Health IT-enabled infrastructure helps reduce American Indian and Alaska Natives health disparities

Larry Jessup and Nickol Todd | April 25, 2014

American Indian and Alaska Natives (AI/AN) face disproportionate health outcomes compared to other Americans.[1] The adoption and meaningful use of electronic health record (EHRs) technology may help to reduce this gap. Like other Americans, many of these individuals have multiple providers in multiple states and EHRs have the potential to provide reliable, consistent patient data that can follow patients wherever they get their care.

Another benefit of EHRs is that patients’ data can be directly transmitted from the EHR to public health facilities for longitudinal disease tracking. In addition, with burgeoning interoperability and health information exchange expanding into these communities, Indian Country is poised to see future positive impact on health outcomes.

But not every health care provider in Indian Country, or across Alaska, is using an EHR yet, or if they are using an EHR they may not yet have the capability to electronically share information safely and securely. ONC-funded Regional Extension Centers (RECs) across the United States have been assisting providers with adoption and implementation of EHRs in a meaningful way. The National Indian Health Board Regional Extension Center (NIHB REC), the REC for Indian Country, has partnered with regional Tribal health organizations to serve as the primary national resource responsible for ensuring that providers across the Indian Health System receive adequate support in optimizing the use of health information technology (health IT).

The NIHB REC is also working with HHS’ Indian Health Service (IHS) to provide complementary support to help providers use the new 2014 Certified Resource and Patient Management System (RPMS). This is the system used by IHS providers as well as tribal hospitals and clinics across the U.S. These Indian Health Service/Tribal/Urban Indian (I/T/U) health facilities provide health services to approximately two million American Indians and Alaska Natives located in 35 states, representing membership in 566 federally-recognized Tribes. The NIHB REC and its partner organizations also support adoption of commercial-off-the-shelf EHRs in Tribal and Urban Indian health facilities with the same commitment to achieving Meaningful Use of EHRs.

Over 1,100 NIHB providers have received over $25M in payments from the Medicare and Medicaid EHR Incentive Program. These incentives support the adoption and implementation of health IT across tribal territories, which is essential to preventing a digital divide between tribal health organizations and the wider health ecosystem.

Providers equipped with EHRs within Indian Country are already using the EHR as a tool to tackle the health challenges facing their patients. Mathiessen Memorial Health Clinic (MMHC) in rural Tuolomne County in Jamestown, California provides healthcare services through the generosity of Chicken Ranch Rancheria of the Me-Wuk Indians of California and the Mathiessen Family of Jamestown. MMHC (one physician and two nurse practitioners) went live on an EHR in 2009 with assistance from NIHB.

MMHC staff report success in “better tracking of patient’s health maintenance activities, easy access to patient history, more secure and better tracking of prescriptions with the use of e-prescribing, and being able to interface with hospitals and laboratories, resulting in a more complete medical record.”

EHR adoption is also positively impacting provider workflow and patient tracking within Indian Country. Data on better patient outcomes are still being evaluated but, as Dr. Howard Hays, acting chief information officer and director of IHS’ Office of Information Technology, poignantly states, “Health IT is an enabler, not a solution. IHS and our Tribal partners are experienced, seasoned users of health IT in the context of our commitment to providing high quality care to American Indian and Alaska Native people. Health IT has been a critical component of our process improvement and performance measurement initiatives for decades, and we expect to see even more positive impacts on health outcomes once interoperability and health information exchange are fully established.”

IHS, the NIHB REC, and partner organizations have developed the necessary infrastructure to advance the implementation of health IT and are continuing to work to ensure the nation’s Tribal Health System has the future potential of improved health outcomes and reduced disparities.

In memoriam of NIHB REC consultant, Tom Dewey Kauley, grandson of the great Kiowa Chief Lonewolf. His tireless service to better the health of Indian country will not soon be forgotten.


[1] “Indian Health Service The Federal Health Program for American Indians and Alaska Natives.” Disparities. N.p., n.d. Web. 8 Apr. 2014. <>.