The United States’ response to the COVID-19 outbreak has seen various pitfalls, but one of the most significant came when national and local public health agencies first tried to understand how bad the virus was. widespread in their communities so that they can target appropriate interventions.
Nationally, test results and reported cases often reached public health authorities via methods such as fax machines, which meant officials had to spend time and resources entering data into their electronic systems before they could identify hot spots and initiate case investigations or contact tracing. To make matters worse, many reports lacked basic information, such as the person’s race or ethnicity, address or phone number. Without these details, it would be nearly impossible to track down others who may have been infected, determine how the disease was affecting different communities, or track the progress of vaccination campaigns and other interventions.
Such problems before the pandemic, and continue to hamper responses to other health problems, including local epidemics of meningitis, increases in type 2 diabetes, or environmentally triggered diseases like asthma. Fortunately, the technology to provide public health agencies with the data they need exists; most electronic health record (EHR) systems can already share this data electronically. However, many healthcare providers do not use these capabilities, citing the reasons which include expensive connections between EHRs and public health systems, limited staff capacity, and a lack of familiarity with where to send data. Now, the Centers for Medicare & Medicaid Services (CMS) have the ability to address some of these issues.
Broadly speaking, public health work relies on four types of data: case, laboratory and vaccination reports which can provide information at the patient level; and syndromic surveillance which uses data from emergency services to paint a broader picture of potential health threats at the population level. All four help health services identify risks and determine what action to take.
For example, lab results that contain demographic information about individuals are essential for tracing contacts and identifying “hot spots” of the epidemic. Syndromic surveillance, on the other hand, provides information on symptoms and behaviors that can help identify potential outbreaks before they become mainstream. For example, if emergency departments see a sudden increase in visits with vomiting and other gastrointestinal issues, it could be a sign of foodborne illness that should be reported to public health agencies.
However, simply collecting this data is not enough. For it to be useful, agencies must receive it quickly, and it must contain all the information necessary to contact individuals and understand how different groups or communities are affected. This makes electronic submission essential, with data ideally coming from the EHRs of hospitals or doctors’ offices or laboratories performing the tests. In this way, the authorities can obtain complete and timely information and quickly decide on interventions.
Although the technology to share this data electronically exists and previous federal incentives have led to more hospitals Doing so, absorption remains lower than it should be. CMS is already taking action to address this issue, but the agency can do more.
The agency recently released a final rule for payment systems in hospital hospitals that would require these establishments to electronically send all four types of data (laboratory results, case reports, vaccinations and syndromic surveillance) to public health agencies. Additionally, CMS already requires electronic reporting through its Interoperability Promotion Program, which provides incentives for hospitals to use EHRs in certain ways in order to be reimbursed by Medicare.
However, the CMS Physician Fee Schedule (the rules governing the remuneration of physicians for the provision of Medicare patient care) only requires the sharing of case reports and immunization data electronically. This means that public health agencies may not have all the data they need to make informed decisions. Although some doctors covered by this rule do not have data that can support syndromic surveillance, those who practice in emergency care centers do. And that information could be vital for public health officials to understand the risks of potential outbreaks. CMS can and should require emergency care clinicians to send this data to the appropriate public health agencies.
These changes alone would not be enough. States and localities should also ensure that their public health agencies can accept this data and require that it be sent to them electronically. Even so, the recent actions taken by CMS represent a major step towards providing these agencies with timely electronic data, which can help save lives, but the agency still has more to do to support this goal.
Molly Murray manages The Pew Charitable Trusts’ Public Health Data Improvement Project.