May Tribal Consultation and Urban Confer Recap: A Focus on Four Directions Warehouse

by Jeanette Kompkoff, Director of Division of Health Information Technology Modernization and Operations, Office of Information Technology, Indian Health Service

June 13, 2025

The Indian Health Service Health Information Technology (IT) Modernization Program hosted its first tribal consultation and urban confer session of 2025 on May 15. Participants from across Indian Country joined the virtual session, which focused on the program’s progress in enterprise design activities, pilot site preparation, and the Four Directions Warehouse (4DW) initiative. The 4DW is the program’s cloud-based environment that will store, organize, and provide secure access to legacy clinical data currently accessible in the Resource and Patient Management System (RPMS).

The event began with an opening by John “Stickboy” Oxendine of the Lumbee Tribe. The session then reaffirmed the program’s vision: to provide the best possible Electronic Health Record (EHR), managed for and by its users, that supports high-quality health care through sustainable, modern, and easy-to-use tools. The program’s guiding principles of human-centered design, collaboration across the IHS, tribal, and urban system, and continuity of care were underscored by IHS Chief Information Officer Mitchell Thornbrugh. Thornbrugh also outlined the 2025 program timeline, which includes ongoing enterprise design workshops, development of end-user training materials, and alignment efforts at pilot sites.

Chief Medical Information Officer Dr. Howard Hays offered updates on the Enterprise Collaboration Group (ECG), a critical partner body composed of subject matter experts from IHS, tribal, and urban Indian organization sites. The ECG continues to play a leading role in informing PATH EHR configuration and will remain engaged in iterative system updates after the conclusion of the design workshops.

The Four Directions Warehouse was the focus of this session. DHITMO Engineering Branch Manager Charles Cross and DHITMO System Engineer Merlin Lucero introduced 4DW as a secure, cloud-based repository. It is designed to store, safeguard, and aggregate legacy clinical data from both RPMS and non-RPMS systems. 4DW will support the seeding of PATH EHR, satisfy record retention requirements, and allow historical data access, while sunsetting legacy servers. 4DW supports a smooth transition to PATH EHR by securely archiving historical clinical data, reducing system burden, and enabling safe, informed care through improved access and interoperability.

The session concluded with an open dialogue between program leadership and tribal and urban partners, facilitated by Senior Organizational Change Manager Kimberly Shije. Participants raised questions about data migration, organizational support for using 4DW, and strategies for retiring legacy systems. These insights will help guide future program activities and support the successful deployment of PATH EHR.

We are grateful to those engaging and collaborating with IHS as we modernize health IT to strengthen health care delivery across Indian Country.

	Register for 2025 Tribal Consultation and Urban Confer Sessions The Health IT Modernization Program is committed to connecting and collaborating with our partners through informative sessions and open forums in tribal consultation and urban confer sessions. Check out the program’s latest Dear Tribal Leader Letter and Dear Urban Indian Organization Leader Letter and enclosure announcing the dates and topics for 2025 sessions. Register now using the links below: August 7 – PATH EHR Scope and Capabilities November 6 – Pilot Site Implementation Pathway
	Statement of Interest (SOI) We invite our partners to complete a non-binding document to help IHS understand which tribal and urban sites are interested in becoming part of the PATH EHR partnership. The SOI form may be submitted by email to modernization@ihs.gov at any time. Federal sites are not required to complete the SOI form.
	Focus Groups The Health IT Modernization Program Awareness Survey intends to measure the effectiveness of the program's communications, assess our partners' awareness and perception regarding PATH EHR, and determine tribal and urban partners' interest in actively participating in program initiatives. The input you provide through this survey provides the IHS invaluable information to better understand the reach of our engagement efforts across Indian Country and how we can continue to circulate information about the PATH EHR implementation. Take the survey here.
	Connect with us! Visit the website for more information about the IHS Health IT Modernization Program Sign up to receive the IHS Updates for Tribes and Tribal and Urban Indian Organizations Sign up to receive Health IT Modernization Program email updates through the Listserv Read IHS Blog posts on modernization Follow IHS on Facebook, LinkedIn and X (formerly known as Twitter) to stay up to date on events, collaboration opportunities and general program updates

Jeanette Kompkoff, Director of Division of Health Information Technology Modernization and Operations, Office of Information Technology, Indian Health Service

Jeanette Kompkoff serves as the director of the Division of Health Information Technology Modernization and Operations within the IHS Office of Information Technology. This division was established to oversee the Health IT Modernization Program and provide strategic guidance to align the goals of the program with the IHS mission. As director, Kompkoff provides oversight and management of software development and maintenance, while also managing deployment, staff training, and maintenance of numerous health IT applications and major electronic health record system updates.

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