Indian Health Service Modernizes Health Information Exchange Across the U.S.

J2 Interactive establishes the InterSystems interoperability infrastructure required for the health information exchange.

The Challenge

Nestled within the Department of Health and Human Services (HHS), The Indian Health Service (IHS) is responsible for providing comprehensive, culturally appropriate health services to members of federally recognized Native American Tribes and Alaska Native people. In pursuit of its mission to develop “healthy communities and quality health care systems through strong partnerships and culturally responsive practices,” IHS created the Health Information Technology Modernization Program in 2023. This program’s goal: replace the outdated HIT systems with a new, unified electronic health record (EHR) to serve any of the 574 federally recognized tribes choosing to participate.

Like many healthcare systems, siloed clinical information capture, storage, and a lack of digital sharing capabilities impeded care for patients, many of whom face systemic disparities. Providers serving the tribes were utilizing a myriad of disjointed information-keeping practices: some maintaining paper patient records or PDFs stored locally in folders, while individuals and their families would hand-carry medical histories and medication lists – often with incomplete or missing data – from clinician to clinician. Information sharing between providers was often carried out by fax, and when electronic clinical data did exist, it lacked standardization, completeness, and technical conduits and connectivity for sharing.

Information from 37 states, representing over 2.56 million people, had to be collected from different EHRs and amalgamated into one place, an already difficult endeavor paired with the unique challenges of IHS’s Health Information Exchange (HIE) initiative.

The Solution

Recognizing the challenges of creating this new unified EHR, IHS began collaborating with J2 Interactive, InterSystems, GDIT, and Chickasaw Nation Industries.

J2 Interactive worked with the other collaborators to create the Four Directions Hub (4DH) unified patient record, data warehouse, and interoperable infrastructure required for sharing and standardizing crucial legacy and new electronic health data, laying the foundation for modern interoperability and ensuring the HIE will be able to support the new EHR solution.

Bringing extensive expertise with HIEs and interoperability standards, J2 helped design, develop, and implement the IHS InterSystems HealthShare environment and its supporting component software: Information Exchange, Clinical Viewer, and Patient Index.

J2 also supported the creation of a data warehouse to store information from the legacy electronic clinical data and accounting technology, the Resource and Patient Management System (RPMS). J2 then integrated the RPMS into the new InterSystems instance as it developed.

To serve the development of the HIE and to support improved healthcare delivery, J2:

• Constructed the 4DH unified patient record, compiled from data within the federal, tribal, and urban IHS sites
• Completed the interoperable data pipeline infrastructure needed to connect providers, IHS, communities, and individuals
• Architected and deployed a single sign-on solution
• Set up, monitored, and supported critical required components such as the HL7 Consolidated Clinical Document Architecture (C-CDA) pipeline and HL7 ADT messages
• Determined and demonstrated 4DH compliance with Trusted Exchange Framework and Common Agreement (TEFCA) guidelines
• Test piloted FHIR API integration with third-party vendors
• Connected HealthShare to the Department of Veterans Affairs’ EHR for two-way data flow
• Supported data management and data-sharing requirements for patient care / clinical workflows

The Result

The development of the 4DH patient record was lauded as a “well-oiled machine” by GDIT, reflecting the successful collaboration between IHS and J2. In addition, collaborations with IHS and our modernization efforts are proceeding so well that GDIT SESS named J2 InterSystems HealthShare subject matter expert Lawrence Williams as their “Employee of the Quarter” in their July 2023 newsletter. He has been instrumental in the project’s ongoing success and stakeholder satisfaction.

Jeremiah Hebert, government healthcare program manager at J2, has worked extensively on this program and feels a personal commitment to its success. He shares, “Previously, I spent twenty years working in a hospital system that provided care for an underserved, high-poverty population. I observed first-hand the positive impact access to high-quality care had on their health and well-being. Now I’m part of a team helping IHS modernize, empowering tribal nations with the systems needed to provide similar care, which is immensely gratifying to me and my team.”

J2 is proud to lend our extensive HIE, interoperability, and InterSystems expertise to the IHS, positively impacting the care and lives of the many tribal members receiving clinical care. The IHS Modernization project is enhancing the standard of work for providers while improving the patient experience and quality of care.