< PreviousFeatured Columns - Gaming & Hospitality SystemsRichard Rader, Director of IT, Cow Creek Band of Umpqua Indians/Seven Featherscan play 10 hands of black jack in an hour and I wager $5 per hand and play for 30 minutes my wagered amount for the time period is $25 and if the par is five percent it means the operations should have won $1.25.Regulatory is a key component and depending on the gaming control board or jurisdiction you fall under there are some specific rules. I’m listing just a few so you can see the importance of capturing this data for compliance and to keep the casino operations up and running to fund the tribal initiatives.• Report Meters Every Hour• Report Cash Every Day• Report Configuration Changes every Activity• Report Cash in Meters every ActivityI will attempt to define terms below but I am specifically calling out a few terms here:TERMDEFINITIONCoin-InWagered amount committed by a player often called Meter Coin-In in the widely accepted SAS protocol.Coin-OutMonies returned a player after the outcome has been determined and the player is due the money, often called Meter Coin-Out in the widely accepted SAS protocol.Games-PlayedThe count of games played with a committed wager or Coin-InDropAmount of money removed from a device that is audited against the metersMeterMeasurement of an activity Meter Coin-In is widely considered an industry standard and is required for gaming and regulatory markets. Most jurisdictions require that the actual amounts are compared to the metered amount to verify if all activities occurred properly. Having a supportable model and the knowledge necessary to support the actual gaming system is key to an IT Organizations success. My organization provides all IT support to the businesses inside the Cow Creek Band of Umpqua Indians. Last year my organization was restructured from just the casino and some businesses to overseeing all IT operations for the Tribe. I have a staff of 25 Technologist over three different geographical locations supporting over 1,200 employees in the various businesses and government along with a tribal membership of over 1,300. I also oversee 70 employees in the Maintenance Departments throughout the organizations. The tribal history of the Cow Creek Band of Umpqua Tribe of Indians is quite impressive and shows the resilience of the people and their culture moving forward. The story is located on the website at: http://www.cowcreek.com/tribal-government/tribal-story. A good resource of information showing how the tribe was forced to disband and collectively were able to reinstate their rights and work as a cooperative partner with the community. In the next segment I will dive deep into the actual systems and what they do and how you need to support them. Some parts of the system only need to be supported 8x5 whereas other parts of the system need effective response and resolution in minutes. An example I often refer to is when the ticketing system is offline the cost to operations can be hundreds of thousands of dollars in an hour. Having the right people, right products, right support will make you and your organization successful.40TribalNetMIP Fund Accounting by AbilaProduct SpotlightDistributed and serviced by Software Simplified, MIP Fund Accounting (MIP) is a financial management solution preferred by nonprofit, small government and tribal nations for planning and managing budgets, maximizing grants, and producing accurate customized reports in minutes. Unlike off-the-shelf commercial products, MIP allows organizations to track and report on multiple funds across multiple budget periods. MIP is easy-to-use and can assist you in increasing efficiencies, reducing your workload, and providing you with accurate reporting in order to maximize your effectiveness as an organization. With our fund accounting software solution, you will be better able to:• Efficiently produce accurate reports for both internal and external key stakeholders that meet GASB 34 requirements• Demonstrate accountability with unlimited budget versions and flexibility to accurately track and report on multiple cost centers through varying budget periods• Maintain a clear audit trail no matter how simple or complex the fund allocation, grant administration, or data segmentation for your organization• Configure and customize your system to work exactly the way you need it to, while tracking data and reporting appropriately• Automate tasks by using features such as special function keys, distribution tables, and automatic offset entries to maximize efficiency and accuracyWho We AreSoftware Simplified is a consulting firm specializing in financial management and time tracking. Industries served include the legal sector, nonprofit organizations, small governments and tribal nations. As an authorized Sage Software Business Partner since 1999, Software Simplified works directly with public and private organizations fully understanding the unique financial reporting and management requirements imposed today. Our professional service team includes financial executives, information technologists, business managers and grants developers. Most recently we have become Business Partners with Microix, ACOM, and Abila (formerly Sage NonProfit Solutions).Value to the Native American Market:As a self-governing tribe, you must create a trustworthy internal activities reporting system which allows you to manage the development and implementation of self-governance policies and procedures, as well as enable staff to manage the development and operation of tribal government programs and services. This enables you to measure your progress toward your goals and objectives, evaluate the performance of the staff assigned to operate the programs, and determine the appropriate development of self-governance.We know that it’s never easy to change accounting solutions – they are so important to the critical processes within your finance office. No one wants to start all over again if they don’t have to. We want to make the transition to MIP Fund Accounting solution as easy as possible. You don’t just need a product, but a dedicated Business Partner like Software Simplified to ensure the success of your finance office. We have fund accounting and technology experts to help ensure a transition to a new accounting solution is as easy as possible. And, you don’t necessarily have to start over. The transition to MIP is easy because you can keep your existing chart of accounts in place, allowing you to continue to report the specific funds, grants or other segments that you need, and staff members the relief of not having to remember new General Ledger codes. Or not…In our experience, we have also found that some tribal finance offices desire to fully revamp their General Ledger codes, and that’s okay too. Software Simplified takes four simple steps with you to move over to MIP Fund Accounting:• DISCOVERY SESSION• DATA CONVERSION• ONSITE TRAINING• ONGOING SUPPORTReferences of Where Installed:• Cowlitz Tribe • Little Traverse Bay Band of Indians • Seminole Nation • Tohono O’odham Nation • Yakutat Tinglet TribeCompanySoftware SimplifiedSales ContactVicki Shipman Vicki@softsimp.com530-227-5221 (Mobile) 209-229-8370 (Office) www.softsimp.com41Spring 2015Featured Columns - Growth & Self-SustainabilityJames Spillane, Informatics and Applications PM, Sitnasuak Health SolutionsOne of the things that makes tribal health so great is that it has been reclaimed. Stakeholders, the people, of tribal health have an outstanding self-determination, a real “do it yourself attitude!” This is great, but it will only take us so far. Now it’s time for us to start thinking about giving some of it up. I know this sounds crazy, but think about it. I’m sure with enough tenacity we could build our own automobiles, but do we? We could probably run all our own cables and set up a local telephone service. We could even purchase our own hardware and create our own television studio in which we hire actors and put on productions that we could then broadcast (come to think of it, that isn’t too bad of an idea…) but the reality is we outsource this. Day in and day out, we choose to drive our Honda Pilot’s, our Chevy Silverado’s and Toyota Tundra’s to work; we depend on Verizon or AT&T for our cell service; we watch Sports Center and Downton Abbey on Direct TV and stream House of Cards on Netflix. We outsource many aspects of our lives to others. Why? Because of economies of scale. In a time of ever growing complexity, with more and more regulations and less and less resources to accomplish them (Meaningful Use Stage 2, ICD10), maybe now is the time for us to start thinking about tak-ing advantage of these economies of scale.Just recently I spent some time in beautiful Sitka, Alaska. We locked our-selves in a room overlooking the harbor (these are some of the best rooms to be locked in). Somewhere along the line, I asked one of the providers to email me the reminder logic that they wanted to use, and to my surprise it was sent from a Gmail account. “ You guys use Gmail?”“ Yes, we use a lot of Google’s enterprise solutions”“ How?” “ We asked them. We got sick of running our own exchange. It just seemed easier.”This was fascinating to me, not because it’s a foreign concept to use Gmail. I use Gmail. It was just fascinating because inside of the Indian Heath landscape, I just sort of got used to tribal sites managing their own exchange servers and Microsoft products. Now, let’s just set the record straight. I’m not an IT person. However, with that being said, what it did do was open my eyes to what was happening around me -- what is happening all around us.With the difficulties of Meaningful Use Stage 2 and the advent of ICD10, there are currently many sites actively looking for other solutions. Tribal sites are some of the quickest to adopt these with alacrity. Their advantage is self-determination - their DIY attitude - creates an acceptance of adapting to new conditions and understandings. They can quickly turn on a dime and change the way they deliver care for the better of the people they serve. Many sites are outsourcing helpdesk options, coding and billing options, even entire EHR systems that offer the ease of MU2 and ICD10 transition. But why stop there? What if we could outsource administrative services, or even look for brokers to find and hire providers? Of course there are costs and benefits to be considered, Take a Load Off42TribalNetJames SpillaneInformatics and Applications PM Sitnasuak Health Solutions“How do we develop programs that not only sustain in these systems of rapid change and growth, but thrive and actually grow stronger? "Featured Columns - Growth & Self-Sustainabilitythe financial costs alone can seem staggering. But all in all the trends seem to be pointing in this direction and they are becoming more and more appealing for places like rural Alaska where getting and keeping the subject matter experts on site is becoming more and more difficult. And when we do hire that IT specialist, the pharmacy whiz, or the champion lab tech…our work flows. Our whole system design becomes dependent on them. One way around this is to grow-our-own. I have seen this work in many places, but it only works to a degree. Just like the Locum, Itinerant or IT specialist, the same rules of supply and demand exist and opportunity knocks. I mean, who can pass up a sweet job in San Diego, or helping a small clinic on the Gulf of Mexico and go live with an Electronic Health Record? These skills are highly valued and the personnel who have honed their skills in some of the most remote conditions, know how to get the job done with limited resources. These folks are in high demand. Meanwhile, the very same systems that sharpened these skills, and became reliant upon the services provided are left with large shoes to fill. So how do we become antifragile? How do we develop programs that not only sustain in these systems of rapid change and growth, but thrive and actually grow stronger? (For more thoughts on the state of antifragility, read Nassim Nicholas Taleb). Perhaps the way to grow this is to take a deep look in the mirror. Let us examine what is really important for us to manage and maintain and what is realistic? And, let’s weigh all these options against the Institute for Healthcare Improvement’s Triple Aim.• Does it improve the patient experience?• Does it reduce per capita cost?• Does it improve population health?If it does, then maybe we should relinquish some of our control, modernize our job descriptions and realign our job duties to focus on what really matters most: our people… the people that we serve; the people that we care most about; the people that thrive.James Spillane is a Clinical Applications Specialist and an IHI Improvement Advisor residing in Anchorage Alaska. Mr. Spillane leverages all aspects of the PCMH model to achieve the IHI Triple Aim in some of the most remote areas of the United States. He is a HealthIT fellow with a passion for design, digital culture and gamification. Spring 2015BUILDWITHUSProviding all facetsof telecommunciations &power construction services800.483.5941Our Work Sells Our WorkTribalNetAgency Updates - CRIHBThe California Rural Indian Health Board, Inc. (CRIHB) provides training and technical assistance to rural tribal health programs throughout the state of California. Our mission is to improve the health and welfare of Native Americans living in California by assisting tribal health programs in the delivery of quality health care services. For many years, CRIHB has successfully assisted tribal health programs in California with the implementation, support and use of electronic health records such as NextGen elec-tronic health record (EHR)/EMR and the Resource Patient Management System (RPMS). While government incentives like Medicare & Medicaid EHR Meaningful Use have pushed the adoption and use of EHRs to the forefront of clinic operations and have increased the demand for tech-nical staff and services to support them, less attention has been paid to the implementation and support of electronic dental records (EDR) within the scope of tribal health programs. Many clinics have special-ists assigned to the administration and maintenance of their EHR, but few have the same level of staffing and expertise assigned to the administration and maintenance of their EDR. Consequently, the dental practices of many tribal health programs are not able to leverage the wealth of data and functionality available in their EDR systems to the same degree that they can with their EHR.To address this disparity, CRIHB is launching a new line of service to support the implementation and use of EDR systems, which will be offered to member tribal health programs, as well as other tribal/urban indian health programs in need of support. CRIHB has chosen to partner with Henry Schein, Inc., the maker of the Dentrix EDR platform, to build its own in-house Dentrix support staff which California tribal health programs can work with to support their Dentrix installations. CRIHB’s technical support services staff will focus on providing technical services to dental practices in the areas of Dentrix installation, maintenance, customization, reporting, troubleshooting, and HL7 interface support for data exchange to third party EHR systems like RPMS and NextGen.In addition to providing technical support services for the Dentrix EDR platform, CRIHB’s CA Dental Support Center (CA DSC) staff will work closely with CA tribal/urban Indian health dental professionals to leverage the Dentrix platform to its fullest within their dental practices. The CA DSC provides a variety of dental continuing education and hands on courses for dental professionals. The CA DSC will provide clinical support services for the Dentrix EDR in rela-tion to the Government Performance and Results Act (GPRA) measures which are monitored by the Indian Health Service. The CA DSC will work closely with tribal/urban indian health clinics to help them achieve key GPRA measures, such as increasing access to dental services, sealant, and fluoride varnish application. CRIHB expects to begin providing Dentrix EDR support services to California tribal/urban Indian health programs beginning at the end of Q2 2015 or at the beginning of Q3 2015. For more information on receiving Dentrix EDR technical support services, please contact:For more information on receiving Dentrix GPRA/Clinical Support Services please contact:California Rural Indian Health Board44Adam CulichInformation Systems OfficerP: 916-929-9761adam.culich@crihb.orgLalani Ratnayake, BDSCA Dental Support Center CoordinatorP: 916-929-9761lalani.ratnayake@crihb.orgAgency Update: CRIHB and Dentrix Electronic Dental Record SupportFeatured Columns - Health SecurityThere are stories in the news every day of health care providers and other business entities that have had some type of “data breach”. The use of health information technology continues to expand quickly in the health care arena, and with that comes abundant promise and abundant vulnerability. These new technologies provide countless opportunities and benefits for consumers and health care providers, but they also pose new risks to consumer’s privacy. This technology is ever changing, and the ways to keep up with the changes also must change every day. This is addressed at least annually with the required Security Risk Analysis (SRA) and mitigation plan that is mandatory to be able to attest for Meaningful Use. As part of this, staff must continually work on the weaknesses listed in the mitigation plan, and other discoveries found during the SRA. Health IT staff need to be vigilant and mindful to do basic tasks constantly to protect the data of our patients.In the current culture, every provider and health care team member is required to document within an electronic health record as they do their daily work. Proper training of staff to protect patient data should be first and foremost to health IT staff. Obvious things like making sure to lock a screen when exiting the room, even for a few seconds, and the use of screen savers on each workstation is an often overlooked potential breach. While health care staff likes to think each system is “all electronic” it is inevitable that there are still some reports, results, etc. on paper. Look around a user’s work area, and see how many identifying papers are lying around face-up. This can be used as a training point to remind staff that if you can see it, others can see it, and thus it’s a breach. With the use of tablets, smart phones, laptops and other personal devices used to diagnose and care for patients, these items must be kept secure to protect patients’ data. While no patient data should ever be stored on a personal device, all personal devices should be set up so that they can be wiped remotely should they be lost. This will protect data that was being accessed prior to the loss of the phone. Remote wiping is a security feature that enables you to remotely erase the data on the mobile device if the device is lost or stolen. When you enable a remote wipe feature on your mobile device, you have the ability to permanently delete data stored on your lost or stolen mobile device (healthit.gov, 2014). Your organization should have strong policies or procedures in place to address mobile device security. These should include data on equipment carried by or left in cars, as this is where many data breaches result from. The rules require the implementation of data encryption on laptops, tablets and other mobile devices to protect data. To avoid a breach of the confidential process or key, the decryption tools for these should be stored on a device or at a location separate from the data they are used to encrypt or decrypt. Personal health information must be safeguarded as it passes from patients to doctors to medical billers and other third-party contractors. Many data breaches are from outside vendors or business associates. Health care organizations should also be mindful of Business Associate Agreements (BAA). These should be set up to make certain all data is protected in transmission and transfer. A BAA is needed with each and every unit your organization does business with. The business associate provisions come in light of revelations that health care vendors are responsible Privacy and Security of Patients’ Health Record DataLisa Lyon, MS, RN, CDEClinical Informatics CoordinatorCherokee Nation Health Services“Personal health information must be safeguarded as it passes from patients to doctors to medical billers and other third-party contractors.” 45Spring 2015Featured Columns - Health Securityfor a surprising number of adverse incidents. In fact, a study by the Office for Civil Rights (OCR) concluded that 45 percent of health care providers and other covered entities had an average of five HIPAA data breaches during any given year, with two-thirds of the incidents involving business associates (Benton, 2013). To confirm they are meeting the provisions, health care organizations should vet all vendors to ensure they are HIPAA-compliant and carefully review their histories with Protected Health Information (PHI) security. Among the most vulnerable areas of a data breach, involve responses to medical record requests from health plans. Make sure to use the proper security approach instead of taking something for granted. Be vigilant in taking the correct action, so it does not pose a costly problem later. The cost of a data breach to facilities are steep regarding monetary figures, but the costs to patients The Annual TribalNet Conference offers a Health IT Track each year. A great opportunity has been missed by each of you if you have not attended. TribalNet offers the Health IT Team, the opportunity to communicate with each other and exchange information for the benefit of serving the same patient population—Native Americans. I would encourage each of you to sign up to attend the conference in November.and facilities in terms of embarrassment, financial identity theft and medical identity theft are often difficult to overcome and long lasting. The intimate nature of health data combine to cause social, psychological and economic harm to those whose privacy is violated. It’s important that all faculty and staff know about these severe penalties, and take ownership in protecting patient data at the highest level possible. Lisa Lyon, MS, RN, CDE, Clinical Informatics Coordinator, Cherokee Nation Health ServicesLisa Lyon, MS, RN, CDE has been a nurse with Cherokee Nation for 15 years, with the last eight spent in Health IT. Lisa is a Health IT Fellow through the Office of the National Coordinator with a strong interest in the Million Hearts Initiative. She is a graduate of the University of Colorado, where she obtained a Masters in Healthcare Informatics.TMCopyright©2015, STS, 1630 E. Beverly Street, Ada, OK. All rights reserved.learn more at healthpicapp.comHealthPic finds the RPMS data you need. Fast.Spend more time loving your job and less time running endless RPMS reports. You may even add a few years to your life. HealthPic lets you see your data in a whole new way.Get HealthPic and get the picture of health in a ridiculously short amount of time. RPMS REPORTINGWORK DAY REMAININGHEALTHPIC REPORTINGWORK DAY REMAINING(and take the kids to school, take a walk, read a book, go to the ballgame, eat lunch out, workout, pick up the cleaning, organize my socks, smell the roses. You get it. Featured Columns - Health Best PracticesSovereign Technology Solutions focus on RPMS products has been very successful this past year and has incorporated exciting new data and report organization, management, and retrieval services. With the focus of providing immediate access to RPMS data without logging onto RPMS and compiling reports, this reporting project began in February 2006, under the direction of the administration of the Chickasaw Nation Medical Division. In many cases, time-consuming efforts to compile several reports were necessary in order to produce the needed data, resulting in delays to view the facility’s status.Our first report was Provider Practice, where we compiled the provider’s Evaluation &Management by CPT, outpatient diagnosis, pharmacy requests, visit service category, visit locations, labs orders, radiology orders, referrals by CPT and OX, as well as patient demo-graphics: gender, tribe, age, community, and now RVU activity by CPT. These time-consuming multi-RPMS reports were compiled and consolidated to provide each provider’s practice utilization.That’s changed with HealthPic. This valuable information is updated hourly and/or nightly according to specific need to provide management with an efficient and timely overview of their work status.Another example of its time-saving capabilities can be illustrated with HealthPic’s first table, Appointment Activity, which displays appointment capacity, appointments expected, cancellations, no-shows, patients seen, walk-ins, same day, overbooks, patients actually seen and third party resources for patients. From the RPMS roll and scroll environment, this six-report process seemed daunting at times. With HealthPic, this information is now updated each hour and enables administration to see the appointment activity for their facility.HealthPic reporting capacity grew from provider practice to providing up to 20 separate reports ranging from appointment activity, third party information, referrals and contract health, to labs, rad, and inpatient data reports. Each site has the ability to control user access by utilizing the RPMS Key structure.HealthPic also incorporates Key Performance Indicator (KPI) that each site can set for their system to determine. For example: blue- exceeding expectations; green- meeting expectation; yellow - falling below expectations or red - not meeting expectations.HealthPic has improved the organization, layout, and ease of accessibility of both data and reports by reconfiguring the information. Now clients will experience colorful, user-friendly formats (such as bar and line graphs, tables, pie charts, grids, etc.), that provide at-a-glance, visual interpretation and understanding of each facility’s capacity, status and performance. Prior to her current role as Health Information Technology Manager at Sovereign Technology Solutions, Renee Fondren was the RPMS Site Manager at a large tribally-run hospital and satellite clinics for over nine years. Before serving as a RPMS Site Manager, Renee served as a database application developer for over ten years. Renee’s philosophy is to empower sites to gain the necessary skills and knowledge needed to manage their own RPMS systems. Having the proper tools and knowledge is key to supporting a RPMS health system patient care database.Improved RPMS Reporting ToolsRenee FondrenMSHR CHA Health IT Manager Sovereign Technology Solutions Chickasaw NationRenee Fondren, MSHR CHA, Health IT Manager, Sovereign Technology Solutions, Chickasaw Nation47Spring 2015CattcommMeet Your VendorsWHO WE ARE:Cattcomm is a consulting and services company specializing in providing and deploying complete telecommunication solutions for small to mid-size organizations. We deliver high-quality consulting and engineering services quickly, confidently and competently; allowing you to achieve your business goals whether it’s lowering overall operating expenses, expanding your network or delivering the highest quality of feature-rich services to your end-user customers. We have the answer.OUR WORK WITH TRIBES:Over the last three years Cattcomm has worked with several Tribes on network and telecom initiatives. We have specifically worked closely with Salish Networks, a newly created subsidiary of the Tulalip Tribes, guiding the process of becoming a facilities based CLEC in Washington state. Upon deploying the infrastructure and turning on the switching platform, Salish immediately began recognizing monthly savings by reducing their own telecom costs. In the subsequent phases which are all underway, Salish is beginning to generate revenue by serving end users on the Reservation - next up is serving end users off the Reservation and ultimately the investment enables delivering wholesale services to other tribes. In a six month pilot that wrapped up this winter, Salish has successfully delivered voice services to a Native partner on the other side of Washington state, 300 miles away, the Spokane Tribe. The Spokane Tribe will now be in position to save money by purchasing voice services for its own use, then services to Tribal members and creating a new revenue stream. This is a great example of how Cattcomm enables nation to nation goals.Andrew MetcalfePresident/CEOP: 509-661-2639metcalfe@cattcomm.comJenny RickelCOOP: 509-661-5100jrickel@cattcomm.com“Cattcomm has truly been a wonderful asset to our company. They led us through the process of becoming our own Competitive Local Exchange Carrier, including business, financial, regulatory, Interconnection agreements, equipment selection and network engineering.”-Travis Hill, Operations Manager, Salish Networks, subsidiary of Tulalip Telecom48TribalNetTelecommunication is the New 21st Century Trade RouteSERVICES:Our first step with you is always to do a complimentary initial consultation. Through this process we will develop a scope of work and recommendation to accomplish your short and long-term technology goals. We also have resources to identify funding sources and formalize a strategy to help you get started. We have extensive experience with rural and underserved communities and the challenges that environment presents. By combining consulting, engineering and operational experts to support you in achieving your technology goals, you will be able to measure the return on your investment. We can guide you through installation and service of telecom systems, help you deal with regulatory matters becoming an ETC or CLEC. We can even provide level 2 & 3 technical support.FAQ’s about the Native Network Initiative:Q: What is Native Network?A: Native Network is a three-part initiative that involves the construction of a nation-wide high performance telecommunications backbone network, to which a member tribe connects. The goal is to have this eventually become a completely member-owned and operated physical network that tribes can not only save money by being part of it, but also make money as well. Q: How can my tribe benefit by becoming a member of this physical member network?A: Native Network is being designed to connect tribal lands for commerce opportunities. The idea is to have a high speed and secure “highway” between tribal lands that will allow tribal entities to diversify their economy and create jobs. As an example, tribe A, who has made an investment in a switching platform can sell wholesale services cost effectively to tribe B. Both tribes get an immediate savings and get additional revenues to fund new technology-centric jobs.Q: What if our Tribe has already invested in infrastructure and/or connectivity? How can Native Network membership help?A: Great! As an early adopter of telecom offerings you might want to provide services over the network and become part of this nation to nation marketplace. Whether over the national backbone, or the web enabled platform, Tribexchange you will be part of enabling increased revenue streams and job creation in Indian Country.Q: What is Tribexchange?A: It is a commerce portal that is being developed with your needs in mind. You can be part of creating the road map for enabling nation to nation sales in a global marketplace. Whether you are a tribe that has a large plant that makes and distributes garbage bags, or a tribal member that makes blankets, all members can benefit from tapping into the Tribexchange.Meet Your VendorsFor more information on CATTCOMM or the NEW Native Network initiative, please visit us online at www.cattcomm.com or contact Andrew or Jenny today!49Spring 2015Next >