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Native American Heritage Month Presentation (Text Version)

Slide presentation from the AHRQ 2009 conference.

On September 19, 2009, Lisa Dolan-Branton made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (1.56 MB).

Slide 1

Slide 1. Are EHR's enough for population health?

Are EHR's enough for population health?

Lisa Dolan-Branton

Indian Health Service

AHRQ Annual Conference Sept 15, 2007

Slide 2

Slide 2. Objectives


  • Indian Health Service.
  • HIT Strategic Priorities.
  • Population Health
    • What matters.

Slide 3

Slide 3. Who are we?

  • A comprehensive health service delivery system for approximately 1.9 million of 3.3 million American Indians and Alaska Natives from 562 federally recognized tribes in 35 states.
  • FY 2009 spend authority is over 4 billion.
  • Indian Health Service total staff consists of about 15,600 employees, which includes approximately 2,500 nurses, 1600 CHRs, 900 physicians, 500 pharmacists, and 300 dentists.

Slide 4

;Slide 4. The IHS Mission

The IHS Mission, in partnership with American Indian and Alaska Native people, is to raise their physical, mental, social, and spiritual health to the highest level.

Slide 5

Slide 5. Images of Native Americans  

Slide 6


Mortality Rate Disparities

(rates per 100,000 population)

  AI/AN Rate 2002- 2004 US All Races Rate 2003 Ratio: AI/AN to US All Races
ALL CAUSES 1027.2 832.7 1.2
Tuberculosis 1.7 0.2 8.5
Diabetes 74.2 25.3 2.9
Unintentional Injuries 94.8 37.3 2.5
Suicide 17.9 10.8 1.7
Cervical cancer 4.7 2.5 1.9
Infant deaths1 11.7 6.9 1.7
Pneumonia/Influenza 32.3 22.0 1.5

1Infant deaths per 1,000 live births.

Slide 7

Slide 7. A Broader Picture of Health

A Broader Picture of Health

  • Personal Health.
  • Family Health.
  • Community Health.
  • Public Health.
  • Population Health.
  • Transparency of Data.

Image a Venn diagram showing how different facets interact in health.

  • Patient and community sharing of information 
  • Commitment to Health Equity.

Slide 8

Slide 8. IHS Strategic Priorities

IHS Strategic Priorities

  • Build and sustain healthy communities.
  • Provide accessible, quality healthcare.
  • Foster collaboration and innovation across the Indian Health network.

IHS Strategic Priorities are supported by technology initiatives, not driven by them.

Slide 9

Slide 9. Care Model for the Indian Health System

Care Model for the Indian Health System

Image of a flowchart showing the care model.

Improved health and wellness for American Indian and Alaska Native individuals, families, and communities.

Slide 10

Slide 10. Care Model for the Indian Health System

Care Model for the Indian Health System

Same image as Slide 9 with the following information superimposed over the flowchart.

  • Use data at the point of care.
  • Facilitate individual patient care planning.
  • Identify relevant subpopulations for proactive care.
  • Provide timely automated reminders for providers and patients.
  • Share information with patients.
  • Allow staff to coordinate care.
  • Monitor performance of practice team and care system.
  • Involve the family, community and populations.

Slide 11

Slide 11. Resource and Patient Management System (RPMS)

Resource & Patient Management System (RPMS)

  • Developed in the 1980s.
  • Over 60 software applications.
  • Used at over 400 sites.
  • 'Every little thing she does is magic'.

Slide 12

Slide 12. PCC (Health data repository)

PCC (Health data repository)

Image of a diagram showing what types of data go in and out of a patient database.

Slide 13

Slide 13. Meaningful Use and Pop Health

Meaningful Use and Pop Health

  • Quality measures for populations.
    • Populated by patients.
    • Ability to report at POC as well as export.
    • Tracking of quality improvement.
  • Ability to share interoperable data with others
    • Immunization data sharing.
    • Lab data sharing.
  • Early sentinel awareness of public health issues
    • Use of iCARE.
      • Suicidal Behavior Surveillance.
      • CDC Nationally Notifiable Diseases.
      • H1N1

Slide 14

Slide 14. Screen Capture of RPMS Software

Screen shot of a patient database.

Slide 15

Slide 15. Screen Capture of RPMS Software

Screen shot of a patient database.

Slide 16

Slide 16. iCare Population Management

iCare Population Management

Screen shot of community alerts in the iCare Population Management web site.

Slide 17

Slide 17. iCare is used to . . .

iCare is Used to... (in descending order)

  • Track performance on GPRA and other national measures.
  • Manage and track group of patients with a chronic disease.
  • Pre-visit or clinic planning to care for patients with appointments on a particular day.
  • Manage and track patients assigned to specific provider.
  • Track patients who need or have received a specific service.
  • Track provision of age and gender-specific preventive care services.
  • Share panel among care team.
  • Target needs within a geographic area or community.

Facilities who are part of the IHS Learning Collaborative more frequently reported using iCare for all of these listed functions with the exception of targeting geographic areas.

Slide 18

Slide 18. H1N1


  • Decision made on a Friday to code query and export file.
  • Codes reviewed/ tested/ updated on Q man queries at large live database.
  • Query logic developed over 4 hours- based on previous quality work.
  • Export logic based on previous work done on bidirectional state based immunization data sharing.
  • Coding done in 8 hours.
  • Testing in 2 days on 3 mirror live data bases.
  • First exports received within 5 working days of initial decision.
  • Over 400 sites with passive nightly exports to Indian Health Service epi center.
  • Logic shared with private vendors.

Slide 19

Slide 19. Lessons Learned - or why could we do this?

Lessons Learned-or why could we do this?

  • Relied on ICD codes, not text based POV.
  • Our "EA" had been, by luck, designed to facilitate boolian logic queries (we knew had to have 'function' between the domains).
  • Applications developed in the last 10 years had relied on electronic queries of different data domains.
  • Export files had been previously developed.
  • Lessons learned had influenced data model decisions as well as understanding of most efficient ways to write M queries in our system.
  • Logic/ data model that supported population health.
    • EHR architecture MUST support pop health from the beginning.

Slide 20

Slide 20. What matters?

What matters?

  • Foresight.
  • Trust.
  • Commitment.
  • Adequate Resources.
  • Appropriate architecture for the Electronic Health Record to support population health.
  • Health Equity- keeping an eye on the ball.

Slide 21

Slide 21. Images of Native Americans

Indian Health Service

Current as of December 2009
Internet Citation: Native American Heritage Month Presentation (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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