Public Health Informatics and the American Indian/Alaska Native Populations: Improving Community Health Despite Challenges

Abstract

The Indian Health Service (IHS) provides care to the most remote and under-resourced communities in the US. American Indian/Alaska Native (AI/AN) patients have some of the highest morbidity and lowest life expectancy among any ethnic group in the US. Beginning in the 1980s, IHS recognized the need to accelerate the impact of their work through the development and integration of effective clinical, population, and public health informatics solutions. The IHS custom-built health information technology (HIT) system, the Resource and Patient Management System (RPMS), has been an effective tool leveraged to improve the health of individuals as well as communities for decades. Currently RPMS faces many challenges that are ubiquitous for HIT systems. These challenges include rapidly changing clinical and public health needs as well as technology, inadequate financial resources to maintain and improve the platform, a limited rural broadband network, a scarcity of a skilled and consistent rural workforce with adequate knowledge of the system, a lack of user-friendly functionality to improve quality and help ensure patient safety, and a variety of implementation concerns. Despite these issues, RPMS has maintained its place as a critical part of the armamentarium needed to improve public and population health for AI/AN communities. Modernization of this system provides the IHS with an enormous opportunity to develop a user—and population-centered HIT model to help close the gap in AI/AN health inequities and continue to illustrate the critical need for public and population health informatics at the point of care.