New Indian Health Service EHR to cost billions of dollars

Agency will replace its legacy system, which currently consists of more than 400 separate local instances.

The Indian Health Service intends to replace its legacy electronic health record system with a modern EHR that will take seven to 10 years to implement and will cost American taxpayers billions of dollars.

That’s the estimate that Rear Adm. Michael Weahkee, IHS principal deputy director, provided on Wednesday to a Senate appropriations subcommittee.

“Our current aging system exists as more than 400 separate instances that are maintained at individual locations throughout the country,” testified Weahkee. “Replacing this antiquated system with a single, modern national system would enable IHS to enhance medical quality, maximize the time that our doctors, our nurses and other healthcare professionals have to provide direct patient care, and increase the security of our patients’ medical records.”

IHS, an agency of the Department of Health and Human Services, currently uses the Resource and Patient Management System (RPMS)—which was developed in close partnership with the Department of Veterans Affairs—to manage its clinical, financial and administrative information.

However, in his testimony, Weahkee said that RPMS is “hobbling our efforts to share medical information efficiently, improve monitoring of medical quality and recover critical third-party financial resources.”

President Trump’s Fiscal Year 2020 budget request for IHS includes an initial $25 million EHR investment to begin transitioning to a replacement for RPMS. According to Weahkee, the funding is critical to allow the agency to conduct planning for the seven- to 10-year transition period and to “address key infrastructure gaps necessary to implement a modern EHR.”

Also See: President’s budget has $25M to fund new Indian Health Service EHR

In March, Weahkee told another Senate committee that IHS is completing a year-long Health IT Modernization Research Project—in collaboration with the HHS Office of the Chief Technology Officer—to help inform the agency regarding potential options to either replace or modernize its existing HIT infrastructure.

However, Weahkee’s testimony on Wednesday confirmed that IHS intends to outright replace RPMS with a new EHR. “I believe this transition represents an opportunity to meaningfully impact the care received by our patients,” he said.

Weahkee testified that IHS is looking to leverage the lessons learned from the Department of Defense and VA efforts to establish a single, common Cerner EHR system between those two agencies. For its part, the VA’s EHR modernization is currently estimated to cost $16.1 billion over 10 years.

“It is a significant undertaking that we have ahead of us and I do believe that the B word—the billion word—is well in range,” observed Weahkee. “We are learning from the VA’s acquisition how much we should anticipate.”

While he said IHS is hoping to save as much money as possible for American taxpayers, Weahkee acknowledged that “with the number of systems that we’ll be replacing, this will be a sizeable request.”

A big focus of the EHR acquisition will be on interoperability with VA, DoD and other healthcare systems, according to Weahkee.

Rear Adm. Michael Toedt, MD, chief medical officer at IHS, added that the agency has been in communication with VA and DoD about “best-of-breed” governance models.

“We want to make sure that we’ve got the voice of our clinicians so we can decrease provider burden,” testified Toedt. “We also want to make sure that we improve the revenue cycle management.”

In addition, he said American Indians and Alaska natives will benefit from a modern EHR system that will include electronic scheduling and access to personal health records.

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