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Opinion | Michigan must address Native American health data disparities

Health disparities among Native Americans are vast and persistent, but technology and the sharing of digital health records is helping improve outcomes among the 200,000 tribal members who are part of the 12 federally recognized tribes across Michigan.

Krystal Schramm
Krystal Schramm, also known as Miskwa Mishiki Que or “Red Turtle Woman,” is a senior technical business analyst with the Michigan Health Information Network. (Courtesy photo)

Research data shows that Native American communities have disproportionately higher rates of disease and shorter life expectancy in Michigan and across the nation when compared to the general population.

Medical providers serving tribal members in Michigan face a host of challenges — including the fact that many members live off traditional reservations, and that reservations are often in rural areas. One challenge being addressed today by the Michigan Health Information Network (MiHIN) is the improved sharing of digital health information at the individual patient level and at clinic and system-wide levels, through a process known as health data interoperability. MiHIN is Michigan’s statewide designated health information exchange tasked with supporting the digital health infrastructure to ensure health data can be exchanged within the healthcare ecosystem.

Because each of the 12 federally recognized tribes in Michigan is a sovereign nation, the tribal health care system faces piecemeal, disconnected and inconsistent data. That leads to poor care, delays and a lack of usable personal health records that can be shared among the various health care providers, clinics and even within families to ensure better outcomes.

As a tribal community member myself, I lead the MiHIN team in meeting one-on-one with tribes across the state to learn about each tribe’s respective patient populations, cultural needs, tribal clinics and clinical workflows and have been working with tribes to initiate utilization of MiHIN’s health information sharing dataflows to exchange data for tribal patients from both tribal and non-tribal facilities.

Because of my heritage, I was acutely aware that tribal populations have historically been underrepresented in public health data. That impedes decision making regarding tribal healthcare at the individual patient level and at clinic and system-wide levels. By enabling the flow of data through the MiHIN network, the health information for the tribal communities can be shared quickly and seamlessly between tribal and non-tribal providers, therefore establishing order and structure in the digital health ecosystem.  However, as important, the inclusion of a data sharing infrastructure will support a more equitable health care experience for the tribal communities. Ensuring their health data can be accessible to all providers is an important step to patient inclusiveness and comprehensive patient care.

By enabling the flow of data through the MiHIN network, health information can be shared quickly and seamlessly between systems, thereby increasing efficiency, improving patient care and safety and, ultimately, improving health equity amongst Native populations. To date, eight of the 12 tribes and the Urban Indian Health Center have signed the necessary agreements to join the statewide network of health information exchanging entities.

Through MiHIN’s tribal engagement activities, it will continue to onboard more tribal providers, health agencies, their members and community-based organizations to advance the sharing of data on patients through admission, discharge, transfer notifications and other health data exchange services. MiHIN is demonstrating a sound path for how states can enable tribes to leverage health information technology and interoperability services and infrastructure to improve health care outcomes.

Increasing tribal representation in healthcare data will ultimately lead to improved health equity, outcomes, and patient satisfaction for tribal patients. To learn more about MiHIN and its work with Michigan’s Native American tribes, visit our website or contact me at

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