Health Information Technology Modernization Executive Steering Committee Charter

Refer to: OIT

1. Background. In 2018, the Department of Health and Human Services (HHS) Office of the Chief Technology Officer (OCTO) embarked on an Indian Health Service (IHS) Health Information Technology (Health IT or HIT) Modernization Research Project on behalf of the IHS. In October 2019, after significant research, Tribal and Urban Indian Organization listening sessions, Tribal Consultation, and Urban Confer, the HHS OCTO completed their analyses and published, “Strategic Options for the Modernization of the Indian Health Service Health Information Technology Final Report.” Their report findings state, in part:

   Establishing a program management structure, as well as ownership by an organizational entity, is an essential next step . . . Leadership must fully understand and establish a long-term commitment to the HIT modernization program through engagement and support for appropriate governance, resourcing, and accountability.

   The fiscal year (FY) 2020 Congressional appropriation authorized base funding to move the IHS Electronic Health Record (EHR) modernization project forward. The IHS received subsequent EHR modernization funding through other key legislative actions in FY 2020 and FY 2021. For purposes of this circular, EHR modernization equates to the HIT Modernization project. 

   With increased funding to support HIT Modernization, the IHS assumes a higher level of accountability and oversight. The IHS is following HHS recommendations for appropriate governance, resourcing, and accountability through implementation of the program management structure to manage the EHR modernization project. 

2. Purpose. This circular establishes the HIT Modernization Executive Steering Committee (ESC). The ESC provides strategic oversight and leadership, and makes executive?level decisions affecting how HIT Modernization is achieved. These decisions impact the scope of the HIT Modernization initiative, funding and acquisitions, organizational change management, risk identification and mitigation, and engagement with key partners and stakeholders, among others. The ESC is accountable for program results and provides strategic guidance that supports the HIT Modernization initiative’s goal to improve health status for American Indian and Alaska Native people. 
3. Executive Steering Committee Authority. The ESC is authorized to make strategic decisions affecting HIT Modernization design and delivery. The ESC refers decisions regarding resource commitments and acquisition selection to the IHS Director or designee for action. The ESC exercises authority over HIT Modernization. In its role, the ESC makes decisions affecting:
   1. HIT Modernization priorities;
   2. Strategic outcomes, program objectives, milestones, and high-level program requirements;
   3. Acquisition strategy;
   4. Recommendation for acquisition selection;
   5. Recommendation(s) for resource commitment(s);
   6. Mitigation of strategic program risks.
4. Membership. Voting members of the ESC consist of officials from across the IHS who encumber the leadership positions detailed below. Non-voting representation comes from the IHS, other HHS Operating and Staff Divisions, and the joint Department of Veterans Affairs (VA) and Department of Defense (DoD) Federal Electronic Health Record Modernization (FEHRM) Program Office. The IHS Deputy Director for Field Operations designates the Area Office Director members and the National Council of Chief Executive Officers designates the Facility Chief Executive Officer members. Membership is reviewed periodically and at least annually to ensure representation is consistent with HIT Modernization requirements. 

   Initial ESC voting membership and non-voting members and representatives are as follows:

1. IHS Membership (voting)
1. IHS Director (Committee Chair);
2. Deputy Director for Management Operations;
3. Deputy Director for Quality Health Care;
4. Chief Medical Officer;
5. Chief Information Officer;
6. Deputy Chief Information Officer;
7. Chief Medical Information Officer;
8. Area Office Director (two positions); and
9. IHS Facility Chief Executive Officer (two positions).
2. IHS Membership (non-voting)
1. IHS Chief Financial Officer; and
2. Director, IHS Division of Acquisition Policy.
3. HHS/VA/DoD Representation (non-voting)
1. HHS Assistant Secretary for Financial Resources;
2. HHS Office of the Chief Information Officer;
3. Chief Medical Officer, Office of the National Coordinator for Health IT;
4. Centers for Medicare & Medicaid Services;
5. HHS Office of Minority Health; and
6. VA/DoD FEHRM Program Office.
5. Roles and Responsibilities.
1. The ESC Chair has the following responsibilities:
1. Direct the business of the ESC to meet HIT Modernization objectives;
2. Convene members and bring forward decisions for their consideration;
3. Make decisions if consensus cannot be met; and
4. Communicate decisions and actions to responsible parties and stakeholders.
2. ESC members have the following responsibilities:
1. Proactively seek and represent the opinions and policies of their respective organizations and peers;
2. Actively participate in the decision-making process;
3. Make evidence-based decisions that support program objectives; and
4. Communicate ESC decisions back through their organizations.
6. Meetings.
1. The ESC receives administrative support for meetings and communications from HIT Modernization project staff provided by the IHS Office of Information Technology (OIT).
2. Meetings occur monthly at a predetermined time.
3. Each regularly scheduled meeting is accompanied by a meeting agenda circulated to members prior to the meeting.
4. Ad hoc meetings may be convened as needed and are scheduled with as much advance notice as possible.
5. Executive Steering Committee decisions cannot be made without a quorum. A quorum is met when at least half of the ESC’s voting members are in attendance. If a quorum is not met, a meeting may proceed with decisions deferred to the next meeting.
6. Executive Steering Committee members may designate an alternate. A designated alternate carries the full voting rights of the principal member.
7. Decision Making.
1. Decision making is by simple majority of voting members present at the ESC meetings. If a decision cannot be reached, the Committee Chair delivers the final decision. Members agree to fully support decisions and subsequent actions in response to these decisions.
2. Other inputs supporting recommended courses of action come through operations-focused governance activities and individual input from participants on focus groups (see below), and Tribal Consultation/Urban Confer, as appropriate.
8. Communications. An agenda is circulated prior to each ESC meeting by OIT HIT Modernization project staff. Meeting minutes are distributed to members following each meeting and are maintained consistent with Agency records management policies.
9. Executive Steering Committee and Governance of Health IT Modernization.
1. To achieve the scope of HIT Modernization, the ESC may direct creation of focus groups comprised of subject matter experts from IHS, Tribal and Urban health programs who have detailed knowledge of the issues that concern HIT management and will provide individual input to the ESC. Focus groups address the following, at a minimum:
1. Interoperability. The participants of this focus group review and suggest strategies, operational requirements, clinical practice standards, and performance measures on an individual basis, that inform the interoperability solution design and project planning.
2. Data Management and Analytics. The participants of this focus group review and suggest strategies on an individual basis that support effective data use, security and privacy controls, and standards.
3. Health IT Implementation. The participants of this focus group help the ESC understand the strategies used by other Federal agencies, Tribes, and Urban Indian Organizations to modernize their Health IT capabilities and resulting performance changes in health care delivery. Individual input from participants of this group inform decisions regarding implementation planning and organizational readiness.
4. Additional focus groups may be convened by the ESC as necessary to receive input on specific issues or concerns.
2. The ESC ensures that focus groups contributing to HIT Modernization governance consist of participants who are providing individual input and feedback to the ESC. At no time will the focus groups provide consenus recommendations or advice to the Agency. The ESC understands that the Federal Advisory Committee Act may be implicated if the groups provide consensus advice to the Agency, triggering additional legal requirements.
10. Charter Review. The ESC will review this charter no less than annually to ensure the purpose and scope are consistent with HIT Modernization requirements.

11. Committee Termination. The ESC will discontinue operations at the discretion of the Committee Chair or upon successful achievement of the HIT Modernization project goals.

12. Supersedure. None.

13. Effective Date. The HIT Modernization ESC Charter is effective upon date of signature.

Distribution: IHS-wide
Date: 03/10/2022