Keeping the circle strong: Using a federal EHR for quick outbreak response and planning in Indian country

Background: As part of the response to the 2009 H1N1 novel influenza outbreak, The Indian Health Service (IHS) requested estimates of the numbers of high risk American Indian/Alaska Natives (AI/AN) who receive care at IHS or Tribal clinics and healthcare workers at risk for exposure. IHS provides all clinics nationwide with access to an Electronic Health Records system, the Resource Patient Management System (RPMS). Methods: A search algorithm and technical manual with step by step instructions was developed. Technical assistance with implementing use of this manual was available for each of the IHS areas through their Tribal Epidemiology Center. Using the manual, all 12 IHS Areas nationwide responded to the request for numbers of high risk patients. IHS requested that facilities share the data with their state point-of-contacts; these estimates were used by some states to determine vaccine and antiviral distributions for IHS and Tribal clinics in 2009. Results: Data was used to justify why the entire AI/AN population should be considered as a high risk group; in 2010-2011 AI/AN were added as a high-risk population for influenza vaccination recommendations. Conclusions: Data received by IHS from 236 facilities indicated that over 50% of the AI/AN population falls into, or cares for, one of the high priority groups. Previous practice of distributing the vaccine based solely on U.S. Census numbers would likely result in an underestimate of the vaccine needed to cover target groups in AI/AN populations.