Budget OMB A-11 Investments

The Office of Management and Budget (OMB) provides specific policy, procedural, and analytic guidelines for planning, budgeting, acquiring, and managing all major capital IT investments, including general guidance issued in OMB Circular No. A-11 and OMB Circular No. A-130. The IHS Office of Information Technology (OIT) delivers some of the best and most affordable health technology systems within the federal government. OIT is made up of three key areas of investments and eight standard investments, all of which work closely with the agency’s programs to help fulfill the mission and goals of IHS. These investments play an important role in ensuring effective healthcare services are provided.

IHS Major Investments

Table 1 Indian Health Service Capital Investments

Indian Health Service Investments	UII	Investment Manager
IHS Health Information Technology Systems and Support (HITSS)	009-000001362	Darby McNutt
IHS National Patient Information Reporting System (NPIRS)	009-000001359	Vanessa Weaver
IHS Division of Health IT Modernization and Operations (DHITMO)	009-000452168	Greta Ziegler
IHS Data Center and Cloud Standard Investment	009-000415538	Kathryn Lewis
IHS Application Standard Investment	009-000415539	Kathryn Lewis
IHS Delivery Standard Investment	009-000415540	Kathryn Lewis
IHS End User Standard Investment	009-000406330	Kathryn Lewis
IHS Network Standard Investment	009-000406331	Kathryn Lewis
IHS Platform Standard Investment	009-000415541	Kathryn Lewis
IHS IT Security and Compliance	009-000006635	Solomon Wilson
IHS IT Management	009-000386499	Phillip Wise

Health Information Technology Systems and Support (HITSS)

The Indian Health Service (IHS) Health Information Technology Systems and Support (HITSS) is a comprehensive Health Information System (HIS) that supports the delivery of high-quality health care to American Indians and Alaska Natives who attend several hundred federal, tribal, and urban facilities nationwide. HITSS is critical to IHS operations; it integrates practice management, medical, behavioral health, population health, and performance reporting functions into a fully capable electronic health record (EHR) suite. HITSS evolved alongside the Department of Veterans Affairs (VA) acclaimed VistA HIS but is the only system designed specifically to support the IHS's direct care and public health mission. HITSS aligns with the VA's commitment to promote the adoption of EHRs due to their ability to improve health outcomes and decrease costs. HITSS supports the Health Information Technology for Economic and Clinical Health Act (HITECH) by establishing interoperability through the electronic sharing of information with states, interoperability with commercial labs, and electronic communication among medical staff participating in patient care.

HITSS supports HHS Goal 1 Objective F by providing a Meaningful Use Certified EHR and empowering the patient with personal health information. The IHS EHR is certified as a complete EHR for ambulatory and inpatient settings according to the Stage 2 Meaningful Use criteria that is in use at more than 300 sites nationwide. HITSS is in the mixed lifecycle phase. Much of the suite is in operations and maintenance, while enhancements are implemented for the Meaningful Use Stage 2 EHR Certification and ICD-10 conversion. IHS is progressing to full implementation of the Nationwide Health Information Network (NwHIN) gateway, supporting OIT Strategic Goal 2 - Objective 2.4. HITSS continues to invest in maintenance, including protecting the privacy and security of information, supporting OIT Strategic Goal 6. As a high-quality, low-cost public domain system, HITSS has also proven attractive to private and public sector healthcare entities outside of IHS. The HITSS investment depends upon the IHS Infrastructure Standard Investments, as they provide the physical computer and networking systems and support on which HITSS operates.

National Patient Information Reporting System

The National Patient Information Reporting System (NPIRS) is the national data repository of the Indian Health Service (IHS). NPIRS produces specific reports required by statute and regulation without significant manual data consolidation thereby saving significant costs each year. Additionally, NPIRS maintains composite patient encounter information, providing managers at all levels of the Indian health system with a broad range of clinical and administrative information allowing better management of individual patients, local facilities, and regional and national programs. NPIRS also provides hosting and administration services to ensure the Health Information Exchange (HIE), Master Patient Index (MPI), Personal Health Record (PHR), e-Rx, and Direct Messaging systems function reliably and provide server hosting services to both IHS and IHS-approved customers.

NPIRS data is derived from various government and commercial healthcare information systems that are largely transaction-based systems used to support patient care. The data comprises patient registration and clinical encounter records. The data repository provides reports and ad hoc searches of the databases thereby providing critical and timely information to customers. Internal users and selected authorized external users have secure access to more structured and specific subsets of this information (data marts). NPIRS key customers, stakeholders, and beneficiaries include IHS Headquarters, GPRA Coordinators, IHS Administrative Areas, HIE/MPI, the Department of Epidemiology, CDC, and Tribal entities.

NPIRS supports HHS Strategic Goal 4 Objective A, ensuring program integrity and responsible stewardship of resources, by maintaining user population and workload information attributed to each of the 12 IHS administrative areas. It provides essential information for measuring IHS performance and allocating funds to tribal facilities, equipping management with the data necessary to allocate limited medical resources cost-effectively. Also, NPIRS supports HHS Strategic Goal 4 Objective B by collecting and integrating information from Tribal, Urban, State, private sector, and other federal sources (e.g. IHS Fiscal Intermediary, CMS) to facilitate effective collaboration and sharing of this information online through the data marts.

Division of Health IT Modernization Operations

The Division of Health Information Technology Modernization and Operations (DHITMO) leads efforts to modernize Health IT systems, ensuring alignment with healthcare in delivery and program administration. DHITMO develops and maintains policies, procedures, and standards for Health IT modernization while overseeing key technical projects and system improvements.

DHITMO’s key responsibilities include:

Guiding the development, implementation, and maintenance of modern Health IT resources, technology products, and services.
Overseeing system and software testing while managing secure and efficient testing environments.
Leading strategic planning and governance efforts to support IT modernization initiatives.
Managing IT activities throughout the system development life cycle, from planning to deployment.
Ensuring high-quality technology infrastructure, products, and services that support IHS healthcare operations.
Supporting business and technology alignment to help teams adapt to new systems and processes.
Providing program and project management support for IHS-developed and acquired IT products and services.
Handling administrative functions, including HR management, performance evaluation, and professional communication development.
Assisting with contractor security clearance processes and records management.
Collaborating with federal, tribal, state, and other partners on crosscutting Health IT initiatives.

Through these efforts, DHITMO plays a critical role in modernizing and maintaining the technology that supports IHS healthcare services.

IHS STANDARD IT INVESTMENTS

IT Security and Compliance is an investment for enhancing the Security Operations Centers (SOCs) and aligns with the Technology Business Management (TBM) IT Security and Compliance initiative. This provides clearer visibility into the costs and outcomes of its cybersecurity activities.

IT Management Investment establishes the enterprise-wide IT management capability as defined by the TBM IT tower.

Network Standard Investment is aimed at establishing an enterprise-wide wide-area network (WAN), local-area network (LAN), and metropolitan-area network (MAN) capabilities, as outlined by the TBM Network tower. It reports the transition costs related to network and telecommunications capabilities within the enterprise infrastructure solution (EIS).

Data Center and Cloud is an investment focusing on providing enterprise-wide data center and/or cloud capabilities, reported at the most granular level available based on data center or cloud procurement, as defined by the TBM Data Center, Storage, and Compute IT Towers.

End User is an investment dedicated to establishing an enterprise-wide End User capability defined by the TBM End User tower. Agencies can choose the most suitable level or approach for reporting investments they manage. It includes all costs and relevant information necessary for effective decision-making and management oversight of the end user portfolio (Sub IT Towers).

Application Standard Investment pertains to the provision of an enterprise-wide shared application capability based on the TBM Application tower. This includes sub-towers such as Application Development, Application Support & Operations, and Business Software. Resources shared across the enterprise—such as testing personnel, integrated development environments, and testing software—are included, as well as tools and services related to development projects for the enterprise application capability itself.

Delivery Standard Investment involves establishing an enterprise-wide shared delivery capability, as defined by the TBM Delivery tower. This includes enabling capabilities such as Business Software. Delivery resources, products, and services that are shared across the enterprise—like PMO personnel and account managers—are included. However, resources and services specific to a particular program IT investment (such as dedicated project manager and business analysts) or other Standard Investments are excluded, as this investment focuses on multi-program and multi-operation centers.

Platform Standard Investment establishes an enterprise-wide platform capability, as specified by the Platform tower. It includes sub-towers such as database, middleware, mainframe database, and mainframe middleware, which were previously part of the Application Tower. There is no Standard Investment Report for Platform Standard Investments.