VSovid-19 has bludgeoned public health agencies and organizations. Future crises, whether from infectious diseases, extreme weather or other sources, are likely to do the same unless they change their approach to public health reporting, data management and information exchange.
Public health management is not easy, especially in the United States. Not only is this country home to diverse populations that have medically significant genetic predispositions and cultural patterns, but it is also geographically immense. How epidemics or climate change affect California may be very different from their impacts in Maine. The needs of Pittsburgh residents can vary greatly from the needs of those who live 50 miles away in rural Pennsylvania.
These factors necessitate that locally targeted public health policies and technology infrastructure – community and statewide – be maintained for most efforts, and that is the right answer in many cases. A top-down approach implemented at the federal level would miss important nuances and reduce the ability to meet people where they are. But a highly contagious virus, or climate change, doesn’t recognize municipal, county or state borders.
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Data management
A problem with a localized public health approach, however, is the resulting patchwork of reporting and decision-making, which comes with huge challenges for public health agencies, healthcare delivery organizations, and developers. supporting data collection and exchange. This is true under the best of circumstances, let alone during a crisis.
People do not always seek treatment from the same care provider each time and may even cross state lines to seek care. Many large healthcare organizations operate in multiple states and must comply with different privacy laws regarding patient consent for the exchange of information. Additionally, there are various approaches to prescription drug monitoring programs, and providers also face a myriad of public health-associated reporting requirements that, during public health emergencies, quickly become daunting.
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Even within the same state or region, state assemblies and public health entities often do not coordinate their efforts to make decisions on technology approaches, governance decisions regarding the exchange of inter-locality information or information that needs to be captured and reported to public health registries by healthcare. suppliers. At the start of the pandemic, a large healthcare system customer of Altera Digital Health, which I work for, was reporting Covid-19 data to 18 different city, county and state public health entities on a daily or weekly basis. Each entity wanted different information, so the health system could not simply share a report with all parties. This multiplied the reporting responsibilities of frontline medical providers, who were tasked with capturing the various patient information in the care process while grappling with staffing shortages and influxes of Covid-19 patients; it also created unnecessary work for the IT department and for us as a partner.
Lessons from Israel
Not only does this fragmented approach to public health reporting create unnecessary burdens, but the health care delivery organizations providing the information often do not benefit from it. Very few public health systems offer a two-way flow of information to providers who submit the data. As a result, hospitals and provider practices rarely receive closed-loop communication about trends in public health data to monitor. And even in today’s highly digitized world, when that information is shared with healthcare delivery organizations, it often arrives by fax.
Israel’s health IT response to Covid-19 is a prime example of a modern, connected public health system in action. Certainly, with a population slightly larger than New York, an area roughly the size of New Jersey, and a national healthcare system, this is not an apples-and-oranges comparison. That said, Israel invested for decades in an interoperable national health IT infrastructure and was able to pivot quickly when the pandemic began.
The country’s Ministry of Health and research community have been proactive in maximizing the anonymized digital information available on Covid-19 patients across the country for research purposes. This allowed its epidemiologists and public health authorities to quickly obtain information on the spread of SARS-CoV-2, the virus that causes Covid-19, the comparative effectiveness of vaccines and retroviral treatments, and more. Again.
The United States, by comparison, had to rely on information and projections from other countries, as its decentralized and heterogeneous reporting systems made data analysis at the federal level slow, difficult and flawed, if not impossible.
To address this challenge, the Public Health Systems Data Task Force, established by the Office of the National Coordinator for Health Information Technology, released a report in 2021 with 22 recommendations for health informatics in the USA. public health as a strong partner in health care, and shared resources and data, where appropriate.
The challenges of maximizing public health data can be met if states focus on investing in health informatics, consistent reporting, and current digital health technologies.
Many state public health departments — and city and county entities under their jurisdiction — are currently using decades-old technology. Instead, they could take advantage of modern health informatics that was designed to maximize collaborative and consensus-based standards. With substantial funds appropriated by Congress in 2020 and 2021, including for the Centers for Disease Control and Prevention’s new data modernization initiative, there is a unique opportunity to invest in newer, modernized systems and break the data silos between public health and healthcare, with health informatics as a conduit.
Electronic health records use standards that provide mechanisms for how data is labelled, categorized, and exchanged. Harmonizing data between public health platforms would make it easier, faster and cheaper to exchange and collect information. And in times of crisis, greater efficiency can make a real difference.
Develop data reporting consistency
Building consensus around reporting for health care delivery organizations can also improve public health. Imagine how much less work hospitals and practices would have to spend if they could report once in a way that many entities – from public health offices at the city, county, state and county levels federal government to researchers and others – could benefit. Researchers and the federal government could compare situations in different states and regions to make evidence-based decisions about public health responses with better access to anonymized data.
Harmonized data and state consensus around reporting would have substantial benefits for clinical research and early identification of public health emergencies, including and beyond infectious diseases.
Many states are currently emphasizing addressing inequitable social drivers of health as part of their broader public health strategies, and the opioid crisis has come to a head during the pandemic. Both are examples of other areas where inconsistent data capture and reporting requirements, as well as a variety of technology implementation approaches across states, are hampering progress. in improving patient outcomes and opportunities for public health surveillance. These and other major issues could increasingly receive the attention they (and our communities) deserve, however, by creating a better way to share the clinical data already mass-collected in the United States.
The necessary changes would not come without difficulties. It is not easy to replace hundreds of entrenched systems or existing policy approaches to data governance. And investing in public health infrastructure is not something that local, state and federal agencies routinely venture into. In fact, it is the lack of investment that has put the country in the difficult position it has found itself in for the past two and a half years.
Seize funding and technology opportunities in health informatics
As the United States emerges from Covid-19, it has a unique opportunity to inject funds made available by Congress into local, state and federal public health infrastructure. But it’s important to remember that Congressional funds can always be reappropriated, and short-term memory often returns to Congress when the urgency of a situation shifts into the past.
If states would collaborate on a consistent and standardized approach to health information technology for public health reporting and consult with the Office of the National Health Information Technology Coordinator as experts in matter in this area, they would be in a much stronger position when the next public health emergency arises, and even before that, as public health officials raise expectations of health care providers to report on social factors of health and other data.
Leigh Burchell is vice president of government affairs at Altera Digital Health and chair of the Public Policy Leadership Task Force at the Electronic Health Records Association.
