1. Indian Health Service April 18, 2005

2. Background information Government-to-government relationship between the federal government and the Indian tribes Relationship was established in 1787 and based on Article I, Section 8 of the Constitution IHS is the principal health care provider and health advocate for Indian people

3. The Indian Self-Determination and Education Assistance Act provides tribes with the option of assuming the administration and operation of health programs within their communities or of remaining within the IHS administered direct health system. Background information

4. Our Mission... to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. Our Goal... to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people. Mission, goal, and foundation

5. Our Foundation... to uphold the Federal Government's obligation to promote healthy American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes.

6. IHS currently provides health services to approximately 1.6 million American Indians and Alaska Natives from over 560 federally recognized tribes in 35 states. The federal system consists of 36 hospitals, 61 health centers, 49 health stations, and 5 residential treatment centers. In addition, 34 urban Indian health projects provide a variety of health and referral services.

7. What we do Assist Indian tribes in developing their health programs: health management training, technical assistance, and human resource development Facilitate and assist tribes in coordinating health planning, in obtaining and using health resources available through Federal, State, and local programs, and in operating comprehensive health care services and health programs.

8. What we do Provide comprehensive health care services: hospital & ambulatory medical care, preventive & rehabilitative services, and development of community sanitation facilities. Serve as the principal Federal advocate in the health field to ensure comprehensive health services for American Indian and Alaska Native people.

9. Health care delivery Preventive measures involving environmental, educational, and outreach activities are combined with therapeutic measures into a single national health system. Special initiatives in traditional medicine, elder care, women's health, children and adolescents, injury prevention, domestic violence and child abuse, health care financing, state health care, sanitation facilities, and oral health

10. Enterprise Architecture As of CY2004, IHS has attained Management Maturity Framework (EAMMF) Stage 3 as defined by GAO Working on a review and update of our existing EA and architectural manual to integrate the FEA, FHA, and HHS EA requirements and processes

11. Patient data capture Patient encounter data is manually recorded on a Patient Care Component (PCC) Encounter Form Medical records clerks input data from each encounter into the clinical system The Resource and Patient Management System (RPMS) is used by most facilities (similar to the VA’s DHCP system)

12. Examples of visit data Purpose of visit Visit location Providers Measurements Treatments Medications Immunizations Allergies Problem list update Adverse reactions Patient Education Radiology Laboratory tests Audiometry Physical Therapy Reproductive Factors

13. IHS Electronic Health Record The IHS-EHR is in various stages of implementation at 10 facilities Eliminates the necessity of data entry by clerks Real-time capture of data Client-server technology http://www.ihs.gov/CIO/EHR/

14. Uses of the data 1. Third Party Billing 2. Quality Improvement IHS Clinical Reporting System (CRS) software is a reporting tool used by the IHS Office of Planning and Evaluation to collect and report clinical performance results annually to HHS and to Congress Includes 23 GPRA performance measures and 25 other key clinical indicators

15. Uses of the data 3. Funding and program planning National Data Warehouse (NDW) Project State-of-the-art, enterprise-wide data warehouse environment Produces reports required by statute and regulation Provides a broad range of clinical and administrative information to managers at all levels to allow them to better manage individual patients, local facilities, regional and national programs

16. Uses of the data National Data Warehouse (NDW) Project Allows analysis of 1.Clinical practice patterns & episodes of care (diagnosis, treatment, wellness, prevention, screening) 2.Measures of quality of care, clinical outcomes, disease management, & prevention 3.Population-based epidemiologic studies of disease states, medical histories, health behaviors, risk factors, and clinical outcomes 4.Patient demographics & healthcare utilization patterns

17. Uses of the data 4. Public Health Surveillance Reportable diseases and conditions reported to the state by each facility LOINC mapping project State Immunization Data Interchange Trends & Regional Differences monographs http://www.ihs.gov/NonMedicalPrograms/IHS_ Stats/IHS_HQ_Publications.asp