[Federal Register Volume 83, Number 142 (Tuesday, July 24, 2018)]
[Notices]
[Pages 35012-35016]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-15740]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Draft Indian Health Service Strategic Plan Fiscal Year 2018-2022
AGENCY: Indian Health Service, IHS.
ACTION: Request for comments; notice of Tribal Consultation and Urban
Indian Confer.
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SUMMARY: The Indian Health Service (IHS) is developing an Agency-wide
Strategic Plan to guide the work and strengthen partnerships with
Tribes and Urban Indian Organizations. The IHS is
[[Page 35013]]
seeking public comment on its Draft IHS Strategic Plan fiscal year (FY)
2018-2022 (Draft IHS Strategic Plan FY 2018-2022). Additionally, notice
is given that the IHS will conduct a Tribal Consultation and Urban
Indian Confer regarding the Draft IHS Strategic Plan FY 2018-2022. In
addition to the virtual town hall sessions, the IHS will seek other
opportunities to solicit input from Tribal and Urban Indian programs on
the Draft IHS Strategic Plan FY 2018-2022 during the comment period.
For IHS Strategic Plan events during the comment period, please check
the IHS Event Calendar at: https://www.ihs.gov/ihscalendar/.
DATES: Comments due by August 23, 2018.
The IHS virtual town hall sessions:
1. Urban Indian Confer on August 3 2018, from 2:00 p.m.-3:30 p.m.
(Eastern Time).
2. Tribal Consultation on August 6, 2018, from 2:00 p.m.-3:30 p.m.
(Eastern Time).
ADDRESSES: Written comments on the Draft IHS Strategic Plan FY 2018-
2022 may be provided by email, or by United States (U.S.) postal mail.
E-mail addresses are as follows:
For Tribes: [email protected].
For Urban Indian Organizations: [email protected].
For IHS Employees and the General Public: [email protected].
Please use ``DRAFT IHS STRATEGIC PLAN FY 2018-2022'' as the subject
line.
U.S. Postal Mail: RADM Michael D. Weahkee, MBA, MHSA, Acting
Director, ATTN: Draft IHS Strategic Plan FY 2018-2022, Indian Health
Service, 5600 Fishers Lane, Mailstop: 08E86, Rockville, Maryland 20857.
FOR FURTHER INFORMATION CONTACT: CAPT Francis Frazier, Director, Office
of Public Health Support, IHS, 5600 Fishers Lane, Mail Stop: 09E10D,
Rockville, Maryland 20857. Telephone (301) 443-0222 (This is not a
toll[dash]free number).
SUPPLEMENTARY INFORMATION: The IHS participated in a strategic planning
process informed by feedback received from Tribes, Urban Indian
Organizations, and staff, as described in more detail below, to develop
the Draft IHS Strategic Plan FY 2018-2022 for consideration. The IHS is
committed to improving health care delivery services and enhancing
critical public health services to strengthen the health status of
American Indian and Alaska Native people throughout the health system.
The Draft IHS Strategic Plan FY 2018-2022 includes a revised IHS
Mission statement, a new IHS Vision statement, and articulates how the
IHS will achieve its mission through three strategic goals. The three
strategic goals are: (1) To ensure that comprehensive, culturally
acceptable personal and public health services are available and
accessible to American Indian and Alaska Native people; (2) To promote
excellence and quality through innovation of the Indian health system
into an optimally performing organization; and (3) To strengthen IHS
program management and operations. Each goal is supported by objectives
and strategies. To review the current IHS Mission statement and
priorities, please visit: https://www.ihs.gov/aboutihs/overview/.
The strategic planning Consultation and Confer process is an
opportunity for the IHS to further refine and strengthen the Draft IHS
Strategic Plan FY 2018-2022. The IHS appreciates the invaluable
feedback received to date on the Draft IHS Strategic Plan FY 2018-2022
and seeks to ensure all Agency stakeholders have the opportunity to
comment. As we build on the current Draft IHS Strategic Plan FY 2018-
2022, we look forward to receiving your comments by August 23, 2018.
The Urban Indian Confer on August 3, 2018, and the Tribal
Consultation on August 6, 2018, will be held telephonically and by
webinar. A letter will be sent to Urban Indian Organization Leaders and
Tribal Leaders to notify them about details associated with conference
call and webinar schedules and call-in information.
To develop the Draft IHS Strategic Plan FY 2018-2022, the IHS used
a process similar to the U.S. Department of Health and Human Services
(HHS) Strategic Plan FY 2018-2022, including use of goals; objectives
and strategies; environmental scans; Strengths, Weaknesses,
Opportunities, and Threats (SWOT) analysis; and workgroup
participation. The environmental scan reviewed several IHS Areas,
Headquarters Offices, and other available documents, and the SWOT
exercise was conducted with IHS staff. Informed by these documents and
analysis, the IHS developed an initial framework for review and comment
by Tribes, Urban Indian Organizations, and IHS staff. The IHS first
initiated Tribal Consultation and Urban Indian Confer on the IHS
Strategic Plan initial framework on September 15, 2017, and formed an
IHS Federal-Tribal Strategic Planning Workgroup (workgroup) to review
all comments and recommend a list of final goals and objectives for IHS
leadership review and approval.
During the initial framework comment period (September 15, 2017-
October 31, 2017), the IHS held listening sessions, presented at Tribal
meetings, and held conference calls with Tribal and Urban Indian
Organization leaders. The workgroup membership included IHS staff at
the Area, Service Unit, and Headquarters levels (including a
representative from the IHS Office of Urban Indian Health Programs);
Tribal leaders or their designees. The workgroup reviewed the comments
received from 150 Tribes, Tribal Organizations, Urban Indian
Organizations and IHS staff on the initial framework and suggested
strategies during six meetings over a 3-month period, resulting in
final recommendations on the IHS Mission, Vision, Goals, Objectives,
and Strategies. These recommendations are the basis of the Draft IHS
Strategic Plan FY 2018-2022.
Since initiating Tribal Consultation and Urban Indian Confer on the
IHS Strategic Plan initial framework, the IHS has issued four letters
to Tribal Leaders and Urban Indian Organization Leaders to update
Tribes and Urban Indian Organizations on progress. Additionally, the
IHS issued several communications stating that comments on the Draft
IHS Strategic Plan FY 2018-2022 will be accepted throughout the
strategic planning process. The IHS strategic planning Web site
includes more information about the IHS strategic plan timeline, as
well as links to the Tribal Leader letters, Urban Indian Organization
Leader letters, and workgroup activities.
The IHS values all feedback and input regarding the Draft IHS
Strategic Plan FY 2018-2022 and invites Tribes, Tribal Leaders, and/or
their designees to Consult and Urban Indian Organization Leaders to
Confer on the Draft IHS Strategic Plan FY 2018-2022. Tribal
Consultation will be conducted with elected or appointed leaders of
Tribal Governments and their designated representatives. Those wishing
to participate in the Tribal Consultation as a designee must have a
copy of a letter signed by an elected or appointed Tribal official or
their designee that authorizes them to serve as the representative of
the Tribe. Urban Indian Confer will be conducted with recognized
representatives from Urban Indian Organizations, as defined by 25
U.S.C. 1603(29). Representatives from other Tribal Organizations and
Native non-profit organizations are welcome as observers. Those wishing
to be recognized representatives from Urban Indian Organizations should
provide documentation that their organization meets the definition at
25 U.S.C. 1603(29) and that the selected participant has the official
capacity to
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represent the organization. This documentation should be submitted by
e-mail no later than 3 days in advance of the Tribal Consultation and
Urban Indian Confer session to the address that follows:
[email protected].
The text of the Draft IHS Strategic Plan FY 2018-2022 is available
at the IHS Web site at: https://www.ihs.gov/strategicplan/and below.
Indian Health Service (IHS)
Draft IHS Strategic Plan Fiscal Year 2018-2022
The Indian Health Service (IHS) provides a wide range of
clinical, public health, community and facilities infrastructure
services to approximately 2.2 million American Indians and Alaska
Natives (AI/AN) from 573 federally recognized Tribes in 37 States.
Comprehensive primary health care and disease prevention services
are provided through a network of hospitals, clinics, and health
stations on or near Indian reservations. These facilities are
predominately located in rural and primary care settings and are
managed by IHS, Tribes, and Tribal Organizations. In addition, IHS
contracts with Urban Indian Organizations for health care services
provided in urban centers. The Draft IHS Strategic Plan FY 2018-2022
includes the Mission statement, a new Vision statement and
articulates how the IHS will achieve its mission through three
strategic goals. Each goal is supported by objectives and
strategies.
Mission: To raise the physical, mental, social, and spiritual
health of American Indians and Alaska Natives to the highest level.
Vision: Healthy communities and quality health care systems
through strong partnerships and culturally relevant practices.
Goal 1: To ensure that comprehensive, culturally acceptable
personal and public health services are available and accessible to
American Indian and Alaska Native people.
Goal Explanation: The Indian Health Service (IHS) provides
comprehensive primary health care and public health services, which
are critical to improving the health of AI/AN people. The Indian
health system delivers care through health care services provided in
IHS, Tribal, and Urban (I/T/U) health facilities (e.g., hospitals,
clinics) and by supporting the purchase of essential health care
services not available in IHS and Tribal health care facilities,
known as the Purchased/Referred Care (PRC) program. Additional
services include environmental health improvements as well as
traditional healing to complement the medical, dental, pharmacy,
laboratory, behavioral health and other primary care medical
programs. Expanding access to these services in AI/AN communities is
essential to improving the health status of the AI/AN population.
This goal includes securing the needed workforce, strengthening
collaboration with a range of public and private, Tribal, and Urban
Indian providers and expanding access to quality health care
services to promote the health needs of AI/AN communities.
Objective 1.1: Recruit, develop, and retain a dedicated,
competent, and caring workforce.
Objective Explanation: Consistent, skilled, and well-trained
leadership is essential to recruiting and retaining well-qualified
health care professionals and administrative professionals.
Attracting, developing, and retaining the needed staff will require
streamlining hiring practices and other resources that optimize
health care outcomes. Within the Indian health system, staff
development through orientation, job experience, mentoring, and
short and long-term training and education opportunities are
essential for maintaining and expanding quality services and
maintaining accreditation of facilities. Also, continuing education
and training opportunities are necessary to increase employees'
skill sets and knowledge to keep pace in rapidly evolving areas of
medical science, prevention science, improvement science, and
information technology, as well as to increase opportunities for
employee career advancement and/or to maintain necessary
professional credentialing and accreditation.
Strategies--The following strategies support this objective:
Health Care Recruitment and Retention:
1. Improve and innovate a process that increases recruitment and
retention of talented, motivated, desirable, and competent workers,
including through partnerships with Tribal communities and others.
2. Continue and expand the utilization of the IHS and Health
Resources and Services Administration's National Health Service
Corps scholarship and loan repayment programs, as authorized by the
law, to increase health care providers at I/T/U facilities.
3. Support IHS sponsorship of fellowship slots in certain
specialized leadership programs for recruitment of future physician
leaders.
4. Evaluate new organizational structure options and reporting
relationships to improve oversight of the Indian Health Professions
program.
5. Expand the use of paraprofessionals and mid-level
practitioners to increase the workforce and provide needed services.
6. Develop training programs in partnership with health
professional schools and training hospitals and expand opportunities
to educate and mentor Native youth interested in obtaining health
science degrees.
7. Enhance and streamline IHS Human Resources infrastructure to
hire well-qualified personnel.
Staff Capacity Building:
8. Strengthen the workforce to improve access to, and quality
of, services.
9. Improve leadership skills, adopt a consistent leadership
model, and develop mentoring programs.
10. Improve continuity processes and knowledge sharing of
critical employee, administrative, and operational functions through
written communications and documentation within IHS.
11. Improve workplace organizational climate with staff
development addressing teamwork, communication, and equity.
12. Strengthen employee performance and responsiveness to the
Agency, Tribes, and patients by improving employee orientation and
opportunities for training and education, including, customer
service skills.
Objective 1.2: Build, strengthen, and sustain collaborative
relationships.
Objective Explanation: Collaboration fostered through an
environment that values partnership is vital to expanding the types
of services to improve population health outcomes that can be
achieved within the health care delivery system. These relationships
include those between Tribes, Urban Indian programs, communities,
other government agencies, not-for-profits, universities/schools,
foundations, private industry, as well as internal cooperation
within the Agency and collaborative project management.
Strategies--The following strategies support this objective:
Enhancing Collaboration:
1. Collaborate with Tribes in the development of community-based
health programs, including health promotion and disease prevention
programs and interventions that will increase access to quality
health programs.
2. Develop a community feedback system/program where community
members can provide suggestions regarding services required and
received.
3. Support cross collaboration and partnerships among I/T/U
stakeholders.
Service Expansion:
4. Promote collaborations between IHS, other Federal agencies,
Tribes, and Tribal Organizations to expand services, streamline
functions and funding, and advance health care goals and
initiatives.
5. Work with community partners to develop new programs
responsive to local needs.
Objective 1.3: Increase access to quality health care services.
Objective Explanation: Expanded access to health care services,
including individual and community health services, requires using
many approaches and is critical to improving the health of AI/AN
people and reducing the leading causes of death risk factors. Among
the needs identified are increased prevention, specialty care,
innovative use of health care providers, traditional medicine, long-
term and aftercare services (which may require advancing holistic
and culturally centered population health models), and expanded
facilities and locations. To assess the success of these efforts,
measures are needed to evaluate provider productivity, patient
satisfaction, and align improvements in support operations (e.g.,
human resources, contracting, technology) to optimize access to
quality health care services.
Strategies--The following strategies support this objective:
Health Care Service Access Expansion:
1. Develop and support a system to increase access to preventive
care services and quality health care in Indian Country.
2. Develop and expand programs in locations where AI/AN people
have no access to quality health care services.
3. Overcome or mitigate challenges and enhance partnerships
across programs and
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agencies by identifying, prioritizing, and reducing access
limitations to health care for local AI/AN stakeholders.
4. Increase access to quality community, direct/specialty, long-
term care and support services, and referred health care services
and identify barriers to care for Tribal communities.
5. Leverage technologies such as telemedicine and asynchronous
electronic consultation systems to include a more diverse array of
specialties and to expand, standardize, and increase access to
health care through telemedicine.
6. Improve team effectiveness in the care setting to optimize
patient flow and efficiency of care delivery.
7. Reduce health disparities in the AI/AN population.
8. Provide evidence-based specialty and preventive care that
reduces the incidence of the leading causes of death for the AI/AN
population.
9. Incorporate Traditional cultural practices in existing health
and wellness programs, as appropriate.
10. Improve the ability to account for complexity of care for
each patient to gauge provider productivity more accurately.
11. Hold staff and management accountable to outcomes and
customer service through satisfaction surveys.
Facilities and Locations:
12. In consultation with Tribes, modernize health care
facilities to expand access to quality health care services.
13. In consultation with Tribes, review and incorporate a
resource allocation structure to ensure equity among Tribes.
14. Develop and execute a coordinated plan (including health
care, environmental engineering, environmental health, and health
facilities engineering services) to effectively and efficiently
execute response, recovery, and mitigation to disasters and public
health emergencies.
Goal 2: To promote excellence and quality through innovation of
the Indian health system into an optimally performing organization.
Goal Explanation: In pursuit of high reliability health care
services \1\ and care that is free from harm, the IHS has
implemented several innovations in health care delivery to advance
the population health needs of AI/AN communities. In many cases,
innovations are developed to meet health care needs at the local
level and subsequently adopted across the Indian health system, as
appropriate. IHS will continue to promote excellence and quality
through innovation by building upon existing quality initiatives and
integrating appropriate clinical and public health best practices.
Recent IHS efforts have been aimed at strengthening the underlying
quality foundation of federally operated facilities, standardizing
processes, and sharing health care best practices with other
Federal, State, Tribal, and Urban Indian programs.
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\1\ High reliability health care means consistent excellence in
quality and safety for every patient, every time. High reliability
in health care improves: organizational effectiveness, efficiency,
culture, customer satisfaction, compliance, and documentation. For
more information about High Reliability Organizations, please see:
https://psnet.ahrq.gov/primers/primer/31/high-reliability.
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Objective 2.1: Create quality improvement capability at all
levels of the organization.
Objective Explanation: Ensure quality improvement is operational
in all direct care, public health, administrative, and management
services throughout the system. Quality improvement will be achieved
at all levels of the organization including Headquarters, Area
Offices, and Service Units and will be made available to Tribes,
Tribal Organizations, and Urban Indian Organizations, as requested.
Creating quality improvement capability at all levels will require
training, resources, commitment, and consistency to assure that
every employee shares a role in continuous quality improvement in
all IHS operations and services. This objective will build upon
current efforts of the 2016-2017 IHS Quality Framework \2\ to
strengthen quality improvement related to data, training, and
standards of care.
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\2\ The IHS Quality Framework 2016-2017 is available at: https://www.ihs.gov/newsroom/includes/themes/newihstheme/display_objects/documents/IHS_2016-2017_QualityFramework.PDF.
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Strategies--The following strategies support this objective:
Quality Data:
1. Improve the quality of data collected regarding health care
services and program outcomes.
2. Develop and integrate quality standards and metrics into
governance, management, and operations.
3. Standardize quality metrics across the IHS and use results to
share information on best practices, performance trends, and
identification of emerging needs.
Continuous Quality Improvement:
4. Provide training, coaching, and mentoring to ensure
continuous quality improvement and accountability of staff at all
levels of the organization.
5. Evaluate training efforts and staff implementation of
improvements, as appropriate.
Standards of Care:
6. Develop and provide standards of care to improve quality and
efficiency of health services across IHS.
7. Adopt the Model of Improvement in all clinical, public
health, and administrative activities in the Indian health system.
8. Adopt patient-centered models of care, including patient
centered medical home recognition and care integration.
Objective 2.2: Provide care to better meet the health care needs
of Indian communities.
Objective Explanation: Key to improving health outcomes and
sustaining population health is culturally responsive health care
that is patient-centered and community supported. IHS will implement
culturally appropriate and effective clinical and public health
tools, as appropriate, to improve and better meet the health care
needs of AI/AN communities. This objective reinforces current
efforts addressing culturally appropriate care and support
dissemination of best practices.
Strategies--The following strategies support this objective:
Culturally Appropriate Care:
1. Strengthen culturally competent organizational efforts and
reinforce implementation of culturally appropriate and effective
care models and programs.
2. Promote and evaluate excellence and quality of care through
innovative, culturally appropriate programs.
3. Promote the total health integration within a continuum of
care that integrates acute, primary, behavioral, and preventive
health care.
4. Explore environmental and social determinants of health and
trauma-informed care in health care delivery. Expand best practices
across the IHS.
5. Continue to develop and implement trauma-informed care models
and programs.
Sharing Best Practices:
6. Work collaboratively within IHS, and among other Federal,
State, Tribal programs, and Urban Indian programs to improve health
care by sharing best practices.
Goal 3: To Strengthen IHS program management and operations.
Goal Explanation: This goal addresses issues of management,
accountability, communication, and modernized information systems.
IHS is committed to the principles of improved internal and external
communication, and sound management. Assuring the availability and
ongoing development of a comprehensive information technology (IT)
system is essential to improving access to integrated clinical,
administrative, and financial data to support individual patient
care, and decision-making.
Objective 3.1: Improve communication within the organization
with Tribes and other stakeholders, and with the general public.
Objective Explanation: This objective addresses the critical
need to improve communication throughout the IHS, with employees and
patients, with Tribes, with Urban Indian Organizations, with the
many organizations working with IHS and with the general public.
Most important is to assist Tribes, Urban programs, and IHS in
better understanding Tribal and Urban Indian needs and IHS program
needs, to encourage full participation in information exchange, and
to engage Tribes and Urban programs in partnership and coalition
building. This includes defining and characterizing community needs
and health program needs, modifying health programs as needed, and
monitoring the effectiveness of programs and program modifications.
Strategies--The following strategies support this objective:
Communication Improvements:
1. Improve communication and transparency among all employees,
managers, and senior leadership.
2. Develop and define proactive communications plans for
internal and external stakeholders.
3. Enhance health-related outreach and education activities to
patients and families.
4. Design social media platforms that will ensure wide
dissemination of information to interested and affected individuals
and organizations.
Strengthened Partnership:
5. Assure quality reporting relationships between service units,
Area offices, and
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headquarters are clearly defined and implemented.
6. Effectively collaborate with other IHS offices (e.g., the
Loan Repayment Program) and HHS Staff and Operating Divisions where
missions, goals, and authorities overlap.
Objective 3.2: Secure and effectively manage the assets and
resources.
Objective Explanation: This objective supports the delivery of
health care through improved management of all types of assets and
non-workforce resources. To elevate the health status of the AI/AN
population and increase access to medical care, IHS must continue to
help ensure patients understand their health care options and
improve business process and efficiencies to the health care system.
IHS will also increase the effectiveness of operations and
reporting, while providing more assistance and infrastructure
support to Areas and facilities.
Strategies--The following strategies support this objective:
Infrastructure, Capacity, and Sustainability:
1. Enhance transparency of the IHS management and accountability
infrastructure to properly manage and secure assets.
2. Ensure that Federal, State, Tribal, territorial, and local
Tribal health programs have the necessary infrastructure to
effectively provide essential public health services.
3. Provide technical assistance to strengthen the capacity of
service units and Area Offices to enhance effective management and
oversight.
4. Apply economic principles and methods to assure ongoing
security and sustainability of Federal, Tribal and Urban Indian
facilities.
Improved Business Process:
5. Routinely review management operations to effectively improve
key business management practices.
6. Optimize business functions to ensure IHS is engaged in
discussions on value-based purchasing.
7. Develop policies, use tools, and apply models that ensure
efficient use of assets and resources.
8. Strengthen management and operations through effective
oversight.
9. Develop standardized management strategies for grants,
contracts, and other funding opportunities to promote innovation and
excellence in operations and outcomes.
Patient Education and Resources:
10. Strengthen patients' awareness of their health care options,
including Medicaid and Medicare enrollment, which may increase
access to health care and optimize third party reimbursements.
Objective 3.3: Modernize information technology and information
systems to support data driven decisions.
Objective Explanation: This objective is to assure the
availability and ongoing improvement of a comprehensive information
technology (IT) system that meets the needs of providers, patients,
and I/T/Us, including using technology to provide improved, timely
access to care and to reduce the need for transit. This objective
recognizes that qualified and capable IT staff and leadership are
fundamental in achieving the strategies listed below and further
reinforces the workforce objectives outlined elsewhere in the plan.
An improved Indian health IT network increases access to integrated
clinical, administrative, and financial data to support individual
patient care, decision-making, and advocacy. The need for data will
require the development of a system integrated with Tribal and Urban
Indian programs that will address the current and projected
clinical, administrative, and fiscal data needs. Timely fiscal data
dissemination to all Federal partners when developing budgets is
necessary to accurately address health care needs of Indian
communities. Data quality (i.e., accuracy, reliability, and
validity) and quality patient care will continue to play a highly
visible role both within and outside the IHS. Data quality is only
partially dependent upon technology. Improved data quality also
reflects other sustained initiatives, such as accuracy of data
entry, legibility of handwriting, appropriate and timely data
exports, and accuracy of coding.
Strategies--The following strategies support this objective:
Health Information Technology (HIT):
1. Evaluate electronic health record needs of the IHS and the
ability for the health information systems to meet those needs,
create seamless data linkages, and meet data access needs for Tribes
and Tribal program health information systems.
2. Develop a consistent, robust, stable, secure, state-of-the-
art HIT system to support clinicians workflow, improve data
collection, and provide regular and ongoing data analysis.
3. Modernize the HIT system for IHS Resource and Patient
Management System (RPMS) or commercial off-the-shelf packages.
4. Align with universal patient record systems to link off-
reservation care systems that serve AI/AN.
5. Enhance and expand technology such as the IHS telecom to
provide access for consultative care, stabilization of care,
decreased transportation, and timeliness of care at any IHS-funded
health program.
Data Process:
6. Provide available data to inform decision making for internal
and external stakeholders.
7. Act upon performance data and standardize data and reporting
requirements.
8. Assure system of data sharing to solidify partnerships with
Tribal Epidemiology Centers and other Tribal programs.
9. Establish capability for data federation \3\ so that data
analytics/business intelligence may be applied to disparate data
stored in a single, general-purpose database that can hold many
types of data and distribute that data to users anywhere on the
network.
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\3\ Data federation provides an organization with the ability to
aggregate data from disparate sources in a virtual database so it
can be used for business intelligence or other analysis.
Note: This draft plan is developed for public consideration, it
is intended to improve the management and administration of the IHS
and strategic direction of the Agency over the next 5 years, and it
is not intended to create any right, benefit, or legal
responsibility, substantive or procedural, enforceable at law by a
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party against the United States, its agencies, or any person.
The IHS will publish an additional Federal Register Notice with the
final IHS Strategic Plan FY 2018-2022 after all comments are received
and considered.
Dated: July 16, 2018.
Michael D. Weahkee,
RADM, Assistant Surgeon General, U.S. Public Health Service, Acting
Director, Indian Health Service.
[FR Doc. 2018-15740 Filed 7-23-18; 8:45 am]
BILLING CODE 4165-16-P