Health Information Technology Systems and Support (HITSS)
The Indian Health Service (IHS) Health Information Technology Systems and Support (HITSS) is a comprehensive Health Information System (HIS) created to support the delivery of high quality health care to American Indians and Alaska Natives who attend several hundred Federal, Tribal, and Urban facilities nationwide. HITSS is critical to IHS operations; it integrates practice management, medical, behavioral health, population health and performance reporting functions into a fully capable electronic health record (EHR) suite. HITSS evolved alongside the Veterans Administration's acclaimed VistA HIS but occupies a unique place as the only system designed specifically to support the direct care and public health mission of the IHS. HITSS aligns with the Administration's commitment to promoting the adoption of EHRs due to their ability to improve health outcomes and decrease costs. HITSS supports the Health Information Technology for Economic and Clinical Health Act (HITECH) by establishing interoperability through the electronic sharing of information with states, interoperability with commercial labs, and electronic communication among medical staff participating in patient care.
HITSS supports HHS Goal 1 Objective F by providing a Meaningful Use Certified EHR and empowering the patient with personal health information. The IHS EHR is certified as a complete EHR for ambulatory and inpatient settings according to the criteria for Stage 2 Meaningful Use, and is in use at more than 300 sites nationwide. HITSS is in the mixed lifecycle phase; much of the suite is in operations and maintenance, while enhancements are being implemented for the Meaningful Use Stage 2 EHR Certification and ICD-10 conversion. IHS is progressing in the full implementation of the Nationwide Health Information Network (NwHIN) gateway, supporting OIT Strategic Goal 2 - Objective 2.4. HITSS continues to invest in maintenance, including protecting the privacy and security of information, supporting OIT Strategic Goal6. As a high-quality, low-cost public domain system, HITSS has also proven attractive to private and public sector health care entities outside of IHS. The HITSS investment is dependent upon the IHS Infrastructure, Office Automation, and Telecommunications (IOAT) Investment as it provides the physical computer and networking systems and support on which HITSS is operated.
Infrastructure, Office Automation & Telecom
The IHS IOAT investment provides the technical foundation which enables IHS to perform its critical mission of raising the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. All other IHS IT investments, including services such as the Electronic Health Record as part of the Resource and Patient Management System (RPMS) as well as the National Patient Information Reporting System (NPIRS Data Warehouse) depend on the IOAT infrastructure for critical service availability and support. This investment includes IHS IT infrastructure support services and costs including but not limited to: Hardware, Software, Email, Helpdesk, IT Security, Networking, Remote Access, Server Support, and Telecommunications.
The IHS infrastructure investment aligns with the HHS' Strategic Plan Goal 1: Transform Healthcare, Objective E: Ensure access to quality, culturally competent care for vulnerable populations by (1) implementing an enterprise approach to information technology infrastructure that fosters communication, innovation, collaboration, standardization and interoperability throughout IHS, and (2) by ensuring that systems provide security that guarantees the confidentiality, integrity and availability of IHS information resources. Technical initiatives for the investment are driven by IHS OIT Strategic Goals (in coordination with IT Governance) which include identity and access management support; keeping infrastructure systems current and well-maintained; continued server virtualization implementation; and the development of shared services strategy within IHS.
National Patient Information Reporting System
The National Patient Information Reporting System (NPIRS) is the national data repository of the Indian Health Service (IHS). NPIRS produces specific reports that are required by statute and regulation without significant manual data consolidation thereby saving significant cost each year. Additionally, NPIRS maintains composite patient encounter information, providing managers at all levels of the Indian health system with a broad range of clinical and administrative information that allow them to better manage individual patients, local facilities, regional and national programs. NPIRS also provides hosting and administration services to ensure the Health Information Exchange (HIE), Master Patient Index (MPI), Personal Health Record (PHR), e-Rx, and Direct Messaging systems function reliably and provides server hosting services to both IHS and IHS-approved customers.
NPIRS data is derived from various government and commercial healthcare information systems that are largely transaction-based systems used to support patient care. The data comprises patient registration and clinical encounter records. The data repository provides reports and ad hoc searches of the databases thereby providing critical and timely information to customers. Internal users and selected authorized external users have secure access to more structured and specific subsets of this information (data marts). NPIRS key customers, stakeholders, and beneficiaries include IHS Headquarters, GPRA Coordinators, IHS Administrative Areas, HIE/MPI, Department of Epidemiology, CDC, and Tribal entities.
NPIRS supports HHS Strategic Goal 4 Objective A, ensuring program integrity and responsible stewardship of resources, by maintaining user population and workload information attributed to each of the 12 IHS administrative areas. It provides composite information needed to measure IHS performance and the allocation of funds to tribal facilities and provides management with the information necessary to cost-beneficially allocate scarce medical resources. NPIRS also supports HHS Strategic Goal 4 Objective B by collecting and integrating information from Tribal, Urban, State, private sector, and other Federal sources (e.g. IHS Fiscal Intermediary, CMS) to facilitate effective collaboration and sharing of this information on-line through the data marts.