During last week’s Tech Forum put on by the federal Office of the National Coordinator for Health IT, technology leaders from several state public health departments described how they have responded to the challenges of the pandemic.
Jennifer McNamara, chief information officer for the Washington State Department of Health, leads a staff of 180 IT employees. She noted that like in many other states, public health in Washington has been underfunded for many years. “When the first case of COVID-19 in the U.S. was diagnosed here, we didn't even have a cloud environment to scale. As the pandemic spread, we struggled to meet the urgent and growing demands of our emergency response,” she said. “But in the 21 months since then, we have completed a staggering 38 COVID IT projects. We now have a cloud data center, a data lake for analytics and reporting, and we're migrating from our on-premise data center at what we call ‘COVID speed’ to ignite our digital transformation.”
She said the state has benefited from the generosity of Washington-based companies that reached out early on to offer their help. “In those first weeks and months, these collaborative efforts were very organic,” McNamara said. “We have since formalized our public/private partnership work with incredible results.” They have partnered with ServiceNow to develop an app that automates rostering for incident management teams, and another app to support timekeeping. ServiceNow shared that globally early on during the pandemic so that others could make use of it. Together, these apps have saved hundreds of hours and provided accurate data to maximize their federal reimbursement for the cost of our emergency response. “We've also developed a handful of dynamic 365 Power Apps, which was really new to my team, but we've done amazing work with Microsoft's help.”
She described one app that gathers real-time data from acute care hospitals, so that emergency response leaders and policymakers can make critical resource and surge capacity decisions in the moment based on disease outbreak. Another app supports case investigation and contact tracing for every individual who tests positive in the state.
McNamara said the state has tried to align all of its COVID investments with its long-range goals so that they can avoid having any throw-away investments. “We're hoping that what we've built is going to serve us well into the future,” she added. The state is trying to use the funding it is receiving now to modernize their infrastructure over the next couple of years.
The value of a regional HIE
Benjamin Stutz is the director of hospital strategy, development and operations for the District of Columbia, and deputy mayor for health and human services. In this role, he leads the development of the District's new healthcare delivery system for residents living east of the Anacostia River, which includes the construction of a new $375 million hospital and three urgent care/ambulatory centers.
Stutz noted that because the region’s population encompasses suburban Maryland and Virginia, they benefited from having a strong regional health information exchange in CRISP. “With our epi investigations and contact tracing, it helped us,” he said. “When people didn't put in their contact information, we were able to then go back and figure out how to get in touch with them. We were able to provide physicians and hospitals with patients’ vaccine status, and we were also able to transfer lab reports without a fax machine.”
Building a new hospital during the pandemic, Stutz added, was an opportunity to “stress the importance of what a new hospital means. Our current public hospital that we are replacing actually doesn't have an operational EHR system. We are able to showcase and really bring to bear resources to primarily Black and Brown communities. Fifty percent of the District is Black, but 75 percent of the COVID deaths we've experienced here are among African-Americans. That has just put front and center the need for quality, access and interoperability.”
Stutz was asked if any other innovations in technology will be helpful in trying to prevent that similar trend line of death in the Black and Brown community moving forward.
“It certainly helps us as policymakers at a macro level,” he responded, “but at an individual level, it has to boil down to an appreciation for what it means for each individual, when they walk into a facility and to know that their doctor, and their hospital physician can see the same exact information in real time. And frankly, right now, that's not a reality when some of our residents go to our public hospitals. I think it's only as good as the user being able to appreciate the benefit of the technology that's available.”
Bill Storm, the electronic laboratory reporting coordinator for the Bureau of Informatics and Data Management at the Ohio Department of Health, said there are numerous obstacles and challenges they have had to overcome during the last 18 months. He said everyone who works in public health probably remembers the June 4, 2020, HHS guidance. “It just kind of shocked the nation — all the data that CDC wanted,” he said. “The unique thing about Ohio is that we're a local home rule state, so we have 88 counties and about 115 local health department jurisdictions, all having their own governing entities. One of the things that we've done well over the years, long before COVID, is just the coordination and communication with all those local health jurisdictions.” When you're dealing with frequently changing guidance with a novel, emerging virus, Storm said, it is a relentless task to communicate all of the guidance to clients, laboratories and hospitals.
The State of Ohio is working on identifying all of the different systems in Ohio that bring in health data, and how they can be more interoperable with one another, Storm said. “A big part of our CDC grants this year is building interoperability among immunization systems, birth and death records systems, and also working with our health information exchanges. We have had a lot of issues with our public health infrastructure systems. Laboratories are going through the same thing. They're working on some pretty ancient systems as well.”
Rob Laing serves as an interoperability informaticist for the acute and communicable disease prevention section at the Oregon Health Authority. He noted that just like their neighbors to the north in Washington state, public health infrastructure has been underfunded in Oregon for years. “It’s always an uphill battle to get enough funding and manpower to do the work,” he said. “We have had a communicable disease database system in place for many years. That led us to be able to deploy that database to the COVID response. When that system got fairly overwhelmed, we spun off a brand new one that mirrors the original system to do our communicable or COVID recording and our COVID case investigation. Like Washington State, we also were able to partner with Microsoft to do some web apps for contact tracing.”
He said Oregon has experienced some difficulties tracking adults in custody and in congregate care settings in general, in addition to hospitals and navigating the logistical challenges of how many patients need ventilators and how many patients need just an observation level of care. “While not all of my colleagues may feel this way, I think a state health information exchange would be really beneficial not only to Oregon, but to other states as well,” Laing added. “It would definitely benefit our ability to exchange data for people who are moving around frequently and also very helpful to hospitals. Especially right now, during this surge, we're having challenges with patients moving from one hospital to another hospital to get the appropriate level of care.”
Making systems talk to each other and turning data into information is becoming more of a recognized discipline, Laing stressed. “We are trying to take advantage of that in Oregon by building out staff capacity to be able to do a lot of these projects that we've done over the last 18 months, and hopefully we'll continue to do in the future.”