First tribal health org on sovereign OpenEMR.
The Skokomish Indian Tribe runs their tribal health program on Tarevo — OpenEMR hosted in their own AWS account, encrypted with their KMS keys, accessed by Tarevo under delegated IAM that they can revoke in a single API call. The result: the revenue cycle and MIPS reporting the program needed, on the infrastructure their sovereignty review required.
Last updated 2026-07-10 · Live deployment, reference available on request
Sovereign infrastructure
Skokomish-owned AWS account + customer-managed KMS keys
Sovereign
Tarevo access delegated, revocable
The clinic
Skokomish Tribal Health.
Skokomish Tribal Health is a multi-service tribal health program serving the Skokomish Indian Tribe and surrounding Kitsap County communities in Washington state. They were a long-standing Greenway Intergy client.
1 · The situation
Four problems had piled up over the contract term.
Skokomish came to us in a bad place with their EHR. Greenway was both their practice management system and their clearinghouse — and they owned every part of the billing pipeline.
Service had degraded.
Support responsiveness and resolution quality had fallen below what a tribal health program needs to keep a clinic running.
Revenue was leaking through billing inconsistencies
that nobody was fixing. Like most independent and tribal clinics, they did not have the internal staff to audit a hundred claims a week — they trusted the system to get it right, and increasingly it wasn’t.
Revenue recovery wasn’t an option on the table.
Greenway’s posture was “this is how the system works.” There was no offer to audit submitted claims, rebill under-coded encounters, or work denials deeper than the first pass.
The AI question was the dealbreaker.
Skokomish asked Greenway to commit — in writing — that their clinical data would not be used to train AI models. Greenway would not. For a tribal health program, that answer was unacceptable. Clinical data sovereignty isn’t a feature request. It’s the requirement.
2 · The stakes
Two things were on the line.
One was revenue and one was sovereignty, and Skokomish was not willing to trade one for the other.
Revenue
Industry baseline for a clinic running on inconsistent billing is $200,000 to $300,000 per year in uncollected, under-coded, or wrongly denied encounters. Skokomish had no visibility into where their leakage was happening because their EHR was also their billing auditor. The system that created the problem was the only system authorized to diagnose it. That was the dynamic they were leaving.
Sovereignty
Tribal clinical data sovereignty is a hard line. When a vendor trains models against a population’s clinical data without a negotiated agreement, downstream accountability becomes impossible.
Skokomish needed an EHR partner whose default was data ownership sitting with the tribe — not product-driven, not contractually negotiable, but architecturally enforced.
3 · The work
Three things made the engagement non-standard.
1. 45-day go-live timeline.
Skokomish’s procurement team had a hard deadline — cutover in 45 days. Most enterprise EHR migrations quote months of professional services before any clinical data even flows. We accepted the timeline because OpenEMR’s deployment profile is fundamentally lighter than legacy systems: AWS Fargate, managed services, no third-party install crew. But accepting wasn’t enough — they’d been burned before by vendors agreeing to timelines they couldn’t hold. We committed anyway.
2. Direct third-party vendor relationships.
Skokomish wanted their name, not ours, on the relationships with their clearinghouse, labs, and other downstream integrations. The reason never came out directly — the read, from the procurement posture, was that they wanted to see what they were paying for, end to end. No markups hidden in a bundle. What was in the soup. We structured the engagement so the tribe had full transparency into every underlying vendor cost.
3. AWS ownership that matched the sovereignty posture.
The engagement is built so the tribe owns the AWS account, the encryption keys, and the root credentials. Tarevo doesn’t hold master access to their environment under any operating condition except the ones the tribe has explicitly approved. That is the architectural answer to the AI-training question — not a policy commitment that could be renegotiated in the next contract cycle, but a control-plane commitment that’s hard to reverse.
4 · The outcome
Two things to call out, because both happened and neither was promised.
Data migration
Greenway quoted Skokomish $12,000 to export their own CCDA clinical data. We pulled Greenway’s public CCDA API documentation, walked Skokomish through what their existing contract entitled them to, and shared it. Greenway delivered the data without charge. Two days after we stood the new environment up, the CCDAs were imported and parsed. On a 45-day timeline, that was four days of engineering time, not four weeks.
Training is in flight.
Skokomish is mid-training now. They have not yet activated the revenue-recovery layer of the platform — that conversation is queued for once their team is operationally stable on the new system.
Where they are headed
Full migration off Greenway, AI-trainable clinical data out of vendor hands, operational autonomy over their stack, and a clean baseline to begin the revenue recovery audit we are set up to deliver. We will update this page as those chapters close.
Or read the broader Tribal Health ICP page for the full segment fit, sovereignty proof, and feature cluster.
Talk to the team
Schedule a Discovery Call
Skokomish-specific reference access is available on request after a brief qualification — we coordinate the conversation with the program's leadership and respect the timing of tribal procurement. We will walk through your current stack, the sovereignty proof, and a deployment plan shaped around your grant funding line.
- Walkthrough of your current IHS / grant reporting stack vs Tarevo
- Sovereignty proof — your AWS account, your KMS keys, our delegated access
- Reference conversation with the active Skokomish Tribal Health deployment
- Migration plan that respects your tribal procurement and contracting timeline
Prefer email? tarevo@polsia.app