Indian Health Service: Many Federal Facilities Are in Fair or Poor Condition and Better Data Are Needed on Medical Equipment
Fast Facts
The Indian Health Service's goal is to improve the health of American Indians and Alaska Natives by providing quality and accessible health care services. However, many IHS facilities are not in good condition and IHS's medical equipment is aging—which can negatively affect patient care.
For example, patients' medical conditions can worsen when their care is delayed due to broken equipment. IHS collects information about its medical equipment, but the data is incomplete. Without better data, IHS doesn't know the state of its equipment and can't properly budget for replacement.
Our 3 recommendations to IHS address these issues.
Broken Dental Sterilization Equipment Awaiting Vendor Repair at an Indian Health Service Facility
Highlights
What GAO Found
Indian Health Service (IHS) data show that the buildings that comprise its federally operated medical facilities range in age from 1 to 171 years, with a median age of 39 years. Of the 212 buildings that IHS has rated, about 61 percent are in fair or poor condition, compared to the goal of having 90 percent in good or excellent condition. According to IHS officials, older facilities may have insufficient space for modern health care delivery needs and outdated infrastructure that can fail and lead to facility closures. IHS officials also reported that funding constraints and other challenges, such as maintaining adequate staffing levels, limit their ability to repair and improve their medical facilities.
Condition of Indian Health Service Federally Operated Medical Buildings
The state of medical equipment at IHS federally operated facilities cannot be determined because IHS does not have complete or reliable data. Although IHS policy requires its facilities to maintain medical equipment inventories in a designated system, GAO's review of data for three selected IHS areas found that not all facilities were doing so. Further, when equipment was recorded, the data, such as the installation date, were not always accurate. IHS leadership was not aware of these problems until GAO's review and does not know the extent to which similar problems may exist in the other seven IHS areas with federally operated facilities. Without complete or reliable medical equipment data, IHS cannot appropriately plan and budget for its equipment needs, putting its ability to deliver high quality health care at risk.
IHS officials reported using a number of strategies to help mitigate negative effects aging facilities and equipment may have on patient care, including transferring patients to other facilities. Despite these efforts, officials described ways their aging facilities and equipment can negatively affect patient care. For example, overcrowded waiting areas or facility deficiencies like uneven walkways can increase the risk of patient infections or injuries. Also, officials noted that broken medical equipment or having to refer patients to other facilities could lead to delays in care—potentially exacerbating patients' medical conditions.
Why GAO Did This Study
IHS provides health care services directly to American Indian and Alaska Native populations at federally operated medical facilities. Well-functioning facilities and equipment are necessary for the provision of high quality and accessible services.
GAO was asked to review IHS's facilities and equipment and how they affect the provision of health care. This report reviews the state of IHS's federally operated medical facilities and equipment. It also describes IHS efforts to mitigate negative effects on patient care. GAO interviewed IHS officials from headquarters, three geographic areas, and 14 federally operated facilities, conducting site visits to 13 of these facilities. GAO also reviewed agency documents, including relevant policies, and IHS data on its facilities and equipment for the selected areas and facilities.
Recommendations
GAO is making three recommendations to IHS, including that IHS should: assess the extent of medical equipment data problems across IHS areas and implement a plan to correct any problems; and regularly monitor adherence to IHS medical equipment inventory management policy requirements. IHS concurred with all three recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Indian Health Service | The Director of IHS should assess the extent of the medical equipment data problems across all IHS areas and service units with federally operated facilities and develop and implement a plan to address any problems identified. The plan should include providing resources and guidance, as appropriate, to help ensure areas and service units have complete and reliable medical equipment data. (Recommendation 1) |
IHS officials provided documentation that in October 2023, they assessed some medical equipment data quality issues, such as the extent to which records of equipment included in its equipment inventory management system were missing key information, and created a plan for correction. IHS published a guidance manual in collaboration with IHS Area Offices, based on input on medical equipment data problems. The guidance manual outlines required information and "best practice" details to be included for each medical device entered into the inventory management system. Additionally, the manual outlines the responsibilities of system users to maintain compliant and complete equipment records. While this addresses some aspects of the recommendation, IHS has not provided evidence that it assessed the extent of a key source of IHS's medical data equipment problems-- that some medical equipment was not recorded in the system, including by some facilities that were not actively using the inventory management system. In addition, while IHS's guide noted that it expected IHS areas to allocate the necessary resources to achieve its goals for improving the equipment data, it has not explained how it expects areas that are understaffed, which was identified as a key cause of the problems, to address this expectation. We have requested additional information from IHS and are awaiting their response.
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| Indian Health Service | The Director of IHS should make the completion of data fields about the useful life or age of its medical equipment mandatory in the agency's inventory management system, consistent with IHS policy. This could include data fields such as "end of life" or "acquisition date." (Recommendation 2) |
On July 12, 2024, IHS officials provided a demonstration of changes made to the agency's medical equipment inventory management system in response to this recommendation. Officials demonstrated that "installation date" and "end of life" are now mandatory fields in the system and that the system was updated to ensure that all mandatory fields are populated before a new asset or edit of an existing asset can be saved. IHS officials stated that IHS entered the missing "installation dates" for 3,383 installed devices, and the missing "end of life" data for 3,702 devices. Overall, officials told us this was a 29.6% and 29.3% data quality improvement, respectively, over a five-month period.
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| Indian Health Service | The Director of IHS should ensure that headquarters officials regularly monitor area and services units' adherence to IHS medical equipment inventory management policy requirements. Such monitoring could include regularly reviewing area biomedical equipment governance committee meeting minutes and the agency's medical inventory equipment data to assess its completeness and accuracy. (Recommendation 3) |
IHS issued an update to its medical management policy on March 27, 2024, as Indian Health Circular 24-06. Officials stated that, per the newly issued circular, IHS will regularly review Area biomedical equipment governance committee meeting minutes and the agency's medical inventory equipment data to assess its completeness and accuracy. We appreciate that IHS has taken steps to further outline responsibilities for monitoring adherence to medical equipment inventory management policy requirements. We plan to keep this recommendation open until IHS has been able to demonstrate regular monitoring over more than one year. This might include, for example, documented reviews of completed Area certifications or meeting minutes from HQ meetings where monitoring was discussed.
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