Indian Health Service Electronic Health Record
The Indian Health Service Electronic Health Record (IHS-EHR), also known as the Resource and Patient Management System Electronic Health Record (RPMS-EHR) is the GUI extension of the Resource and Patient Management System (RPMS). RPMS was developed in the 1970's, and is a direct derivative of the Veterans Health Administration's VistA system. Subsequent to the VHA's development of a GUI system for VistA, the Computerized Patient Record System (CPRS) in the 1990's, IHS leadership asked the Information Technology Support Center to begin development of an RPMS GUI interface. Crow Indian Hospital in Montana was the site of a pilot project that took elements of the CPRS GUI to create an IHS specific GUI interface for VistA. This work was done by an independent IHS contractor, Clinical Informatics Associates. The goal was to bring most of the features of the "roll and scroll" RPMS system used into a windows interface, including patient look-up; problem lists; results notification; clinical reminders; order entry of pharmaceuticals, labs, and radiology studies; encounter documentation; consult documentation and tracking; and data entry to support billing and coding activities.
The IHS-EHR was alpha tested at 7 IHS sites and was certified as an official RPMS application on January 21, 2005. Between 2003 and 2005, 26 IHS sites implemented the IHS-EHR. According to a survey published in JAMIA, 66% of clinicians saw the implementation experience as a positive one.
EHR Clinical Overview:
The RPMS Electronic Health Record (EHR) is intended to help providers manage all aspects of patient care electronically, by providing a full range of functions for data retrieval and capture to support patient review, encounter and follow-up. By moving most (and eventually all) data retrieval and documentation activities to the electronic environment, patient care activities and access to the record are able to occur simultaneously at multiple locations without dependence on availability of a paper chart. Moreover, point-of-service data entry ensures that the record is always up to date for all users.
The RPMS EHR combines the powerful database capabilities of the Resource and Patient Management System (RPMS) with a familiar and comfortable presentation layer, or graphical user interface (GUI). Integration of various RPMS components into the user interface allows providers to obtain a more comprehensive view of the clinical process. Access to patient information is available via "point and click", rather than the user having to log in and out of separate RPMS applications to retrieve different types of data.
Installation of the most current RPMS applications and/or patches is required for optimal functionality of the EHR (see Technical Overview). With the appropriate server-side RPMS components, EHR supports such functions as:
- Patient lookup and management of personalized patient lists
- Problem list management
- Provider order entry for laboratory, radiology, medications
- Results notification and retrieval
- Report retrieval
- Health maintenance and disease state management reminders
- Clinical encounter documentation
- Clinical decision support (order checks and clinical reminders)
- Documentation of immunizations, patient education, health and personal health history, etc.
- Coding support (ICD and CPT)
- Consult/referral generation and tracking 
As of October 28, 2009, the IHS-EHR has been implemented at 31 federal hospitals, 74 federal health centers, 9 tribal hospitals, 96 tribal health centers, and 5 urban health centers. 7 hospitals and 3 tribal centers have implmeneted the EHR on their inpatient wards. The ambulatory component of the EHR has achieved CCHIT certification, and the inpatient component is currently being reviewed for certification.
- The Office of the National Coordinator for Health Information Technology (ONC) certified the IHS Resource and Patient Management System (RPMS) on April 2011, which allowed for participation in the Centers for Medicare and Medicaid Services (CMS) EHR Incentive program. On August 22, 2014, the RPMS EHR was also certified by the ONC 
1. Hays H. The IHS Electronic Health Record Project. The IHS Primary Care Provider. 2003;28:233-236.
2. Sequist TD, Cullen T, Hays H, Taulii MM, Simon SR, Bates DW. Implementation and Use of an Electronic Health Record within the Indian Health Service. JAMIA. 2007;14:191-197.
- EHR Clinical Overview http://www.ihs.gov/ehr/index.cfm?module=clinicaloverview
- Indian Health Service EHR: Facility Status Map http://www.ihs.gov/ehr/index.cfm?module=currentstatus
Submitted by Anthony Dunnigan