In the world of tribal health, the Resource and Patient Management System (RPMS) EHR has long been a staple of care delivery for Native American communities. Developed and designed specifically for American Indian healthcare decades ago, RPMS has been utilized by Indian Health Services (IHS) sites and many other tribal organizations to improve the care they provide.

One of the key benefits of RPMS is that it is cost-efficient to maintain compared to similar systems derived from the Veterans Health Administration’s venerable VistA platform. It has also kept up well with federal requirements and was the first VistA-related EHR to be certified for Meaningful Use Stages I and II. (It will likely also be the first to certify for aspects of Stage III.)

Did you know? Medsphere Government Services Division was recognized for helping the IHS become the first federal agency to achieve Meaningful Use Stage 1 certification.

However, we can’t ignore a recent assessment and survey conducted by The Department of Health and Human Services (HHS) and the Regenstrief Institute, which showed that 60.3 percent of RPMS EHR users believe RPMS needs either significant improvements or a complete overhaul.

Here we will address possible improvements, focusing on the top enhancements from Medsphere that can be done short-term to modernize RPMS EHR.

Top 6 RPMS Enhancements

1. Advanced Medication Reconciliation: Medsphere developed this module to meet the needs of clinical staff looking to efficiently incorporate medication reconciliation into their daily workflow. A Med Reconciliation button would be part of the visit pane and automatically highlight when a new outpatient visit, inpatient admission, inpatient ward transfer, or provider discharge order occurs. A visual reminder for clinicians that reconciliation is due or completed, this component supports and enhances their daily inpatient and outpatient medication management workflows, making the process straightforward, obvious and simple. The Advanced Medication Reconciliation component also has a variety of predefined workflows and reports.


2. Clinical Scheduler: This component would make the scheduling process more intuitive for patients and facility support staff by enabling improved and integrated organizational function.


3. Nursing Flowsheets: A key component for clinical staff, especially nursing, is the Flowsheet. One of the long-missing features of most EHRs has been the ability to view and record necessary clinical data in a logical, aesthetically pleasing way to better help clinicians treat and care for patients. Typical data elements included in Flowsheets track with the types of tasks nurses do at the bedside or within clinic rooms, including taking vitals, conducting nursing assessments, entering shift notes, tracking input/output, reviewing lab results and administering medications.
   
   Medsphere’s Nursing Flowsheets module is an electronic version of the paper Flowsheets that nurses and physicians have used for years. Nursing Flowsheets presents a graphical timeline of clinical data in a graphically pleasing format that rapidly enables clinicians to understand the status of their patients.
   
   Medsphere’s Nursing Flowsheets is designed for the multiplicity of vital signs frequently taken in emergency departments, and in both inpatient and outpatient settings. Flowsheets ties them all to the visit (admission) date and provides a way to qualify a measurement (BP standing, ankle BP, O2 on room air or with a mask, rectal temperature, etc.), as well as offering numerous other features essential to the assessment and management of patients.


4. Revenue Cycle Management: Medsphere’s Revenue Cycle Management (RCM) Cloud system is a true end-to-end solution that eliminates the need for bolt-ons and is available via web/cloud or on-premise. RCM Cloud helps hospitals, behavioral healthcare providers, and integrated health networks to truly transform their revenue via reduced AR days, increased cash flow and enhanced efficiencies.
   
   As an all-inclusive suite of patient access (enterprise scheduling, patient registration, eligibility checking), patient accounting (universal billing, collections & payments, contract management), claims management, and informatics solutions, RCM Cloud replaces any existing HIS and add-on applications. The system is also Meaningful Use certified, and 5010 and ICD-10 ready.
   
   RCM Cloud fully leverages its superior technical architecture by embedding key functions, e.g., contract management and an enterprise-wide Master Patient Index (MPI), directly into the application suite resulting in a comprehensive solution set.


5. Practice Management: ConnectGov Practice Management through Medsphere is proven to help organizations increase revenue and get paid sooner. 
   
   Automatic eEligibility enables practices to take control of collections by running automatic checks on each patient in advance of visits and supplying complete information on co-pays and insurance deductibles. 
   
   The Collection Center then automates many tasks, improving the collections process with very little effort from office staff.
   
   Quick Claims Entry and One-Click Payment Posting simplify patient checkout and save time and money on a typically cumbersome process that generally requires a lot of manual data entry. Where more than 30 percent of claims are usually rejected nationally, ConnectGov PM reduces claims rejections to less than 5 percent. Virtually all potential problems can be resolved before they hit the A/R report, ensuring payment in a timely manner.
   
   The Appointment Scheduler makes setting up new or recurring appointments a breeze, and it’s flexible enough to correlate with each doctor’s chosen schedule. 
   
   Patient Registration, an essential component for busy practices, allows users to view an at-a-glance summary of demographic information, appointment history, and family structure for each patient. Everything needed, from insurance information to physician referrals, is conveniently located.
   
   Additional Practice Management features include the following: 
   • Advanced Reporting manages billing, workflow analysis, and many other administrative tasks, as well as producing custom reports.
   • Patient Statements automates and tracks patient billing for when its necessary to bill patient after the fact for services rendered.
   • User Dashboard showcases everything you need in one location with easy-to-understand modules and summaries.
   • Claims Scrubbing identifies claim errors before they are submitted and cause future issues.
   • Insurance Verification helps users find out if the patient is covered beforehand, reducing the time spent on follow-up.


6. Surgery Scheduling and Monitoring: Medsphere’s Surgery Scheduling module manages operating room planning and scheduling to optimize capacity, better control the flow of supplies, and track patients throughout a surgical encounter. Used by surgeons, surgical residents, anesthetists, operating room nurses, and other surgical staff, this component includes the ability to create and maintain electronic procedure cards. In addition to providing specific OR setup instructions, procedure cards detail the supplies and quantities required for a case, including consumable products, reusable products, instrumentation and equipment. These tools help clinicians reduce case and turnover times and free up more time for patient care, which can improve staff and patient satisfaction. They also assist in the accurate billing of services and materials utilized during a surgical case. 
   
   The OR patient tracking board monitors patient times and milestones throughout the operative encounter, from patient check-in through discharge. By integrating surgical case scheduling and clinical patient data tracking, a variety of valuable administrative and clinical reports are available. 
   

All of the above components have been developed by Medsphere using the latest technologies and frameworks, and they can be ported or further enhanced for incorporation into EHR RPMS. Native American health organizations interested in replacing RPMS have the option of moving to Medsphere’s ONC 2015 certified CareVue EHR/RCM Cloud solution, utilized by many healthcare organizations throughout North America and abroad.  

Got CARES Act funding? As part of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), over $1 billion in funding was authorized for COVID-19 response efforts through the IHS. A portion of that funding is dedicated to healthcare IT and support and updates for IHS, Tribal and Urban healthcare facilities. Although it is still unclear exactly how much funding will actually be allocated and distributed, it is still worthwhile for tribal organizations to consider modernizing their EHR RPMS, even without CARES Act funding.

To learn more about RPMS EHR enhancements or CareVue EHR/RCM Cloud (or on-premise), click here.

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About Medsphere’s Government Services Division (GSD): Medsphere GSD has decades of healthcare IT software and services experience serving the needs of the Indian Health population. With unparalleled expertise in the IHS Resource and Patient Management System (RPMS) and VistA platforms, as well as the technologies used to modernize them, Medsphere offers superior software development, system integration and professional services.