IHS iCare System: An EHR for Population Health in a NationwideHealth System

The Indian Health Service (IHS) provides information technology tools to diagnose, monitor, and effectively manage the public health and health care problems that confront nearly 1.5 million active patients in the American Indian/Alaskan Native population. Many people served by the IHS live the most remote and poverty-stricken areas of the country where these health services represent their primary source of health care. The Resource and Patient Management System (RPMS) Electronic Health Record (EHR) and its population-health component, iCare, support the agency's ability to provide both individual and public health care to this population. iCare includes functions that allow providers to use population health-centric views of clinical reminders, standardized performance measures, clinical condition-specific best practice prompts, standardized diagnostic tagging, community alerts for CDC nationally notifiable diseases and public health surveillance, and registry-creation. The programming logic employed to compute these derived measures has a high level of complexity and requires significant computing resources to sift through the tremendous amounts of health information data in the system. Approaches for extracting and aggregating complex data abstractions such as those listed above often involve additional shadow reporting servers requiring asynchronous processing. However, the IHS approach utilizes a unique combination of data mining techniques that are optimized to allow on-the-fly aggregation and reporting across patient groups dynamically created by providers. The lessons from our design of the iCare application are applicable to new efforts to use EHRs for population health in the context of health reform. These features include the early identification of trends in care, automated registry creation, and the synchronous processing of alerts for surveillance, clinical prevention, and patient- or panel-specific treatment measures.