January 26, 2023
Dakotah Lane decided to switch careers and become a doctor because he felt called to serve his people. After starting out as an electrical engineer, he went back to school for a medical degree at Weill Cornell Medical College in New York, returning to the Lummi Reservation in 2016 to practice family medicine and improve health care.
Four years later, as Lummi Tribal Health Center’s (LTHC) medical director, Lane led the search for a new electronic health record (EHR) system that would help manage patient care, streamline clinical workflows, and securely share digital information with LTHC’s 4,800 patients and other clinicians. He considers joining the OCHIN network a critical part of completing the circle of care in the Lummi community.
“We chose OCHIN for a lot of reasons—interoperability, improved revenue, increased outreach and interaction with our community members, and population health management—and we’re just scratching the surface of the tools that are available,” Lane said. “OCHIN is providing us with a method and system that will help lift our community members to the best health they can get.”
Rooted in community
OCHIN network members currently serve more than 45,000 American Indian and Alaska Native patients at 154 health care delivery sites across the country. Lummi Nation is a self-governing nation within the U.S., the third largest tribe in Washington state serving over 5,000 members.
Located on the Lummi Reservation outside of what is now known as Bellingham and Ferndale in Washington state, LTHC’s mission is to raise the health status of the Lummi people, other American Indian, and Alaska Natives to the highest possible level. LTHC was built in 1978 by Lane’s late great aunt, Violet Hillaire, during a time when Native communities were pushing to re-establish their treaty rights and faced systemic barriers to accessing quality health care. Tribal nations have experienced a long history of broken promises by U.S. federal and state agencies, and treaty rights were often ignored by the government.
“In order to get funding from the Indian Health Service (IHS) to build this place, she would literally pack all her food, fly over to D.C., sleep in a hallway or on the couch of a local representative, and then go to IHS, present her case, and then fly back,” Lane said. “It’s because of her that this clinic was built.”
Over 40 years later in 2018, Hillaire’s nephew and Lummi Nation’s first doctor of medicine (MD) from its own community would become LTHC’s executive medical director. Hillaire died of breast cancer in the 1990s, but a totem pole in her honor still stands outside of the health center that she founded.
Supporting financial independence and self-determination
Financial independence and tribal sovereignty are both essential to ensure Native communities can achieve their full health potential through access to affirming, culturally responsive care. LTHC started as an IHS clinic, but historically IHS did not deliver the best care, and non-tribal providers would gain at the expense of tribal communities, Lane said.
“We got tired of the way IHS was managing our clinic. Often, we would run out of money by June. Tribes had been advocating for the federal government to pay for more, but they just never allocated more funding. Then, we got self-governance in 1994.”
With self-governance, the Lummi Nation took over funding and received a block grant from the federal government. This enabled them to use any extra money they generated as revenue and direct resources where they are most needed to meet the unique health care priorities of the Lummi community.
When President Obama signed the Indian Health Care Improvement Act in 2010 as part of the Affordable Care Act, the federal government granted American Indians and Alaska Natives the ability to do third-party medical billing with Medicaid-Medicare and private insurance. But LTHC’s old EHR system, which was given to them by IHS, wasn’t designed for it.
“We knew we were providing good service, but we weren’t appropriately billing and getting reimbursed,” Lane said. “The billing looked like an MS-DOS prompt … it just was not automated in the way [OCHIN] Epic was.”
Since launching OCHIN Epic in 2021, LTHC has been able to increase their revenue and save enough money to build a larger clinic to support their growing number of patient visits—about 29,000 in October 2022 alone, or about three patients per minute— including behavioral health; physical therapy; medical, dental, and lab services. Their “clean claims” rate, or average number of claims paid upon the first submission, has also improved from between 60% and 70% to 94%.
“OCHIN Epic has greatly increased our ability to not only provide care to our community and expand services, but also to support building a new 50,000-square-foot facility,” Lane said. “We’re going to have to pay back a loan, and I have confidence that we’re going to be able to make that payment. It’s been a vast improvement.”
Providing secure interoperability and data sovereignty
In addition to improved billing, the ability to exchange health records with local hospitals that also use Epic was a priority during LTHC’s search for a new EHR. But when Lane presented the OCHIN contract to the Lummi tribal health commission, which was comprised mostly of tribal elders, Epic’s Care Everywhere interoperability platform was the one sticking point.
“The question the community asked is, ‘What are they going to do with our data? And why should we share our data with everyone else?’ It’s certainly a fine balance,” Lane said.
He explained to the health commission that although data access and sharing always comes with some risks, Care Everywhere has data protection in place that does not exist with social media and mobile phone apps. “I contrasted that data sharing risk with the benefits [of Care Everywhere], and the benefits truly outweigh the risks.”
One of the greatest benefits is that the providers at PeaceHealth, the local hospital system, also use it. Having “one patient, one record” ensures all health records flow seamlessly between patients and their many providers, giving clinicians greater insight into their patients’ health and helping to complete the circle of care in the community.
“They can go right on to Care Everywhere and see our latest note, they can see which medications were prescribed, they can see how often the patient has been seen here. Sometimes the patient hasn’t been seen here for a long time, and that’s why they’ve ended up in the hospital,” Lane said. “The flipside is we can also read the physician notes and then call them up if they’re missing a piece of information that’s important regarding that patient’s health care. Which I’ve done, because I can see that sometimes they’re going down their own path because they don’t know the patient as well as I do.”
Data sovereignty is important because it is rooted in the right of tribal nations to govern their own people. It protects Indigenous people from a history of medical exploitation by ensuring the confidentiality of sensitive health information across generations, and it can help close health disparities for Native communities by advancing both individual and collective well-being.
To ensure data sovereignty, OCHIN’s legal team provided a letter that Lane shared with the tribal health commission committing to the data protections in place by Care Everywhere. OCHIN also offered to have the legal team available if the health commission or Lane’s legal team had questions.
Increasing access to culturally specific, community-based care
Becoming part of the OCHIN network has allowed LTHC to tailor their offerings to meet the needs and concerns of the Lummi community within their EHR. OCHIN also created a new workflow so LTHC could send medications internally—since they have their own pharmacy and lab—and has been supporting their offsite school-based clinic.
“With OCHIN, it truly is a blank slate,” Lane said. “You have to put in the work to build it in a way that works for your clinic, and that’s where OCHIN gives us the flexibility.”
“Our community is hard to get a hold of. Very often phone calls go unanswered, voicemail is not set up, or voicemail is full. Roughly 80% of our population qualifies for Medicaid, so many of them are close to poverty, and the ability to pay for a cell phone is limited,” Lane says. “But all of them do eventually get access to Wi-Fi somewhere, or they get data somewhere.”
Because of this, LTHC has been aggressively encouraging MyChart adoption. They are now above 40% and expect the number of patients who use MyChart to increase.
“It’s truly been a game-changer for a lot of our community members,” Lane said. “They’re now using it for communications with the doctor—they like it better than trying to call. They’re using it to schedule appointments, and I think it’s just making it easier.”
In addition to helping LTHC to reach patients, Artera’s WELL app has decreased the health center’s no-show rate from between 20% and 25% to between 17% and 18%. This ensures that providers’ time is being used efficiently and that patients receive timely care.
“The community greatly loves those text reminders. It’s been a fantastic way for community engagement,” Lane said. “The downstream effect is we’ve had increased cancellations, and that allows our front desk to fill those in. They are now taking that workflow one step further, noting who was cancelling and then calling them within 24 hours asking if they want to reschedule.”
LTHC will launch Wisdom, Epic’s dental record module, in January 2023, and they will soon be moving to the new facility they have been building. While it was challenging to launch a new EHR in the middle of a pandemic, Lane says OCHIN Epic has provided LTHC with the infrastructure they need to deliver high-quality care.
“We have a very tight-knit community, and we’re so glad OCHIN is part of it,” he said. “OCHIN has really helped me to bring our health system into the 21st century.”