# Presentation: 513051

## Howard Hays, MD, MSPH

**AHIC Workgroup**
**January 11, 200&**

## Topics

- Background – Indian Health Service
- RPMS Health Information System
- RPMS Electronic Health Record GUI
- RPMS Case Management Applications
- RPMS Clinical Reporting System
****Screenshots contain fabricated data****
****for demonstration purposes only****

## Indian Health Service

- Provides comprehensive care to over 1.6 million American Indians / Alaska Natives
- Nearly 600 health care facilities
- 						Federal		Tribal
- Hospitals				    36		   13
- Health Centers			    61		  158
- Health Stations			    49		    76
- Residential treatment centers	      5		    28
- Alaska village clinics		    		   170
- Urban programs				    34

## Indian Health Service

- Over 50% of programs are operated by tribes through tribally run compacted or contracted facilities
- 34 urban programs are contracted to provide care to AI/AN populations in metropolitan areas
- Remaining care is provided through federally operated ‘direct’ programs (majority of the user population still receives care in direct programs)

## IHS Health Information Solution since 1984
RPMS is an integrated Public Health information system
Composed of over 60 component applications
Patient and Population based clinical applications
Patient and Population based administrative applications
Financially-oriented administrative applications
www.ihs.gov/CIO/RPMS

- RPMS is an integrated Public Health information system
- Composed of over 60 component applications
- Patient and Population based clinical applications
- Patient and Population based administrative applications
- Financially-oriented administrative applications
- www.ihs.gov/CIO/RPMS

- Resource & Patient Management System

## VistA and RPMS

- Common programming/database architecture (M/Cache)
- Applications shared by VHA and IHS
- Most developed for use in VHA and adapted for IHS
- Some developed for use in IHS and adapted for VHA
- RPMS focused around Visit data contained in Patient Care Component (PCC)
- IHS uses HRN instead of SSN

## IHS is not VHA

- Cradle to grave care
- Pediatrics
- Prenatal and obstetrical care
- Smaller facilities, more rurally located
- Decentralized administration
- Tribal autonomy
- Community and population-based mission
- Very modest IT staffing & budget

## RPMS Integrates MultipleClinical Systems

## RPMS Electronic Health Record

- Graphical User Interface to RPMS
- User-friendly and intuitive access to RPMS database for clinicians and other staff
- Componentized to allow incorporation of CPRS functionality as well as new capabilities developed within IHS
- Proprietary “framework” for presentation of various GUI components
- Licensed from Medsphere Systems

## Slide 10

## Slide 11

## RPMS EHR Commonalities with CPRS

- Notifications
- Text Integration Utility – note author
- Reminders application
- IHS-specific national reminders
- Consults application
- RPMS has separate referred care application
- Order Entry, Lab, Radiology, Pharmacy
- Numerous IHS customizations esp with medication management

## Oral Contraceptive Help

## Slide 16

## Reminder Dialogs

- Resolves pending reminders
- Create orders
- Document education
- Creates a TIU document of the intervention

## IHS-Specific EHR Components

- Medication management interface
- Immunizations
- Patient Education
- Problem List
- Diagnosis entry and coding
- Superbills and CPT coding
- Numerous others

## Slide 19

## Additional Development

- Well Child Care
- CDC Growth Charts
- Breastfeeding information
- Developmental screening
- Well Child Knowledgebase
- Prenatal Care
- Data collection for first & subsequent prenatal visits
- Data carries over to future pregnancies
- Flowchart presentation where appropriate

## RPMS Behavioral Health System

- First complete electronic record in IHS (1990s)
- Ability to document:
- 1:1 patient encounters
- Group encounters
- Patient Education, Health Factors and screening (depression, EtOH, DV)
- Treatment Plans and Treatment Plan reviews
- Case Management Information
- Incidences of Suicidal Behavior
- Integrated with RPMS medical information

## IBH Screenshot

## RPMS Case Management Applications

- Registry-based systems with reminders, performance indicators, and population-based reporting
- Immunizations
- Diabetes Management System
- Asthma Management System
- Women’s Health
- HIV Management System
- Integrated Case Management (iCare)

## Integrated Case Management (iCare)

- Graphical interface for a fully integrated case management system
- Decision support and patient management for multiple chronic conditions
- Nationally defined preventive and disease-specific healthcare reminders
- Customizable patient panels
- Quick performance views using CRS/GPRA logic for any patient or group of patients
- Plan to incorporate current and future disease-specific register systems (DM, Asthma, HIV/STD, CVD, WH, etc.)

## Slide 27

## Slide 28

## Clinical Reporting System (CRS)

- Tracks multiple performance measures for local use as well as national reporting
- Available in both GUI and roll-and-scroll versions

## CRS 

- Identical logic ensures ***comparable*** performance data across all facilities
- Updated annually to reflect changes in the logic descriptions and to add new measures
- Local facilities can choose to transmit data for National GPRA, Elder Care and HEDIS performance reporting to their Area
- Area Offices can produce aggregated Area performance reports

## CRS 2006 Clinical Measures

- 21 **GPRA** treatment and prevention measures
- 23 **other key clinical measures**  Examples:
- Diabetes Comprehensive Care
- Osteoporosis Screening
- Comprehensive CVD-Related Assessment
- 21 **HEDIS** measures
- 23 **Elder Care** measures (patients 55+)
- 17 **CMS** (hospital) measures

## Sample Performance Summary

## Discussion

- RPMS:  www.ihs.gov/cio/rpms
- EHR:  www.ihs.gov/cio/ehr
- RPMS Clinical:  www.ihs.gov/cio/ca
- CRS:  www.ihs.gov/cio/crs
- GPRA:  http://www.ihs.gov/cio/crs/crs_gpra_reporting.asp