The Indian Health System provides a comprehensive health service delivery system for 2 million American Indians and Alaska Natives serving members of 566 federally recognized tribes. This is accomplished through a network of hospitals, clinics, and health stations managed by the Indian Health Service (IHS), tribes, or urban Indian health programs. IHS finds it challenging to deliver healthcare in primarily rural locations, deal with the rapidly growing population, with problems recruiting and retaining medical providers, and working with old facilities and equipment.
In Alaska, telemedicine is being delivered through the Alaska Federal Health Care Access Network (AFHCAN). The use of teleconsultation via the AFHCAN store-and-forward solution has significantly reduced waiting time for the ENT specialist evaluations. The percentage of patients who wait four or more months for an ENT evaluation in one Alaska village community has gone from 48 percent before telemedicine to less than 3 percent after telemedicine services were initiated.
In addition, teletrauma, teleradiology and smart phone technology is being used in Indian country. The lessons learned while providing trauma care are now being applied via telemedicine to provide care to individuals with spinal injuries and others in need of stroke management in rural areas.
VistA Imaging developed by the VA and distributed by IHS as its multimedia component for the Resource and Patient Management System (RPMS), is currently used in more than 30 facilities for radiology image storage. Several facilities onsite or offsite have radiologists using VistA imaging’s “VistARad Diagnostic Display” software for primary interpretation.
In addition to radiology use, some facilities are taking advantage of VistA Imaging for ophthalmology image storage and display, patient photo ID programs, and are being used when interfaced with GE Muse to display EKG tracings.
In the past, IHS deployment of VistA Imaging and its many functions have been about two years behind the VA due to the need to recode the software to fit IHS use. The IHS is currently working with the VA to close that gap.
According to the Director of the Indian Health Service, Dr Yvette Roubideaux speaking at the University of Colorado, School of Public Health, “The IHS is working to improve the quality of and access to care. However, health disparities continue to persist for American Indians and Alaska Natives as compared to other populations. For example, diabetes mortality rates are still nearly three times higher for American Indians and Alaska Natives than for the general U.S. population.”
Congress established the “Special Diabetes Program for Indians (SDPI) that currently provides grants for 404 diabetes treatment and prevention programs in IHS, tribal, and urban Indian health programs in 35 states. The funding has enabled the Indian health system to make changes for the better in the American Indian and Alaska Native communities.
The IHS National Telenutrition Program is also helping people with diabetes. The program is used at IHS and Tribal health sites to offer telehealth services to expand nutrition training provided by registered dietitians. Also, the IHS Medical Nutrition Action Team provides continuing education webinars and training to healthcare professionals to help reach isolated and rural providers.
According to an article appearing in the IHS Primary Care Provider Journal, the IHS has taken on the task of building an injury surveillance system to be based on information from emergency rooms, hospitals, and mortality databases to benefit the many tribes in California, Nevada, and Arizona. Reliable injury data sources were used from the three states to provide injury surveillance data to the Fort Mojave and Chemehuevi Tribes located in the three states.
The data provided on injuries has helped to develop programs to help prevent injuries, manage medications better, develop home modifications to reduce falls, provide sobriety checkpoints to help reduce motor vehicle-related injuries, provide for partnerships among law enforcement, and working with behavioral, environmental health, and social services to develop action plans to reduce violence.
Further analysis of the data will explore total costs by injury type, costs per injury event, and enable injury rates to be obtained by gender and age group to help identify high-risk populations to establish needed priorities for intervention.