Analyzing Legacy Health Information Technology Insights and Strategies from a US Indian Health Service HIT Study

Analyzing Legacy Health Information Technology: Insights and Strategies from a US Indian Health Service HIT Study provides a detailed presentation of the unique and original methodology, findings, and products of a year-long analysis of the Indian Health Service health information technology system, including recommendations for its modernization. Included in the book are reproducible take-aways to guide and elevate HIT modernization efforts throughout other situations, including a site visit kit, a HIT capability maturity model, and a HIT roadmap.

The book discusses a comprehensive approach to modernization decision making: the development of a comprehensive qualitative, quantitative, and research-based platform to identify and evaluate approaches to modernization, with a reliance on human centered design processes. The evaluation of HIT modernization for the Indian Health Service included researchers, cutting-edge technology innovators, veterans of healthcare in Indian country, and icons of health IT leadership in the US brought together to help answer how to approach health IT modernization in the IHS. Frameworks developed, lessons learned, and alternative analyses applicable to multiple organizations are presented. In addition, the book provides three reproducible take-aways to guide and elevate a HIT modernization effort, including a site visit kit, a HIT capability maturity model, and a HIT roadmap.

This book is a valuable resource for researchers, policymakers, clinicians and healthcare workers involved in development, implementation and modernization of health information technology systems.

• Presents a comprehensive description of how an analysis of health information technology legacy system is conducted, with a detailed framework for the methodology and human centered design approach that can be used to support a HIT modernization effort
• Discusses the value of a human-centered research approach during the early phases (research portion) of the software development lifecycle and provides methods, tools, and recommendations for applying human centered design (HCD) in other health informatics projects
• Provides graphics presenting a comprehensive depiction of the American Indian/Alaska Native health inequities, social determinants, geographic obstacles, and health care underfunding, and how they compare to the US population, in order to make the content reproducible at other challenging environments

PART I: Modernizing HIT with Fiscal Constraints
1. People
2. Process
3. Technology

PART II: The Indian Health Service - From Inception to Today
4. History of the Indian Health Service
5. The IHS Today
6. American Indian/Alaska Native Profile

PART III: The Indian Health Service HIT System - the Resource and Patient Management System (RPMS)
7. The Resource and Patient Management System (RPMS)

PART IV: Assessment of the IHS HIT Legacy System -- RPMS
8. RPMS Legacy Assessment

PART V: Listening to the Voices of IHS HIT Users
9. Qualitative Data Analysis
10. Three Data Calls - Methodology, Discussion, and Analysis

PART VI: HIT Modernization Within and Outside of the IHS - Voices from Stakeholders
11. Interfacing with Experts -- Modernization Interviews
12. Exploring Previous Works -- Literature Review

PART VII: The Role of a Technical Advisory Commission
13. Selection and Formation of the Technical Advisory Commission (TAC)

PART VIII: Investigating Modernization Options
14. The Analysis of Alternatives - Examining RPMS
PART IX: Crosswalk and Analysis of all Findings and Recommendations
15. Synthesis, Crosswalk, and Analysis of Findings and Recommendations

PART X: Forging a Path to HIT Modernization
16. Development of a Capability Maturity Model
17. The IHS HIT Roadmap to Modernity
18. Establish Communities of Practice to Engage Users

PART XI: Conclusions and Applicability to Other HIT Modernity Efforts
19. Implication for Future HIT Modernizations

Dr. Terry Cullen was the director of a year-long U.S. Department of Health and Human Services Office of the Chief Technology Officer Indian Health Service Health Information Technology Modernization research project. She is a family physician who retired from the US Public Health Service as Rear Admiral in 2012 after leading multiple software development and deployment initiatives within the Indian Health Service (IHS). Under her leadership as CIO, the Resource and Patient Management System (RPMS) -- the health information technology (HIT) system for IHS -- became the only certified HIT software suite within the federal government. Between 2012-15, Dr. Cullen worked as the chief medical information officer for the Veterans Health Administration to develop a new model for field/community involvement in HIT and expand work in multiple domains, including interoperability/data sharing, standards and terminology, and informatics patient safety.