Indian Health Service IT Modernization: Using Human-Centered Design to Improve Government Systems

The Department of Health and Human Services Office of the Chief Technology Officer (CTO) seeks to deploy innovative methods in approaching Health Information Technology (HIT). Staff are asked to support a human-centered design approach to identifying technical gaps in the current electronic health records system utilized by Indian Health Service (IHS).

Indian Health Services (IHS) is currently undergoing a HIT modernization project to improve on the critical healthcare services provided to the American Native and Native Alaskan populations. The primary focus of the modernization is the Resource and Patient Management System (RPMS), which is a decentralized, integrated HIT solution for managing clinical and administrative information in healthcare facilities.

In an effort to better understand the value of approaching HIT modernization by focusing on human-centered design, we have asked team members Eduardo Ortiz (EO) and Victor Garcia (VG) to share insights about how their methods and mission impact the project:

How have you applied innovative methods to technology design in the Indian Health Services project?

EO: People are always at the center of everything you do, especially when you're talking about healthcare. This is the first time that a human-centered design approach has been deemed a requirement of a technical assessment of the systems used to provide these services to American Native and Native Alaskan populations. The most important thing we're doing, which is innovative in and of itself, is we're listening to the users in those communities where IHS systems are used, trying to define what the problems are, and then trying to figure out how to address those problems.

VG: We recognize the technology is important, but we don't start there. The approach for trying to answer whether RPMS could be modernized needed to start with the people behind it, and not from a purely technical perspective, otherwise we risked missing an opportunity to think past the limitations of the current systems.

EO: To that end, we've implemented a series of techniques from the human-centered design space. Contextual inquiries, KJ methodology, diagrams, journey maps, card sorting, design studio, empathy maps, stakeholder and user interviews, user scenarios, and task flow analysis just to name a few. Those activities individually don't mean much, but it's how we're using them as a whole and what we are using them for that's innovative--together, these methods allow us and our partners to develop a clear understanding of the situation on the ground and truly grasp the challenges from a People, Process, and Technology point of view, humanizing our approach.

What new, nuanced solutions have resulted from using innovative methods in the IHS project?

VG: It results in a more holistic view of the problem, and in the right questions being answered. It's much harder to discount a real user's lived experiences with a system when we're hearing directly from them than it is to discount someone above or outside the organization without direct experience living day-to-day with the technology.

EO: Using innovative methods helped us create a framework that puts the user at the center of it all rather than putting the technology at the center. In the project we're working on with IHS, users are patients, healthcare workers, network administrators, system engineers, programmers, hospital administrators--anyone and everyone that interacts with the RPMS and the electronic health record system is technically a user of the system. We're looking at their specific pain points and the different goals they are trying to achieve in order to map out the best solutions.

Read more about the IHS IT modernization effort here.