COvid-19 slammed public health agencies and organizations. Future crises, whether from infectious diseases, extreme weather, or other causes, are likely to do the same unless they change their approach to public health reporting, data management, and information sharing.
Managing public health is not easy, especially in the United States. Not only is this country home to diverse populations with different genetic predispositions and cultural patterns of medical importance, it is also geographically vast. How epidemics or climate change affect California can be very different than in Maine. The needs of Pittsburgh residents can be very different from those living 50 miles away in rural Pennsylvania.
These factors require that locally-focused—community and statewide—public health policies and technological infrastructures be maintained for most efforts, and this is the right response 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 recognize no local, regional or state boundaries.
One problem with a localized public health approach, however, is the resulting patchwork of reporting and decision-making, which creates tremendous challenges for public health agencies, healthcare organizations, and the developers supporting data collection and data sharing. This is true in the best of circumstances, let alone during a crisis.
People do not seek treatment from the same provider every time and may even cross state borders to receive care. Many large healthcare organizations operate in multiple states and must comply with different privacy laws related to patient consent to information sharing. Additionally, there are different approaches to prescription drug surveillance programs, and providers also face a variety of public health-related reporting obligations that quickly become daunting during public health emergencies.
Even within the same state or region, state legislatures and public health organizations often do not coordinate their efforts to make decisions about approaches to technology, governance decisions about sharing information between places, or what information needs to be collected by health care providers and reported to public health registries. In the early days of the pandemic, a large Altera Digital Health healthcare system customer I work for reported daily or weekly Covid-19 data to 18 different city, county and state public health facilities. Each entity wanted different information, so the healthcare system couldn’t easily share a report with all parties. This multiplied the reporting requirements for frontline medical providers tasked with capturing the disparate information about patients in the care process while grappling with staff shortages and the influx of Covid-19 patients. it also created unnecessary work for the IT department and us as partners.
Lessons from Israel
Not only does this fragmented approach to public health reporting create unnecessary burdens, but the health care organizations that provide the information often derive no benefit from it. Very few public health systems provide a two-way flow of information back to the providers submitting data. As a result, hospitals and physician offices rarely receive cohesive communication about trends in public health data to monitor. And even in today’s highly digitized world, this information is often transmitted by fax when shared with healthcare organizations.
Israel’s response to Covid-19 through health IT is a great example of a connected, modern public health system in action. With a population slightly larger than New York City, a land area roughly the size of New Jersey, and a national healthcare system, this is certainly not a apples-and-oranges comparison. However, Israel has spent decades investing in an interoperable national healthcare IT infrastructure and was able to adapt quickly when the pandemic began.
The country’s Ministry of Health and the research community have been proactive in trying to maximize de-identified digital information available about Covid-19 patients across the country for research purposes. This allowed its epidemiologists and health officials to quickly gain insights into the spread of SARS-CoV-2, the virus that causes Covid-19, the comparative effectiveness of vaccines and retroviral treatments, and more.
By comparison, the US had to rely on information and forecasts from other countries because its decentralized, heterogeneous reporting systems made federal-level data analysis slow, difficult, and imperfect—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 IT in the US. This contained guidelines for a “new normal”. Public health as a strong partner of healthcare and shared resources and data where appropriate.
The challenges of maximizing public health data can be addressed when governments focus on investing in health IT, consistent reporting, and up-to-date digital health technologies.
Many state health departments — and the city and county governments under their jurisdiction — are currently using technology that is decades old. They could instead leverage modern healthcare IT designed to maximize collaborative, consensus-based standards. Thanks to significant funding made available 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 data silos between the public health and healthcare sectors break up health IT as a channel.
Electronic medical records use standards that provide mechanisms for how data is labeled, categorized, and shared. Harmonizing data across public health platforms would make it easier, faster and cheaper to share and collect information. And in times of crisis, greater efficiency can make a real difference.
Develop consistency in data reporting
Creating consensus on reporting for healthcare organizations can also improve public health. Imagine how much less work hospitals and practices would have to do if they could report in a way that would benefit many entities, from city, county, state, and federal health departments to researchers and others. Researchers and the federal government could compare situations in different states and regions to make evidence-based decisions regarding public health responses with better access to unidentified data.
Harmonized data and a cross-state consensus on reporting would have significant benefits for clinical research and the early detection of public health emergencies, including and beyond infectious diseases.
Many states are currently prioritizing addressing unequitable social drivers of health as part of their broader public health strategies, and the opioid crisis has reached a critical juncture during the pandemic. Both are examples of other areas where conflicting data collection and reporting requirements and a variety of approaches to technology implementation from state to state are impeding progress in improving patient outcomes and public health surveillance capabilities. However, these and other important issues could increasingly get the attention they (and our communities) deserve by providing a better way to share the clinical data already being collected en masse across the US
The necessary changes would not come without challenges. It is not easy to replace hundreds of incumbent systems or existing policy approaches to data management. And investments in public health infrastructure do not routinely venture to local, state, and federal agencies. In fact, underinvestment has brought the country into the challenging position it has found itself in for the past two and a half years.
Seize the funding and technological opportunities of healthcare IT
As the US emerges from Covid-19, it has a golden opportunity to channel funds made available by Congress into public health infrastructure at the local, state and federal levels. But it’s important to remember that Congressional funds can always be reappropriated and short-term memory often stalks Congress when the urgency of a situation recedes.
If states collaborate on a consistent, standards-based health IT approach to public health reporting, while consulting the Office of the National Coordinator for Health Information Technology as subject matter experts in the field, they would be in a much stronger position if the Der The next public health emergency arrives, and even before it, as public health leaders increase expectations for healthcare providers to report on social drivers of health and other data.
Leigh Burchell is Vice President of Government Affairs at Altera Digital Health and Chair of the Electronic Health Records Association’s Public Policy Leadership Workgroup.