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NIHB Urges House Veterans Committee to Invest in Health IT, Electronic Health Records to Improve Native Veterans Care Beyond COVID-19 Pandemic
NIHB also shares care coordination challenges between VHA and IHS
during the pandemic. 
WASHINGTON, DC – June 23, 2020 – Today, the National Indian Health Board (NIHB) Vice Chair Chief Bill Smith from the Valdez Tribe of Alaska testified before the House Committee on Veterans Affairs, Subcommittee on Health and Subcommittee on Technology Modernization on the state of health for American Indian and Alaska Native (AI/AN) Veterans during the COVID-19 pandemic. The hearing titled, “VA Telehealth During the COVID-19 Pandemic: Expansion and Impact,” provided an opportunity for NIHB to share its priorities for the Veterans Health Administration (VHA), including significant investments in Health Information Technology (HIT) and Electronic Health Records (EHR).

“The United States federal government has a dual obligation to American Indians and Alaska Natives Veterans – one obligation specific to their political status as citizens of sovereign Tribal Nations and the other for their courageous service in our Armed Forces,” said Chief Smith who is a Vietnam Veteran. “NIHB is committed to ensuring the highest health status and outcomes for Native Veterans and we stand ready to work with Congress in a bipartisan manner to enact legislation that strengthens the government-to-government relationship, improves access to care and raises health outcomes for all Native Veterans.”
In his testimony, Chief Smith urged the House VA Committee to implement specific policy recommendations to improve healthcare within the VHA for AI/AN Veterans:
  1. Pass the bipartisan H.R. 4908 – Native American PACT Act that would exempt Native Veterans from paying copays and deductibles into the VA health system on the base of federal treaty obligations for healthcare that exist in perpetuity.
  2. Ensure parity in legislation and funding between the VHA and IHS, especially for HIT modernization and telehealth infrastructure, which can lead to greater quality and access to care for thousands of AI/AN Veterans across the country.
  3. Pass the bipartisan H.R. 2791 – Department of Veterans Affairs Tribal Advisory Committee Act of 2019 which would establish a committee essential to strengthening the government-to-government relations between Tribes and the VA and improving VA accountability to AI/AN veteran health needs. 
NIHB pointed out that Congress has not provided comparable emergency funding to the Indian Health Service (IHS) compared to VHA in response to the COVID-19 pandemic. For instance, the Coronavirus Aid, Relief, and Economic Security Act (CARES) Act invested $15.85 billion into medical care at the VHA, including $3.1 billion specifically for HIT and telemedicine; but only $1.032 billion for IHS, of which only $65 million was allocated for HIT support.

“It is unclear how many of the VA patients with COVID-19 are American Indian or Alaska Native because the VA and IHS electronic health record systems do not speak to each other. There is a major lack of interoperability among VA, IHS and Tribal health program facilities causes significant problems in coordinating care for Native Veterans. There needs to be serious investment in health IT and EHR infrastructures. It is shameful that Native Veterans have to find their own ways to share their health records between doctors and clinics, some are even hand-carrying them because the systems cannot share the information,” said Chief Smith whose submitted written testimony outlines four out of 12 strategic goals in the VA-IHS Memorandum of Understanding (MOU) that are directly related to improving HIT and EHR that have yet to see full implementation at IHS and Tribal facilities. 
Chief Smith referred to the VA-IHS MOU stating that during the COVID-19 pandemic, the VHA has largely failed to act on existing partnerships and MOUs with IHS and Tribal programs to deliver resources, improve care coordination and increase access to telehealth based delivery systems. Through advocacy and community outreach, NIHB learned about COVID-specific care coordination challenges impacting AI/AN Veterans, such as:
  • VA has not committed any additional funding towards outreach to AI/AN Veterans to prevent gaps in access to care as VHA facilities reduce services or shutdown in response to COVID-19.
  • VA has failed to commit resources to assist AI/AN Veterans with rescheduling cancelled appointments.
  • VA Native American Direct Loans for housing have purportedly been put on hold during the pandemic, creating even further barriers for homeless AI/AN Veterans.
  • For AI/AN Veterans that have been able to utilize telehealth, many have anecdotally reported frequent connection issues including dropped calls especially in areas with poor broadband access. In areas with many fluent Native language speakers, access to care is further encumbered by lack of culturally and linguistically appropriate virtual care.
  • VHA has yet to release any demographic-based breakdowns of use of telehealth-based care delivery making it difficult to learn about any population-specific obstacles in access to virtual health services.
Find the full NIHB testimony at For more information or questions about Native Veterans healthcare, please contact Shervin Aazami at
National Indian Health Board Mission Statement

Established by the Tribes to advocate as the united voice of federally recognized American Indian and Alaska Native Tribes, NIHB seeks to reinforce Tribal sovereignty, strengthen Tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People.
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