Indian Health Service IT Exec Describes Plans for EHR Transition

Dec. 8, 2023
Jeanette Kompkoff, director of the Division of Health Information Technology Modernization and Operations, says the most challenging aspect will be ensuring a smooth data migration

Jeanette Kompkoff serves as the director of the Division of Health Information Technology Modernization and Operations (DHITMO) at the Indian Health Service (IHS). In a recent interview, conducted via e-mail, with Healthcare Innovation, she detailed IHS’ recently announced plans to transition from a home-grown EHR to Oracle Cerner. 

The IHS, an agency in the U.S. Department of Health & Human Services, provides health services for approximately 2.8 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 states. 

DHITMO, which was established to oversee the Health IT Modernization Program, sits within the IHS Office of Information Technology. As the DHITMO director, Kompkoff provides oversight and management of the enterprise electronic health record (EHR) system and its maintenance. She also manages the acquisition activity for numerous health IT services and products that supplement the EHR investment and oversees a team of more than 80 federal and contract IT personnel who support the program’s efforts. 
Kompkoff joined the IHS in 1988 and brings nearly 35 years of health IT implementation expertise to the IHS Health IT Modernization Program. During this time, she created infrastructure requirements, led multiple software development projects, managed multimillion-dollar IT contracts, and led national teams to implement and manage large and complex IT investments, including the IT modernization effort.
Healthcare Innovation: Can you explain some of the reasons why the IHS is working to replace the Resource and Patient Management System (RPMS) with a commercial enterprise health IT suite?

Kompkoff: Implementation of modern technology is essential for IHS to enhance the user experience for patients and providers, centralize the system for rapid, responsive support from technology experts nationwide, and bolster disaster recovery and continuity of care. This modernization aims to minimize system disruptions and streamline access to patient data across facilities, granting patients greater control over their care and providing providers with a comprehensive care overview. By transitioning from the RPMS to a commercial enterprise health IT suite, IHS is addressing these critical needs, laying the groundwork for improved health care delivery and operational efficiency.

In listening sessions that discussed findings of the 2018 analysis of the current state of the agency health IT system, 60 percent of the Tribal and Urban Indian Organization (UIO) partners were in agreement that full replacement of RPMS is the most appropriate and realistic modernization solution. In a comprehensive study conducted by the U.S. Department of Health and Human Services (HHS) between 2018 and 2019, deficiencies in the RPMS technology used across IHS, Tribal and Urban medical facilities came to light, resulting in a strong recommendation to replace the system. Highlighted by two critical reports from the HHS Office of Inspector General, these shortcomings called for immediate action. Compounding the issue, the impending replacement of the U.S. Department of Veterans Affairs’ VistA system, upon which the IHS has dependencies, underscores the urgency for IHS to transition to a commercial enterprise health IT suite, ensuring the continued delivery of top-tier health services. 

HCI: Could you give a timeline of what has been done so far in terms of planning and engaging with stakeholders — and what the next steps are? For instance, has an RFP process started? 
Kompkoff: Across the Health IT Modernization Program, the IHS seeks ways to actively share updates with, listen to, and obtain inputs from partners to build the enterprise EHR solution. IHS desires a partnership in the journey to build the enterprise EHR solution using governance frameworks that promote collaboration.   
One of the central principles of the IHS Health IT Modernization is to build and operate the enterprise EHR solution with our partners, not for them. The Enterprise Collaboration Group will serve as a forum for partners to provide input regarding the configurations and workflows that the enterprise EHR solution provides. Additional opportunities for input will be available through focus groups, with initial topics focused on interoperability, implementation, data management and analytics.
HCI: What kind of appropriations have there been so far for this project? Is there a projected overall cost and timeline?  
The IHS Health IT Modernization Program is a comprehensive, multi-year initiative aimed at updating health IT systems across IHS, Tribal, and Urban Indian health care programs, following a clear timeline from research and planning stages in 2018 to 2021, to buying and building in 2022 to 2024, and finally training, developing, and operating from 2025 onwards. Financially, the project has a Life Cycle-Cost Estimate ranging from $4.5 to $6.2 billion to be expended throughout a 10-year period, accounting for the necessary infrastructure to support an enterprise EHR solution. The Fiscal Year 2024 President’s Budget Request includes a request for $913 million for the initiative, with an additional $1.1 billion per year to be requested for FY2025 through FY2029, totaling $5.5 billion over five years to provide stable funding to support the planned duration. Each budget request is subject to annual congressional approval.  
HCI: The Military Health System and VA are in the process of upgrading to a new enterprise system from Oracle Cerner. Are there interoperability advantages for IHS to be on the same system as the military and VA?

Kompkoff: In November 2023, the Indian Health Service announced that General Dynamics Information Technology, Inc. will build, configure, and maintain the enterprise electronic health record solution using Oracle Cerner technology. The enterprise EHR solution will be shared by both federal and non-federal partners and prioritizes Tribal sovereignty and our collective mission of improving the health status of American Indian and Alaska Native people. 

While the VA and DoD efforts and the IHS Health IT Modernization Program will both use Oracle Cerner technology, every instance of an EHR build is different. The IHS enterprise EHR solution will be a different product than the VA and DOD products and it will be implemented differently. IHS has had successful implementations of similar products throughout Indian Country and we have the advantage of gaining lessons learned from our federal, Tribal and Urban partners and will build the system with our users. Interoperability will be supported using certified technology between VA, DOD and commercial partners.

HCI: What are some elements of the IT governance approach that DHITMO is taking with this project?
Kompkoff: IHS is proactively establishing a collaborative governance structure to guide the development of an enterprise EHR solution. The Executive Steering Committee will manage federal functions, ensuring alignment with our goals. The federally led Enterprise Collaboration Group, supported by IHS informatics, provides recommendations for the enterprise EHR solution’s design and configuration. This comprehensive governance approach, spearheaded by the DHITMO, underscores our commitment to a collaborative and effective development process for the enterprise EHR solution. 
HCI: What do you foresee as the most challenging aspect of the transition?
Kompkoff: The transition to an enterprise EHR solution is complex. We anticipate the most challenging aspect to be ensuring a smooth data migration, aiming to prevent data issues such as data loss, misinterpretation, or mis-mapping fields. To minimize downtime and maintain productivity, we plan to conduct robust testing at facilities prior to go-live. To ensure sites have the proper infrastructure, staff, and workflows before implementing the solution, we are actively incorporating feedback from our partners across Indian Country. Clear communication and strong leadership are crucial to navigate this transition, preventing misunderstandings and errors, ensuring a successful implementation that aligns with our mission, and serves our patients and providers efficiently. 
HCI: Are there many issues related to data migration from legacy systems? 
Kompkoff: IHS is proactively addressing several issues related to data migration from legacy systems to ensure seamless access to complete information for both patients and providers in the enterprise EHR solution. Key challenges include preventing data loss, avoiding misinterpretation of information, and ensuring accurate mapping of data fields between the old and new systems.
HCI: Are some clinics in the system already using some other type of EHR rather than RPMS?  And if so, will they be allowed to stay on those rather than switching to the new system?
Kompkoff: All federally recognized Tribal nations and Urban Indian programs that operate their own EHR can opt into the new system at any time or continue to use a system of their choice. If a Tribal or Urban program is currently using RPMS, they will need to either adopt the IHS selected enterprise EHR solution or pursue a different system of their choice.  All IHS-operated facilities will have RPMS replaced with the selected IHS enterprise EHR solution.
HCI: I read that the proposed architecture involves establishing a new database – “Four Directions Warehouse (4DW)” – in a federal cloud environment. Can you describe briefly what Four Directions will involve?

Kompkoff: Four Directions Warehouse is set to be a central repository in a federal cloud environment, with long-term storage solutions for comprehensive RPMS data archive and capabilities to incorporate data from multiple EHR solutions. It enables seamless access to clinical data for both patients and providers across various facilities, boosting visibility into patient care needs. 

The system facilitates the use of legacy information without the need for loading the full history of patient healthcare data into the enterprise EHR, and it requires no maintenance of RPMS systems. With robust security controls and a comprehensive data analytics environment, 4DW ensures the protection of patient data on the IHS-managed platform, streamlining the transition to modern healthcare solutions while laying the groundwork for advanced patient care optimization. 

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