA/GPRAMA), Uniform Data Set (HRSA), MU Clinical Quality Measures, etc.
Personal Health Tools
Patient Wellness Handout, Personal Health Record portal
Infrastructure and Health Information Exchange
FileMan, Kernel, Master Patient Index, Direct HISP, CONNECT gateway, etc.
BLUE = VistA-derived
Blue = VistA-derived applications

13. HIT in the I/T/U All IHS (federally-operated) facilities use RPMS
Most tribal and urban Indian health care programs continue to use RPMS as well
However, many have adopted commercial off-the-shelf (COTS) HIT solutions
At least eight (8) and likely more COTS EHRs are in use across Indian country
Tribes continue to evaluate and exercise their options to use alternative solutions
As tribes acquire COTS solutions, remaining funding to support RPMS and related HIT is reduced
IHS needs to understand the drivers for tribal/urban adoption of COTS; this understanding will:
Inform IHS priorities about modernization efforts for IHS HIT
Inform IHS decisions about modernizing RPMS vs transition to COTS solutions

14. Assumptions
The VA announced in 2017 it would sundown VistA and transition to Cerner
This means the IHS has only about 10 years to figure out what it will do about the parts of RPMS that still derive from VistA
More importantly, RPMS (like VistA) resides in an architecture that some would call dated, others archaic
IHS needs to plan for modernizing its HIT solutions, by replacing RPMS entirely, updating/modernizing RPMS, or a combination of both

15. Technical Assessment - Legacy
Among the tasks on the IHS HIT Modernization Analysis Project contract is a technical assessment of legacy systems at IHS, i.e. RPMS
The idea is to assess the potential for the existing capabilities which were developed for the needs of Indian country over the past few decades to be brought into a modern technology architecture
This assessment must occur in order to objectively inform decision-making at IHS regarding its modernization options

16. Questions for Consideration
What does “modernization” mean to you (in the context of RPMS)?
What would it take to get there, at the –
Infrastructure level?
Database level?
Applications level?
What do you think would be the barriers?

17. Discussion
What does “modernization” mean to you (in the context of RPMS)?

18. Discussion What would it take to get there, at the –
Infrastructure level?

19. Discussion
What would it take to get there, at the –
Database level?

20. Discussion What would it take to get there, at the –
Applications level?

21. Discussion
What do you think would be the barriers?

22. Thank You!
If you have additional thoughts, comments, or documents to share that you believe may be useful to this effort, please send them to:
We cannot guarantee to acknowledge or incorporate them into the recommendations but welcome all input.