Indian Health Service

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Indian Health Service
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Mission and Goal

• Mission
• To raise the physical, mental, social, and
  spiritual health of American Indians and Alaska
  natives to the highest level.
• Goal
• To assure that comprehensive, culturally
  acceptable personal and public health services
  are available and accessible to American Indian
  and Alaska Native people.

3

IHS provides comprehensive health service
for 1.8 Million American Indian/Alaska
Natives 550 Federally Recognized Tribes 36 States

• IHS
  Tribal Urban
  
• 33 Hospitals 15 Hospitals
  34 Urban Indian
• 49 Health Center 198 Health Centers
  Health Programs
• 46 Health Stations 121 Health
  Stations
• 180 Alaska Village
  Clinics

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Resource and Patient Management System (RPMS)

• RPMS is a decentralized health information system
• Over 60 integrated software applications
• Used at over 300 sites
• The Patient Care Component (PCC) is the clinical
  data repository within RPMS.

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HIV Management System (HMS)

• Case management component of RPMS designed to
  improve the direct care and management of
  people living with HIV/AIDS or those who have are
  at risk of exposure.
• Intended for use by both experienced HIV case
  managers as well as providers without specialized
  knowledge
• Maintains a register and stores HIV/AIDS related
  data

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Primary Functions of HMS

• To identify patients who could benefit from case
  management
• Assist providers in the pro-active management of
  people living with HIV/AIDS and those who are at
  risk for exposure
• Provide condition-specific reminders and reports
  to assist providers in improving the quality of
  care extended to this population.

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HMS FEATURES

• Candidate list
• Register
• Patient Record
• Reminders
• Health Supplement
• Reports

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Candidate List

• Auto populated
• Criteria
• at least one POV or Problem List diagnosis of
  HIV
• ever OR
• a positive result on an HIV test OR
• at least 2 of any antiretroviral medications
• (NRTI, NNRTI, PI or FI medications)
• Site schedules routine searches for new candidates

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Candidate List

• Name HRN
  DOB STS
  Visit Value
• 1. ALPHA, ONE 111111 03/03/1984 UNR QMN HMS
  pts w AD
• 2. BETA TWO 222222 08/24/1950 UNR 06/30/1998
  MED LAMIVUDINE
• 3. THETA, THREE 333333 07/22/1981 UNR
  QMN HMS pts w AD
• 4. OMEGA, FOUR 444444 01/17/1958 UNR
  03/28/2000 DX 042.
• 5. GAMMA, FIVE 555555 12/28/1970 UNR
  04/16/1996 DX 042.
• 6. DELTA, SIX 666666 03/25/1968 UNR
  07/28/2000 LAB HIV
• A Accept Candidate(s) E Expand
  Candidate N Not
  Accept Candidate(s)
• Select Item(s) Next Screen//

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Register

• Register Master List for HMS REGISTER
• Status Active,Deceased,Inactive,Transient
• Sorted by Patient Name
• CONFIDENTIAL PATIENT INFORMATION
• Patient HRN Community Age Sex
  Reg Dx Reg Provider
• -------------------------------------------------
  -----------------------------
• Register Status ACTIVE
• ALPHA, ONE 1111 AYTOWN 55 M AIDS C2
  DOE, JOHN
• BETA, TWO 22222 THIS TOWN 42 M AIDS C2
  DOE, JOHN
• THETA, THR 33333 THAT TOWN 41 F HIV
  B2 DOE, JOHN
• OMEGA, FOU 44444 ANYTOWN 58 M HIV A3 DOE,
  JOHN
• DELTA, FIVE 55555 THIS TOWN 48 M AIDS C2
  DOE, JOHN
• OMIKRON, T 66666 THAT TOWN 23 F AT
  RISK DOE, JOHN

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Patient Record

• Patient Specific Data
• HIV Specific Data
• Register Diagnosis
• HIV Clinical Classification
• Onset Dates
• CDC Etiology Category
• HAART medication appropriateness/compliance
• State and Partner Notification

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• HRN 104771
  
• Patient ALPHA, ONE Age
  48 Gender M
• Address 111 AVENUE STREET, YOUR TOWN,
  USA 12345
• Home Phone [phone]
  DOB Oct 01, 1959
• Work Phone [phone]
  Comm YOUR TOWN
• 
  
• Register Status ACTIVE
  
• Current DX AIDS Clinical
  Class C2
• Initial HIV DX Sep 13, 2000 Initial AIDS
  DX Sep 13, 2000
• Last Visit Aug, 23, 2007 Next Visit
  Dec 10, 2007
• 
  
  
• ED Edit Register Data ADD Add Patient
  Data REF Referral Review/Order
• HS Health Summary/Supp REP Patient
  Reports PROB Prob List View/Edit
• REM Clinical Reminders GUID Guidelines
  PED Pat Educ Review (PCC)
• OI Opp Inf/AIDS Def Ill LAB Lab Review
  (PCC) AP Appointment Review
• NOT Notification Status MED Meds Review (PCC)
  MAIL Send Mail Message
• ET CDC Etiology ART Allergy Review

Enter ?? For more actions
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Reminders

• Clinical Reminder Oct 22, 2007
  174343
• DEMO INDIAN HOSPITAL
• Patient ALPHA, ONE HRN 11111
• NAME LAST DOCUMENTED DATE NEXT
  DUE DATE
• CD4 10/15/20O7
  02/15/2008
• Viral Load 08/02/2007 12/02/2007
• RPR Syphilis Test 08/21/2006 May
  Be Due Now (Was due 08/21/2007)
• Hep C EIA Test 05/25/2000 May
  Be Due Now (Was due 05/25/2001)
• Hep B Test 06/01/2004
  
• Toxoplasmosis Test 07/06/2007
  07/06/2008
• Chlamydia Test 07/06/2005
  May Be Due Now (Was due 07/06/2006)
• Gonorrhea Test 01/22/2006
  May Be Due Now (Was due 01/22/2007)
• Hep B IZ (11/06/2007)
  
• Hep A IZ 06/30/2005 (dx)
  
• Pneumovax IZ 06/12/2002
  May Be Due Now (Was due 06/12/2007)
• Influenza IZ 04/26/2007
  04/26/2008
• Tetanus IZ 12/06/1995
  May Be Due Now (Was due 12/06/2005)
• Dilated Eye Exam 07/14/2006 May
  Be Due Now (Was due 01/14/2007)

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HMS Supplement

• Demographic Data
• Register data
• Opportunistic Infections/AIDS Defining Illnesses
• Recent Laboratory Data
• Immunizations
• ARV Medications
• Other Medications
• Last Screenings/ Exams/ Pt Education
• HIV Related Reminders

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Reports

• Due/Overdue
• Quality of Care Audit
• Register Master List
• State Reporting Status
• CRS Report
• Provider Guidelines

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HIV Quality of Care Audit

• TOTAL PATIENTS REVIEWED 25
• Gender Male 18 72.0
• Female 7 28.0
• Age lt15 yrs 3 12.0
• 15-44 yrs 17 68.0
• 45-64 yrs 5 20.0
• gt64 yrs 0 0.0
• LABORATORY EXAMS
• w/ CD4 count
• (in last six months) 20 80.0
• most recent lt 50 3 15.0
• most recent 50-199 8 40.0
• most recentgt200 8 40.0
• Undetermined 1 5.0
• w/ Viral Load
• (in last six months) 18 72.0

w/ Tuberculosis tests
Needed 23 92.0 PPD Received 17 73.9
PPD 2 11.7 w/ Treatment
Given 0 0.0 PPD- 8 47.1
PPD Refused 6 35.3 PPD Status
Unknown 1 5.9 VACCINATIONS w/
Pneumovax (in last 5 years (or 2
ever) 17 68.0 w/ Tetanus (in past 10
years) 22 88.8 EXAMS (Yearly) Dilated
Eye Exam 14 56.0 Dental Exam 7 28.0 Pap
Smear 5
100.0 TREATMENT (past 6 mos.) ARV
Therapy given 21 84.0 HAART 14 66.7
Mono Therapy 2 9.5 Other
Combination 5 23.8 PCP Prophylaxis given (if
CD4 50 and lt200 in last six
months) 7 87.5 MAC Prophylaxis given (if CD4
lt50 in last six months) 1 33.3 RISK
FACTORS Tobacco Use Screening 19 76.0
Current Tobacco User 9 47.4 If Yes,
Counseled 6 66.7 Not a Current
User 6 31.6 Not Documented 4 21.1
Substance Abuse Screening 15 60.0 Current
User 9 60.0 I/V - Yes Unavailable
Not a Current User Unavailable Not
Documented 6 40.0
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Questions??

• Cindy Gebremariam, RN
• Clinical Analyst, OIT/ Indian Health
  Service
• 520-670-4697
• cynthia.gebremariam_at_ihs.gov