Indiana’s ‘Enhanced Research Environment’ Supports Statewide COVID Response

Feb. 18, 2021
In addition to fueling internal and public dashboards, the data hub also allows researchers to test policy scenarios

The State of Indiana created a shared research environment just weeks before the state’s first case of COVID-19 were reported. The “Enhanced Research Environment” soon had 17 different data sources related to the pandemic and researchers from governments, academia and consulting partners doing analyses on the data.

A group of health and technology leaders from Indiana state government gave a presentation about the Enhanced Research Environment at the Health Datapalooza conference this week. Josh Martin, the state’s chief data officer, is also executive director of the state’s Management Performance Hub (MPH). He described how the MPH was created in 2014 to bring together organizations to better leverage data to solve problems. “The core concept behind MPH was that problems don't reside in one transactional system or another. We really need to leverage data across these systems as true assets as we're making better decisions about things.” MPH was codified into state laws as a stand-alone state agency in 2017.

Martin said the MPH is empowering its partners to leverage data in innovative ways, facilitating data-driven decision-making and data-informed policy-making. “Our enhanced research environment is something that we started to think about back in 2019. We were trying to figure out a way that we can better collaborate around data in a secure fashion that was scalable. So the concept was leveraging cloud infrastructure so we could be all working in the same environments and using the same data, that would speed up our ability to do things and enhance our transparency about this use of data. This enables people to be analyzing data jointly from multiple sources in multiple clusters. We facilitate the data and accelerate the advanced analytics using best-in -class data science and analytical tools, so that we can get the computational needs of users met in real time.”

 Martin noted that they deployed the Enhanced Research Environment just in time for the state’s COVID response. “We were only a few days into actually having this environments up and running. To be able to tackle this new need, we needed to be getting data to a lot of different folks so that they could make timely decisions. On March 19, just two weeks after our first cases of COVID, our Enhanced Research Environment went from concept to reality, and we were just really fortunate to have this capability at our disposal.”

“Without this environment,” Martin said, “our COVID response would have been so much more difficult to stand up. Prior to having this, we didn't have a centralized location where all data could be quickly consumed and analyzed. Data sharing was really one off and streamlined, not automated. If we would have been relegated to using e-mail, most of the computation would have been done on local environments, would have been less secure, less accurate and a heck of a lot slower,” he added. “Our ability to engage third-party partners like the Regenstrief Institute, Fairbanks School of Public Health, the health information exchange here in Indiana, and other IU researchers, was so critical to the response speed in the early days of the outbreak, when every single minute mattered to try to get in front of this pandemic. This really enabled analysts and researchers to access these critical data sets in hours rather than waiting weeks.”

Kristina Box, M.D., the Indiana State Health Commissioner, said that during the early days of the pandemic, “there was an overwhelming sense of helplessness and a little bit of frustration. We had the governor and his team and Hoosiers from our entire state, looking to us for answers: How is this spread? Is it airborne? Can it be on surfaces? Is there asymptomatic spread of this? Are children super spreaders? Do masks really help? And the information that we really needed was not at our fingertips; it was all being learned on the fly,” she said.

Box said the state took advantage of the university/state partnership that was developed very quickly, with Indiana University librarians and researchers gathering and digesting information based on data requests from the state. “It was difficult to figure out what messaging to do,” she recalled. “Our governor is an incredibly data-driven governor, so he really wanted data at his fingertips from day one immediately. That was a challenge to get that up and running.  We could literally could pick any topic that we needed information on, and the providers and hospital systems across the state could tune in with experts on infectious disease or other experts around the state. We could identify what was the most recent information not just from the United States, but from around the world, and coming directly out of the CDC.

She said the data they really needed involved: who was infected and where they were infected? What is the race, ethnicity, and age of those infected? What were their outcomes? Do they go to the hospital? Do they take ICU beds? Do they need ventilators? Did they get Remdesivir? “And all of that was really critical,” Box said.

“The State Department of Health was lucky in that we had just implemented an emergency preparedness platform called EMResource that allowed us to include every hospital and every long-term care facility in the state and our local health departments,” Box said. They could see across the state the number of ventilators, ICU beds, PPP supply, and testing equipment.  The ability to gauge surge capacity was critical, she added, “because overwhelming our healthcare system was a big part of what we were concerned about. So that really helped us, especially in breaking it down, not just at a state level, but in all of our preparedness districts, or regions across the state. All  of that became critical and our  health information exchange, our Indiana Hospital Association and Regenstrief were critical in that part of it.”

John Roach, president of KSM Consulting, described some of the data being gathered. They received case data, lab data, information on available resources in hospitals, contact tracing data, immunization data, historical immunization data, and data from the surveillance system that was already in place. “We also have the data that's maintained by the health information exchange, including admission discharge and transfer data from all across the state. There are other data sets necessary to provide context and facilitate the joint analysis of that data. For contact tracing, you need context on those people to understand where they live, So we used other data sets to augment those direct datasets.”

Roach said that besides fueling internal and public dashboards, the data hub also allows academic researchers and modelers to project what they think is going to happen, and to be able to test scenarios around policy. “The data necessary to fully understand COVID is spread across lots of different systems,” he said. “As you might imagine, there are data quality issues in those systems. They weren't necessarily built to be analyzed in tandem with one another. So there's a lot of effort going on behind the scenes or below that waterline to homogenize all of that data and position it for analysis.”

Roach explained that they wanted to be able to test scenarios and understand, with new information on the efficacy of masks, if we mandate masks, what is that likely to, to do to disease propagation rate? "If we change this regulation about the allowed capacity in restaurants,  how might that change the disease propagation rate? Or how might that change the census in hospitals?” He said this involves using advanced analytics in a purposeful way to enable decision makers to make better decisions about what to do. “All of the available information that we have about the crisis, in combination with some advanced analytical techniques enable us to accurately project disease propagation, and hospitalization going forward.”

Connor Norwood, chief data officer for the Indiana Family & Social Services Administration, led much of the data-gathering effort at FSSA. He said he came to the position from academia  three years ago and didn’t know what he was getting himself into, with being in charge of the data strategy for things like Medicaid and Temporary Assistance for Needy Families. He was told he would never have an army of PhDs to help generate all this information. “I took that as a challenge, because I like to prove people wrong,” he said. During that time frame the agency added its first chief data officer position and hired its first chief medical officer over the entire agency and first chief science officer. “But more importantly, we were really able to collaborate with the Management Performance Hub and other groups to build the Enhanced Research Environment that is literally intended to create an army of PhDs with access to secure government data, to collaborate and analyze data and provide the information directly back to government and publish it for the general body of knowledge,” he said. “Now that we have the Enhanced Research Environment, we're on the precipice of that army of PhDs in collaboration with our academic institutions, to generate a lot of information, a lot of knowledge by freeing up and making the data available to those individuals.”

Box said it is important to build this infrastructure for data sharing to address the pandemic, “but what I want really in the end is to make sure that as we do an after-action, we have developed a platform or a basis so that we can continue to improve on that connectivity across the state,” she said. “Why shouldn't our hospitals be connected with our local health departments and be connected with our long-term care facilities? Why should we not be able to have data that is shared freely as long as their data agreements in place about that. We need to make sure that we truly are putting ourselves not just as a state, but as a country, in a better position to be able to respond more quickly and more efficiently next time.”

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