The IHS EHR Project

(From IHS provided material)

The Indian Health Service Electronic Health Record (IHS EHR) is an ongoing project that was conceived after successful implementation of the VA VistA connectivity engine.   For example, a few providers at the Crow Indian Hospital have used a prototype electronic health record based on a graphical framework developed by the VA since summer 2002.  It allows for direct entry of orders and prescriptions by the provider, and for use of keyboard entry or templates for clinical notes. This important preliminary work has served both to illustrate the possibilities for an electronic health record in the Indian health care setting and to disclose a number of issues that need to be addressed before the IHS EHR project is ready for general deployment.

The IHS EHR is comprised of two key parts: the Framework and the clinical functions that operate within it.  The Framework is not an end user application, but is a technical infrastructure that supports graphical user interface (GUI) development in the Mumps environment (MSM, DSM or Caché). The Framework, originally developed by the Veterans Health Administration (VHA), displays various clinical functions in a graphical user interface (GUI) format.

The IHS EHR project is designed to integrate clinical and administrative information from any clinical RPMS application into a single, easy to use interface.

The focus of the project was to provide an architecture that features most of the characteristics of the VistA technology so that providers within IHS will be able to manage all aspects of patient care by providing a full range of functions for data retrieval and capture to support patient review, encounter and follow up.

Even though IHS EHR was planned after careful study of VistA technology and other health information systems, assessment and incorporation of user feedback concerning a robust EHR system that will be able to support enterprise-wide clinical applications was a very important activity considered during the initial preparation.  User feedback is especially important in light of prior negative experiences with the implementation of Electronic Health Records.  Electronic Health Record Clinical Advisory Team (EHR-CAT) has been formed to determine the specific clinical requirements for an electronic health record. The EHR-CAT consists of physicians, nurses, and other practicing clinicians representing IHS and Tribal facilities across the country. This group met and actively reviewed as well as refined the near and long-term plans for EHR functionality within the Indian Health Services setting.

The IHS·EHR utilizes a technical infrastructure, or framework that displays various clinical functions in a graphical user interface (GUI) format. These clinical functions, or "components," are a collection of discrete objects that are visually and operationally integrated within a graphical user interface (GUI) so that the provider sees one "view" of the clinical process.

December 2001 ITSC released the first multifunctional Graphical User Interface (GUI) for RPMS, called Patient Chart. Many I/T/U facilities have implemented this application, which facilitates access to patient information contained in a variety of RPMS packages and permits direct entry of problems, measurements, and other data. Create a link here:

Ref:  http://www.ihs.gov/Cio/GUI/gui-patient-chart-resources.asp (Patient Chart application resources link --- graphical user interface)

The IHS Electronic Health Record project as is currently envisioned will be highly componentized and customizable to the needs and capabilities of the various facilities that use it. The plan is that, instead of deploying the system as one monolithic product, componentization will minimize the amount of upgrading of “back-end” Resource and Patient Management Services (RPMS) package that needs to be done before the EHR can be used.

One advantage that is most likely to be derived from this component-based technical is that, each facility can select the clinical components they want to run and determine their own pace for software and other infrastructure upgrades. This creates room for the desired customization of application integration that is needed on individual facility levels.  Indian Health Services (HIS) feels it is more effective to develop and deploy EHR components that can be integrated incrementally at participating hospitals and clinics. There is no doubt that the availability of a variety of solutions will allow the system to be flexible in meeting the needs of different facilities, which are at various levels of infrastructure and technology sophistication. The ultimate aim is to develop technology solutions that are easily extensible to tribes and other rural communities, and more importantly, to be able to ensure much needed application connectivity needed within enterprise-wise level.

It is still hoped that, the componentization will allow facilities to set their own pace for upgrading their systems while still taking advantage of the electronic health record.

In a nutshell and with the appropriate "back-end" RPMS components, a facility will have objects that support such functions as:

patient lookup; clinical encounter documentation; on-line ordering; results retrieval decision support; problem list management; coding support; referral generation; report retrieval and image viewing.

To ensure smooth preparation and fast adoption the envisioned HER, the project team currently has ported the existing Patient Chart functions into the graphical framework used in the Crow EHR prototype. This framework allows for integration of a variety of RPMS and non-RPMS programs into a display that permits the user to have simultaneous access to all of them.

Not only that, but also plans were made to alpha test an EHR prototype at another facility during the spring of 2003. It was hoped that this test would utilize formal benchmarking and evaluation processes for both technical installation and end-user acceptance.   Another rationale behind this prototype testing is that, lessons learned will be used to document planning, installation, and training procedures for I/T/U-wide deployment. With this prototype testing, developers are currently transferring RPMS GUI functions from the existing client-server Patient Chart infrastructure to the new Framework. The Patient Chart clinical components will retain the same functionality within the Framework.