The Indian Health Service Service should be sending vital immunization records from the Southern Ute Health Clinic to Colorado’s health department daily. But that has not happened in over a year.
When a child receives a vaccine at the SUHC, the clinic uploads a record of that care to a Resource and Patient Management System operated by the IHS, a federal agency with an area office in Albuquerque.
That IHS system is supposed to communicate with individual state health departments so that states can maintain a single, definitive database of immunizations.
Consolidated electronic medical records in the state’s database allow for multiple providers to view a patient’s updated information, help patients stay up-to-date on vaccinations and keep records safe in the event of a natural disaster or emergency.
But on Feb. 24, 2023, the Southern Ute Indian Tribe notified the Colorado Department of Public Health and Environment that the files sent daily from IHS to the Colorado Immunization Information System were all blank.
“The inability of the CIIS to receive actual immunization data via the daily (Immunization Interface Management Package) export files means the tribe cannot provide up-to-date vaccination records to the State and creates the intolerable and completely avoidable risk that the children may be double vaccinated and suffer severe negative health outcomes,” SUIT Chairman Melvin J. Baker wrote in a Dec. 19 letter to the Albuquerque Area IHS Director Dr. Leonard Thomas.
In the letter, provided to The Durango Herald along with other documents by the office of U.S. Rep. Lauren Boebert, Baker says the two systems have failed to communicate since Nov. 18, 2022.
The exact cause of the breakdown in technological communication appears unclear, internal communications indicate.
Baker said the system was “fundamental” to the tribe’s ability to provide basic health care pursuant to the Indian Self Determination and Education Assistance Act.
On Jan. 10, 2024, nearly a year after the tribe first brought the issue to IHS’s attention, Thomas said the agency would have the issue fixed by the end of January 2024.
Now, Boebert and Sens. Michael Bennet and John Hickenlooper are pressuring IHS to fix the problem.
In a Jan. 5 letter to the IHS Director Roselyn Tso, Boebert called the situation “alarming and unacceptable.”
“This failure is in the face of extensive efforts by the Tribe to work with IHS toward a resolution over nine months to no avail,” she wrote. “IHS’s disregard for the Tribe’s critical need and IHS’s inadequate responses merit future review.”
Tso did not respond, Boebert’s press secretary said.
The situation remains unsolved and has seemingly grown more complicated.
It appears that Colorado’s public health department and IHS do not know why the breakdown in communication between the agencies’ systems first occurred.
In his letter to Baker last month, Director Thomas blamed the state.
“During April of 2023, the State of Colorado changed their Immunization vendor without providing prior notice to the Southern Colorado Ute Tribe (sic) or the Indian Health Service,” he wrote.
The state says this is not the case, and is pointing a finger back at IHS.
AnneMarie Harper, spokeswoman for CDPHE Division of Disease Control and Public Health Response, told the Herald in an email that the CIIS has been managed by Envision Technology Partners since 2011, although the vendor does update security practices from time to time.
“There were no changes on CDPHE’s side and security updates to the Colorado Immunization Information System did not break the connection,” Harper wrote.
CDPHE changed where data is stored in December 2023, but Harper said this could not have caused the issue, which first occurred in November 2022.
IHS acknowledged a request for comment but did not respond to further questions.
The SUIT also declined to comment for this story, but said the tribe has not gotten as much traction on this issue as officials would like. In his Dec. 19 letter, Chairman Baker said that the Southern Ute Health Center sought help from IHS in the form of a support ticket shortly after the problem was noticed.
“IHS failed to adequately address the ticket,” he wrote.
Harper said the state had a similar experience.
“CDPHE also initiated a number of outreach attempts to Indian Health Services in the hopes of resolving the connection issue directly,” she wrote. “CDPHE confirmed that Indian Health Services was aware of the issue, and that Indian Health Services participation was required to reestablish connection, but were not able to secure a timeline or commitment for resolution.”
What occurred between February 2023 and Baker’s Dec. 19 letter is unclear. The tribe reached out to IHS in October, Baker wrote, and offered to cover the cost of an expedient repair.
The offer was met with what he described as IHS’s “characteristic lack of urgency.”
With no apparent solution in the works, Baker wrote his strongly worded letter two months later.
Despite Thomas’ stated goal to have the problem resolved by the end of January, the month passed with no apparent fix within reach.
Thomas did explain in his response to Baker that the IHS has been in the process of updating the outdated Resource and Patient Management System.
Although he indicated that IHS officials had made progress toward tying the 638 tribal locations under its jurisdiction into an updated system, email communications from Jan. 30 detail more setbacks.
The IHS consultant assigned to get individual tribal clinics looped into a new system contacted the tribe on Jan. 30 asking the SUHC to complete the paperwork that would allow IHS to connect the tribal records with the New Mexico health department’s records system.
“Tribal Health Director requests that the CIIS (Colorado) interface is fixed first,” the tribe’s pharmacy director replied. “We haven’t reported to New Mexico in the past so that is not our priority.”
When asked why IHS could not first connect the tribe back to Colorado’s health department, the consultant said that the IHS wanted to test its updated system with New Mexico first.
Boebert’s office asked the Congressional Research Service to look into the matter. The agency found that while New Mexico’s system is newer, and Colorado’s has yet to be upgraded, there is no known federal policy or requirement for that step to precede or preempt the necessary support of records transfer from IHS to the Colorado system.
Furthermore, the agency told Boebert’s office that although there might be a functional rationale for IHS to send data to New Mexico, the reasoning was unknown.
In the meantime, IHS insists that the SUIT immunization data has not been lost.
CDPHE says it has provided the SUIT in October with a temporary alternative means of transmitting the records directly to the state.
Still, Baker slammed IHS for its lack of action.
He drew from a passage of the U.S. Department of Health and Human Services budget (IHS falls under HHS) noting a passage which said: “The Electronic Health Record is an essential tool for provisions of clinical care, administrative functions of hospitals and health clinics, and third-party billing for reimbursements that are foundational to the operating budgets of many health facilities.”
“IHS’s continued failure to take any meaningful action to resolve this nearly year-old problem further exacerbates stark health disparities faced by tribal communities, severely undermines the government-to-government relationship the Tribe has with the United State, and endangers the health of the Tribe’s patients, especially children the SUHC vaccinates,” he wrote.