By: Garrett Sprague – Sr. Director, Client Services and Justin Cooper – Director, Business Development & Recruitment
Left: Keynote Session: The Power of the Middle Seat – discovering connection at the edge of your comfort zone, delivered by Dr. William Paiva, Executive Director, Center for Health Systems Innovation at Oklahoma State University
Right: Garrett and Justin at the HealthTECH booth at TribalNet 2025
September 2025 marked a pivotal moment for tribal healthcare technology, with two major conferences happening back-to-back in the Southwest. First, the National Indian Health Board’s National Tribal Health Conference brought together over 2,000 tribal health leaders, practitioners, and advocates to Phoenix from September 7-12. Just days later, TribalNet 2025, the premier technology conference for Indian Country, convened at the Grand Sierra Resort in Reno from September 14-18, drawing more than 3,000 IT professionals from tribal governments and enterprises across the nation.
The timing and proximity of these conferences wasn’t coincidental. As tribal health organizations face an unprecedented convergence of challenges – from the massive IHS PATH EHR transition to escalating cybersecurity threats – the need for alignment between health leadership and IT infrastructure has never been more critical.
HealthTECH Resources attended both events, with Account Managers Garrett Sprague and Justin Cooper engaging with IT directors, health executives, and technology leaders managing some of the most complex healthcare environments in the country. What emerged from hundreds of conversations and dozens of sessions was a clear picture: tribal healthcare IT stands at an inflection point, where decisions made in the next 12-18 months will determine whether organizations thrive or merely survive the coming digital transformation.
The discussions at both conferences revealed not just technical challenges, but fundamental questions about sovereignty, sustainability, and self-determination in the digital age. From the packed session rooms in Phoenix discussing data modernization to the crowded TribalNet exhibit hall showcasing the latest cybersecurity solutions, one theme dominated: the technology exists, but who will implement and maintain it?
The Cybersecurity Crisis is Now – And It’s Personal
The statistics presented at TribalNet were sobering: Six ransomware events reported to IHS this year alone, with over 50,000 tribal members affected by service disruptions. Average downtime? 23 days. But behind these numbers lies a more troubling reality. When a tribal health facility goes down for three weeks, it’s not just an IT problem. It’s elders missing dialysis appointments, diabetic patients unable to refill critical medications, and behavioral health clients losing continuity of care.
The presentation at TribalNet Healthcare Cybersecurity – Rising Attacks and Disaster Recovery led by IHS CISO Benjamin Koshy emphasized that tribal health organizations face unique vulnerabilities. Many lack the resources for next-generation firewalls, network segmentation, or even basic backup testing. One attendee shared their organization’s extreme response: completely revamping their Active Directory infrastructure after repeated breaches. Another mentioned implementing Forescout for asset visibility.
The free resources from CISA (Cybersecurity and Infrastructure Security Agency) were highlighted repeatedly, but free tools don’t help when you don’t have the staff to implement them. When your IT team is already stretched thin managing day-to-day operations, who handles incident response? Who tests the backups? Who runs the phishing exercises?
PATH EHR: More Than a Technology Upgrade
The IHS PATH EHR modernization represents one of the largest healthcare IT transformations in Indian Country. With 200 experts currently in the build phase, the scope is staggering – 30,000 data points to migrate, 15 healthcare domains to coordinate, and a critical emphasis on configuration over customization.
But the real complexity lies deeper. In their session Charting the Future of IHS PATH EHR, Donnie Parish from GDIT and IHS CIO Mitch Thornbrugh outlined three critical pain points that reveal why this transition is so challenging:
Data Analytics and GPRA Reporting: The current RPMS system, despite its limitations, has decades of tribal-specific reporting built into its DNA. PATH must replicate not just the data, but the complex reporting requirements unique to IHS and tribal facilities, from GPRA metrics to workload reports that determine funding.
Interoperability Challenges: Tribal health doesn’t exist in isolation. Patients move between IHS facilities, tribal clinics, urban Indian health centers, and private providers. The Purchased/Referred Care (PRC) system alone requires complex integrations that most commercial EHR implementations never encounter.
Historical Data Migration: This isn’t just moving records from one system to another. It’s preserving decades of patient histories, maintaining legal health records, and ensuring continuity of care for chronic conditions that have been managed for generations.
The staffing implications are significant. As noted in the session, “How do we staff and support tribes? Take a boutique approach to everything.” This resonates deeply with our experience at HealthTECH. Tribal health IT isn’t just healthcare IT with a different logo. It requires understanding of federal regulations, tribal sovereignty, unique funding mechanisms, and cultural considerations that generic healthcare consultants often miss. This is precisely why boutique firms specializing in tribal health, rather than massive consulting companies, can provide more effective support.
PATH EHR: More Than a Technology Upgrade
The sessions on data modernization revealed a fundamental tension in tribal healthcare IT. On one hand, tribes need to participate in state and federal data sharing initiatives to access funding, demonstrate outcomes, and coordinate care. On the other, data sovereignty – the right of tribes to govern the collection, ownership, and application of their own data – is non-negotiable.
Several presentations highlighted the challenges:
- “Never ending MOAs/MOUs” that require legal review for every data sharing agreement
- Long wait lists for data from state repositories
- Organizational bureaucracies that don’t understand tribal governance structures
- Lack of expertise at the community level in public health epidemiology and biostatistics
One presenter’s slide captured it perfectly: “Moving our Nation into a mode not dependent on outside entities…” This isn’t just about technology infrastructure, it’s about self-determination. But building that independence requires specialized skills.
Building Effective IT Governance: Beyond the Org Chart
The push for formal IT steering committees across both conferences wasn’t just about better project management. It was about survival. The recommended structure – including CEO, CFO, CMO, HR/Operations, CIO, and Legal Compliance – serves a deeper purpose than coordination.
As presenters noted, effective IT governance:
- Takes IT out of the political tug-of-war
- Ensures infrastructure projects get proper prioritization
- Creates transparency around the true cost of technology
But tribal IT faces unique “gotchas” that complicate governance:
- Resistance to change isn’t just organizational inertia – it’s often rooted in historical trauma from systems imposed without consultation
- ROI calculations must factor in community benefit, not just financial return
- Priority setting must balance urgent clinical needs with long-term infrastructure investments
- Business cycles (W2s, performance reviews) that don’t align with project timelines
Presenters emphasized the importance of developing a Risk Register to identify and protect critical assets, and ensuring IT infrastructure projects receive proper transparency through formal governance structures.
The Workforce Crisis Behind the Technology Crisis
Every technology challenge discussed at these conferences ultimately traced back to workforce issues:
- Retention challenges and flight risk as private sector salaries dwarf tribal health compensation
- Burnout from managing aging infrastructure with skeleton crews
- Physician disengagement from EHR systems that don’t support their workflows
The behavioral health gap was particularly emphasized. As one presenter noted, “local tribal partners need behavioral health and physical training. Not enough access to Providers.” This creates a cascade effect: without behavioral health providers, the burden falls on primary care, increasing their documentation load, driving EHR dissatisfaction, and accelerating burnout.
The Digital Front Door: An Unfunded Mandate?
The IHS “Digital Front Door” initiative represents a massive modernization effort encompassing:
- Advanced scheduling systems
- Telehealth platforms
- Secure messaging
- Patient portals
- Patient-owned data access
- Online training resources
But as one attendee pointedly asked: “Who’s going to build and maintain all this?” The initiative assumes technical capabilities that many tribal facilities simply don’t possess. It’s not just about purchasing software, it’s about having staff who can configure, customize, train, support, and continuously optimize these systems.
The Vendor Reality Check
Perhaps the most memorable quote from the conferences: “The vendors who thrive in the next decade won’t be the ones with the slickest demo. They’ll be the ones who reduce technical debt, amplify EHR’s strengths, and will help us STOP paving the same broken road.” This sentiment reflects a maturation in how tribal health IT leaders evaluate partners. They’ve seen too many failed implementations, too many vendors who don’t understand PRC, too many consultants who don’t grasp why a tribal council meeting schedule affects project timelines. The call for vendors to “reduce technical debt” is particularly significant. Many tribal facilities are still running systems from the early 2000s, not because they resist change, but because previous “upgrades” created more problems than they solved. They need partners who will honestly assess what’s working, what’s not, and provide realistic paths forward, not just sell the latest shiny object.
Looking Forward: From Crisis to Opportunity
Despite the challenges, there was measured optimism at both conferences. The PATH EHR project, despite its complexity, represents unprecedented investment in tribal health IT infrastructure. The focus on data sovereignty is driving tribes to build internal capacity rather than rely solely on external vendors. The cybersecurity crisis is forcing long-overdue conversations about infrastructure investment and disaster recovery.
But success requires addressing the fundamental workforce challenge. As tribal health organizations navigate these transformations, they need:
- Immediate support for crisis situations (ransomware recovery, staff departures)
- Specialized expertise for complex projects (PATH transition, interoperability initiatives)
- Cultural competence in understanding tribal governance and healthcare delivery
- Flexibility to work within tribal procurement and budget constraints
The “boutique approach” mentioned throughout the conferences isn’t just a business mode, it’s recognition that tribal health IT requires specialized knowledge, cultural sensitivity, and long-term relationship building that large consulting firms often can’t provide.
The Path Forward
The conferences made clear that tribal health IT stands at a crossroads. The challenges are real and mounting – from cybersecurity threats to workforce shortages to massive system transitions. But so are the opportunities. With proper support, strategic partnerships, and sustained investment in both technology and people, tribal health organizations can build IT infrastructure that not only meets federal requirements but advances tribal sovereignty and improves community health outcomes.
The question isn’t whether transformation will happen, it’s whether tribal health organizations will have the partners and resources they need to navigate it successfully.
For over 25 years, HealthTECH Resources has provided specialized healthcare IT staffing solutions to tribal health organizations, IHS facilities, and urban Indian health programs. As a boutique firm focused exclusively on healthcare IT, we understand the unique challenges of tribal health technology and provide EHR consultants who can work within the complex regulatory, cultural, and technical requirements of Indian Country healthcare. Learn more at healthtech-resources.com.
