Dr. Howard Hays, acting director of the Indian Health Service's Office of Information Technology, says the agency has been working 'extremely hard' to enhance its system to meet evolving federal standards for recording and storing health records electronically. (Courtesy of Howard Hays)
The federal agency charged with providing health services to more than 2 million American Indians and Alaska Natives is undergoing a multimillion-dollar project to upgrade its electronic health record system by 2014.
For the Indian Health Service, enhancing its Resource and Patient Management System (RPMS) to meet evolving federal standards for recording and storing health records electronically has been a huge undertaking. The $10 million project includes upgrades intended to make it easier for RPMS to communicate with other electronic health record systems and to enable providers using the system to share more patient health data electronically with other health professionals and organizations, such as the Veterans Affairs Department.
“We’ve been working extremely hard to analyze and develop changes, [and] we expect to certify [the system] late this summer,” said Dr. Howard Hays, acting director of the Indian Health Service’s Office of Information Technology. “It’s more than a full year’s project, and we will continue to test and release software changes.”
The project is part of a larger effort to encourage federal and private health care providers to use common standards for their health information technology systems, which the administration expects will lay the groundwork for more health information sharing nationwide. Health IT experts often refer to this as system interoperability, which for many organizations is easier said than done.
“People assume interoperability is so easy,” Hays said. “We are not there yet from the standpoint of interoperability and health information exchange. That’s the state of the industry.”
The challenge isn’t just sharing records outside of the Indian Health Service’s network of hospitals and clinics but among facilities using customized versions of RPMS that suit their specific needs.
“At this point in time, the electronic health records at different facilities are independent of each other within the Indian Health Care System, so there is no direct communication between facilities,” said Hays, who also serves as the agency’s acting chief information officer.
A lot of record sharing today happens via fax and mail, but the administration has set various deadlines through 2016 for health care providers to become certified as “meaningful users” of health IT. By doing this, hospitals and physicians can become eligible for Medicare and Medicaid incentive payments.
As of April, the Indian Health Service and its partnering organizations had received $50.5 million in incentive payments from the Centers for Medicare and Medicaid Services (CMS). A small portion of that money is used to further develop the agency’s system, but most of the money remains at the tribal, urban and Indian Health Service facilities providing direct care.
While Indian Health Service isn’t required to build its system to federal standards, users of the system will have their Medicare payments reduced in 2016 if their systems don’t meet the standards.
“We don’t want to put our hospitals and providers in a position where they are subject to those penalties,” Hays said.
Some 391 federal and tribal hospitals, clinics, health centers and stations nationwide rely on RPMS to register patients at their facilities and to track patient scheduling, laboratory results and other medical care, billing and referrals.
In addition to upgrading its electronic health record system, Indian Health Service is exploring more immediate benefits of a public-private partnership that would allow the agency to electronically request and review patient health data maintained by other participants in the eHealth Exchange, which is a growing group of federal and private organizations nationwide that shares health information. The effort is supported by a nonprofit organization called Healtheway, and participants include the VA, CMS, Social Security Administration, Defense Department, Kaiser Permanente and dozens of other health organizations. Hays said Indian Health Service plans to be an active participant in the information exchanges by the fall.
Hays’ office is contending with federal mandates to transition to a new classification system for diagnoses and procedures before October 2014. The agency’s electronic health record system, along with other providers that get payments from CMS, must be able to interpret the new classification, known as the International Classification of Diseases (ICD) 10, or else risk forfeiting payments from CMS.
“It magnifies the complexity of what we’re doing,” Hays said.