Pew: 4 Ways Federal Policies Can Bolster Public Health Data Infrastructure
The COVID-19 pandemic has highlighted what many experts believe is a fragmented public health data infrastructure, and a new article from research group The Pew Charitable Trusts identifies four key areas where eliminating information gaps and improving systems for data sharing will help public health agencies do their jobs.
The piece, written by Pew’s Ben Moscovitch and Molly Murray, notes that, “As state health departments continue their COVID-19 vaccination efforts and work to halt the virus’s spread, a lack of critical data undermines their ability to effectively accomplish either task, a reality that could prolong the pandemic.”
They wrote that some test results are shared using outdated methods such as faxes and may not include the demographic information needed to conduct contact tracing. Similarly, the vaccine rollout has highlighted issues with incomplete data, they wrote, pointing out that the CDC estimates that it lacks data on the race and ethnicity of nearly half of those who have been immunized.
As such, they stated, “The federal government can help to make data-sharing among healthcare providers and public health agencies more seamless through its rules related to electronic health records (EHRs).” Updated rules could support data collection and sharing in four key areas, the asserted: case reporting, lab reporting, syndromic surveillance, and immunization information systems.
Case reports provide state and local health departments with important information about patients with conditions of public health importance, such as communicable diseases, which can in turn help agencies design strategies to reduce a disease’s spread and impact, including plans for increased testing or education campaigns, the authors wrote. But they noted that the CDC estimates that as few as 10 percent of reportable cases are submitted to public health agencies, and even when they are, the reports often lack key data and arrive in paper form. Leaders of federal agencies could increase and facilitate case reporting by requiring that EHR systems be able to automatically transmit reports to relevant health authorities, Moscovitch and Murray said.
Lab reports provide data to health departments on individuals who have tested positive for an illness, which is critical to conduct contact tracing. Similar to case reporting, lab reports often lack critical data. For example, one study showed that patients’ phone numbers can be missing half the time, which can make contact tracing difficult, Pew pointed out. While that that information is typically in patients’ EHRs, providers may not send it to labs, which then cannot forward it to health agencies, they added. As such, federal rules could require providers to send labs all the information that health agencies need, and do so electronically, regardless of where the test occurs.
Syndromic surveillance can signal health threats at a community level. For example, EDs and urgent care centers may send information without specific identifiers on patients’ core complaints—such as shortness of breath or vomiting—from their EHR systems to public health authorities. This aggregated data can alert officials to threats, such as particularly bad flu seasons or tainted food. But as Pew noted, as of last year, more than 30 percent of EDs report to CDC, along with a smaller percentage of urgent care facilities and other providers, limiting the surveillance data available. Policies should encourage more providers to automatically send this data to health agencies to help understand any threats to their communities, they stated.
Immunization information systems are managed by states and local jurisdictions, and help stakeholders track who has received a vaccine, monitor immunization rates, and investigate cases of vaccine-preventable diseases. However, in some jurisdictions, their use is mandated only for children; in others, some providers, such as pharmacists, aren’t required to use them, Pew reported. These gaps can make it harder to track vaccine distribution and should be closed. Federal requirements can help ensure that all systems can send and receive important vaccine data, the authors said.
Interestingly, one analysis of health system executive survey responses published in JAMIA (the Journal of the American Medical Informatics Association) last spring found that 41 percent said the largest barrier to electronic lab reporting and syndromic surveillance was that public health agencies lacked the capacity to electronically receive data. The study concluded that “digitizing hospital records without a concomitant investment in the IT capabilities of state and local public health agencies contributed to our reliance on a patchwork system of fax, e-mail, and paper to track the spread of COVID-19.”
So in the end, what can the government do to improve its public health data infrastructure? For one, Pew argued, the Office of the National Coordinator for Health IT (ONC), which oversees EHRs, can update its certification requirements for those systems to ensure that they can send complete data electronically to public health agencies for each of these uses.
Additionally, they said, the Centers for Medicare & Medicaid Services (CMS) can also require the use of those EHR functions through its payment policies for hospitals and providers, such as the Promoting Interoperability Programs, which determine reimbursement rates based on the use of health IT. Ultimately, Pew concluded, “Policymakers should make improved public health data exchange a priority to help the country prepare for future threats before the next crisis hits.”
