The Division of Facilities Operations (DFO) provides information and technical consultation on the planning, coordinating, evaluating, and management and accountability of IHS owned facilities. The OEHE Technical Handbook provides guidance for the maintenance, repair and improvement of IHS facilities and guidance on how to assess, improve, correct, and report on the effective and economical management and utilization of IHS-held real property. DFO is responsible for providing data submissions to the Department of Health and Human Services in response to the data call requirements of the Federal Real Property Profile (FRPP) system.
Backlog of Essential Maintenance, Alteration and Repair
Backlog of Essential Maintenance, Alteration and Repair (BEMAR), a subset of the FEDS data in HFDS, is reported to Congress annually and supports the need for M&I funding.
Energy and Water Conservation and Sustainability
In 1973, the Federal government issued a comprehensive energy conservation policy. The IHS began reporting quarterly on energy consumption at IHS facilities in compliance with the Energy Policy and Conservation Act of 1975. Reporting has progressed such that IHS facilities record their energy and water usage on a monthly basis in Energy Star Portfolio Manager and report usage to the Department of Health and Human Services annually.
Energy and water use is linked to overall environmental sustainability. Area Offices as well as facilities shall use life-cycle cost analysis in making decisions about their investments and planning.
Environmental Compliance and Remediation
Compliance with environmental regulations at the federal, state, and local levels has been mandated by Congress. As a result, environmental assessments have been performed at IHS and tribal facilities to identify and evaluate potential environmental hazards. These assessments form the basis of the IHS facilities environmental management plan. Congress appropriates $3,000,000 annually for remediating environmental hazards at IHS and tribally owned facilities. Another $500,000 is appropriated to demolish excess federal property in the IHS inventory.
Facilities Engineering Deficiency System
The Facilities Engineering Deficiency System (FEDS) is a module within HFDS and is used to manage deficiencies including the Backlog of Essential Maintenance, Alteration, and Repair (BEMAR) and unmet space needs. A deficiency is a need to repair, replace or alter buildings and structures. These deficiencies are typically beyond the scope or resources of the Facility Managers and their staff or have been overlooked and discovered during a Facilities Condition Survey. FEDS is used to:
- Compare an installation’s condition to other IHS installations
- Define regular maintenance requirements
- Define capital repair and replacement projects
- Develop cost estimates
- Eliminate conditions that are either potentially damaging to the property or present life safety hazards
- Identify energy conservation measures
- Better forecast the facilities budget
Facility Condition Assessment Program
The Facilities Condition Assessment Program (FCAP) is a process that incorporates a schedule for surveying IHS facilities to assess their condition which is reported and documented in the HFDS. This data may then be used to plan and implement the repair and modernization of IHS facilities, including the repair, modernization, and replacement of equipment and other systems and components.
The objective of the FCAP is to ensure that:
- Good facilities condition data are available and used in the decision making process at all levels of IHS
- Data are developed at a reasonable cost
- Data are evaluated using a consistent methodology across all Area Offices
The FCAP applies to all Government-owned and direct leased IHS facilities and is optional for Tribally-owned healthcare facilities that provide data to HFDS. The FCAP program may be used, but is not required, for Government-owned quarters. However, Area Offices must report the condition of Government-owned quarters by other means if the FCAP is not used (e.g., through change of occupancy inspections).
Responsibilities of the Clinical Engineering Program include:
- Provide technical support for clinical equipment throughout the IHS including scheduled and unscheduled maintenance and maintaining parts inventories
- Document actions and test results within the Computerized Maintenance Management System
- Perform incident investigation and equipment performance analysis as required
- Develop and/or update emergency and safety plans related to use and operation of critical patient care equipment
- Review patient care equipment safety alert and recall notices and take appropriate actions to ensure the affected equipment is tested or removed from service where appropriate
- Develop evaluation criteria to compare patient care equipment and devices under consideration for purchase
Accurate clinical diagnosis and effective therapeutic procedures depend in large part on healthcare providers using modern and effective medical equipment/systems to assure the best possible health outcomes. IHS and tribal health programs manage approximately 90,000 biomedical devices supporting laboratory, medical imaging, patient monitoring, pharmacy, dental, physical therapy and other specialties valued at approximately $500 million. With today's medical devices/systems having an average life expectancy of approximately six years and rapid technological advancements, medical equipment replacement is a continual process. It is necessary to replace worn out equipment or provide equipment with newer technology to enhance the speed and accuracy of diagnosis and treatment.
Many healthcare services delivered by IHS require biomedical equipment. Each healthcare facility must be equipped to meet its mission and IHS continues to explore innovative methods and new technologies to provide healthcare. Medical equipment is acquired for IHS and tribal healthcare facilities either as a part of construction of a new facility or with funds appropriated specifically to purchase equipment. There are two components to the medical equipment program: management of existing medical equipment, and funding/acquisition of new medical equipment.
Medical Equipment Management
To help meet the requirements of accrediting bodies, biomedical engineers and technicians use a computerized maintenance management system to manage and track service/repairs of medical equipment. IHS deploys state-of-the-art technology to bring primary care and specialty services to remote locations reducing geographic barriers between remote sites and healthcare providers. For example, remote sites use telemedicine to provide x-rays and digital images to distant healthcare providers. Telemedicine also enables communities to communicate through video conferencing during emergencies when transportation is difficult or impossible.
The Indian Health Service (IHS) Realty Management program ensures that federally owned real property (buildings, land and structures) are developed, managed, utilized and accounted for in a timely and efficient manner. The program’s transactions range from acquisition, demolitions, transfer and the use and occupancy of IHS-owned real property. Realty executes instruments and agreements allowing the use of IHS real property by Federal agencies, tribes, and public and private entities. It also provides guidelines, procedures, and reporting requirements for the acquisition, utilization, and disposal of IHS-owned assets.
The IHS Quarters Management Program ensures the availability of safe, suitable housing for essential personnel required for healthcare services delivery. It develops, implements, and manages federal quarters policies and guidance to Area and Service Units housing and tenant managers servicing their housing. Oversight of the Area and Service Units’ operation and management of their quarters sites also includes utilizing the Department of Interior’s Internet Quarters Management Information System (iQMIS) to calculate local rent and rent-related charges for housing units, utilities, appliances, and services in accordance with OMB Circular A-45.
Healthcare Facilities Data System (HFDS)
The HFDS contains data related to IHS real property, lease holdings and tribal healthcare buildings. These include, but are not limited to, Federal Real Property Council data elements, Maintenance & Improvement and Equipment funding allocations, Facilities Engineering Deficiency System , Self Governance, Energy Management, Stewardship (Historic Preservation) reporting and Asset Management.