The Indian Health Service has begun the roll-out of its new PATH EHR solution, starting at the Lawton Service Unit in Lawton, Oklahoma, as part of its health IT modernization program. 

PATH EHR went live on September 26 at Lawton Indian Hospital, Anadarko Indian Health Center, and Carnegie Indian Health Center. The Lawton Service Unit is the first IHS site to transition to PATH EHR and will serve as the pilot implementation for the functionality, usability, and compatibility of PATH EHR in a real-world healthcare environment before it is rolled out on a larger scale.

The IHS, an agency in the U.S. Department of Health & Human Services, provides health services for approximately 2.8 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 states. 

Like its federal health counterparts, IHS is working to replace a homegrown EHR, the Resource and Patient Management System (RPMS), with a commercial EHR from Oracle Health. The replacement of the U.S. Department of Veterans Affairs’ VistA system, upon which the IHS has dependencies, underscored the urgency for IHS to transition to a commercial enterprise health IT suite.

In a December 2023 e-mail Q&A with Healthcare Innovation, Jeanette Kompkoff, director of the Division of Health Information Technology Modernization and Operations (DHITMO) at the IHS, stressed that while the VA and DoD efforts and the IHS Health IT Modernization Program will both use Oracle Cerner technology, every instance of an EHR build is different.

“The IHS enterprise EHR solution will be a different product than the VA and DOD products and it will be implemented differently. IHS has had successful implementations of similar products throughout Indian Country and we have the advantage of gaining lessons learned from our federal, Tribal and Urban partners and will build the system with our users. Interoperability will be supported using certified technology between VA, DOD and commercial partners,” she said. 

Kompkoff said at the time that the project had a Life Cycle-Cost Estimate ranging from $4.5 billion to $6.2 billion throughout a 10-year period.


As the Lawton Service Unit continues through the go-live period, IHS said it would gather feedback and identify opportunities to improve workflows. The lessons learned at Lawton will help inform future PATH EHR deployments across the IHS.

Contractor partners on the PATH EHR pilot include General Dynamics Information Technology (integration services), Oracle Health (EHR product suite), Kadiak (Program Management Office support), and Totem (Organizational Change Management support).

IHS said that PATH EHR has successfully exchanged immunization information with the Oklahoma State Immunization Registry, including sending immunization reports to the registry and querying registry information. Tribal and private sector providers are also successfully sending electronic prescriptions to the Lawton Pharmacy.

“The launch of PATH EHR at the Lawton Service Unit is an important step toward building a more modern, connected health information environment at the IHS,” said IHS Chief Information Officer Mitchell Thornbrugh, in a statement. “The implementation at Lawton will help shape future deployments, strengthen implementation and support processes, and build an approach that can adapt to the needs of sites and communities across Indian Country.”

The IHS provides at-the-elbow support throughout the go-live period, working closely with the Lawton team to address questions and resolve tickets. The IHS is also using feedback from staff to update job aids, guidance, and other resources to support the transition and help staff become more comfortable with new workflows and functionality.

All clinical services, including emergency room, ambulatory, surgical, and inpatient admissions have continued successfully during the transition. 
In our 2023 interview, Kompkoff described a Four Directions Warehouse (4DW), which is set to be a central data repository in a federal cloud environment, with long-term storage solutions for comprehensive RPMS data archive and capabilities to incorporate data from multiple EHR solutions. "It enables seamless access to clinical data for both patients and providers across various facilities, boosting visibility into patient care needs,” she said. “The system facilitates the use of legacy information without the need for loading the full history of patient healthcare data into the enterprise EHR, and it requires no maintenance of RPMS systems. With robust security controls and a comprehensive data analytics environment, 4DW ensures the protection of patient data on the IHS-managed platform, streamlining the transition to modern healthcare solutions while laying the groundwork for advanced patient care optimization.”