C.ovid-19 has hit public health agencies and organizations. Future crises, whether due to infectious diseases, extreme weather, or other causes, are likely to do the same unless we change our approach to public health reporting, data management, and information exchange. I have.

Managing public health is not easy, especially in the United States. The country is not only home to a diverse population with different genetic predispositions and medically significant cultural patterns, but it is also huge geographically. Epidemics and climate change could affect California very differently than Maine. Pittsburgh’s needs are very different from those in rural Pennsylvania, 50 miles away.

These factors require that locally-focused (community and statewide) public health policies and technical infrastructure be maintained for most efforts, which is often the right response. A top-down approach implemented at the federal level overlooks important nuances and reduces the ability to meet people where they are. But highly contagious viruses and climate change don’t recognize municipal, county, or state lines.

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data management

However, one of the problems with localized public health approaches is the resulting patchwork of reporting and decision-making, which presents significant challenges for public health agencies, healthcare delivery organizations, and developers supporting data collection and exchange. becomes. This is true even under the best of circumstances, let alone during a crisis.

Patients do not always seek care from the same providers and may even cross state borders to obtain care. Many large healthcare organizations operate in multiple states and must comply with various privacy laws regarding patient consent to exchange information. Additionally, prescription drug surveillance programs come in a variety of approaches, and healthcare providers face numerous public health-related reporting requirements that become difficult as soon as a public health emergency occurs.

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State legislatures and public health agencies, even within the same state or region, make decisions about technology approaches, governance decisions about the exchange of information between regions, or what information health providers obtain and report to the public health registry. They often do not coordinate their efforts in making decisions about what is needed. provider. In the early days of the pandemic, Altera Digital Health, a large healthcare system client I work for, reported Covid-19 data to 18 different city, county, and state public health agencies on a daily or weekly basis. Each entity needed different information, so the healthcare system couldn’t simply share her one report with all parties. This has doubled the reporting responsibility of frontline healthcare providers. A health care provider was tasked with collecting various information about patients in the care process while dealing with staff shortages and an influx of her Covid-19 patients. It also created unnecessary work for the IT department and our partners.

Lessons from Israel

This fragmented approach to public health reporting not only creates an unnecessary burden, but the health care delivery organizations that provide the information often derive no benefit from it. Few public health systems provide a two-way flow of information back to the provider sending the data. As a result, hospitals and health care provider clinics rarely receive closed-loop communication about notable public health data trends. Even in today’s highly digital world, when that information is shared with healthcare delivery organizations, it often comes by fax.

Israel’s health IT response to Covid-19 is a great example of a modern, connected public health system in action. Admittedly, with a population slightly larger than New York City, a land area roughly the size of New Jersey, and a national health care system, this is not a straightforward comparison. That said, Israel has decades of investments in an interoperable national health IT infrastructure and was able to pivot quickly when the pandemic began.

The country’s Ministry of Health and the research community have been active in making the most of available anonymized digital information about Covid-19 patients across the country for research purposes. was able to quickly gain insights into the spread of SARS-CoV-2, the virus that causes COVID-19, the efficacy of vaccines versus retroviral treatments, and more.

In contrast, the United States has had to rely on information and projections from other countries. Because its decentralized and heterogeneous reporting system has made data analysis at the federal level slow, difficult, and incomplete, 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, will publish a report in 2021 outlining 22 recommendations for health IT in the United States. . Public Health as a strong partner in healthcare, and resources and data shared as needed.

State investments in health IT, consistency in reporting, and focus on current digital health technologies can help meet the challenge of maximizing public health data.

Many state public health departments, and the city and county agencies under their jurisdiction, are now using decades-old technology. Instead, you can take advantage of modern healthcare IT built to maximize collaborative, consensus-based standards. Thanks to the substantial funding allocated by Congress in 2020 and 2021, we will invest in newer and more modern systems, including the Centers for Disease Control and Prevention’s new data modernization initiative, to help bridge the gap between public health and healthcare. A unique opportunity exists to break down data silos. Health IT as a conduit.

Electronic medical records employ standards that provide mechanisms for how data is labeled, classified, and exchanged. Harmonizing data across public health platforms makes information exchange and collection easier, faster, and cheaper. And in times of crisis, efficiency gains can make a real difference.

Improve data reporting consistency

Building consensus on the reporting of healthcare delivery organizations can also improve public health. How much less work hospitals and clinics would have to expend if they could report at once in a way that would benefit many agencies, from public health departments at the city, county, state and federal levels to researchers and others. Imagine what it would be like. Researchers and the federal government can compare conditions in different states and regions to make evidence-based decisions about public health responses while enhancing access to de-identified data.

Interstate consensus on coordinated data and reporting will greatly benefit clinical research and early identification of public health emergencies, including or beyond infectious diseases.

Many states are now focusing on addressing unfair social factors as part of their larger public health strategies, with the opioid crisis reaching a tipping point during the pandemic. Inconsistent data collection and reporting requirements, and varying approaches to technology implementation from state to state, are examples of other areas where progress in improving patient outcomes and public health surveillance opportunities has been hampered. These and other major issues could receive more and more the attention they (and our community) deserve by building better ways to share the clinical data already collected in the United States. There is a nature.

Necessary changes do not come without challenges. Replacing existing policy approaches to hundreds of established systems and data governance is no easy task. And investing in public health infrastructure is not something local, state, and federal agencies routinely do. In fact, inadequate investment is what has kept the country in trouble over the past two-and-a-half years.

Seizing Healthcare IT Financing and Technology Opportunities

As the United States emerges from Covid-19, we have a once-in-a-generation opportunity to inject funds provided by Congress into local, state, and federal public health infrastructure. But it’s important to remember that Congress’ funds can always be reused, and short-term memory often befalls Congress as the urgency of the situation shifts into the past.

States are in a much stronger position if they collaborate on a consistent, standards-based healthcare IT approach to public health reporting, and in doing so consult the Office of the National Coordinator for Health Information Technology as a subject matter expert in the field. can do. Even before the next public health emergency hits, public health leaders are increasing their expectations of health care providers reporting on health and other data social factors.

Leigh Burchell is Vice President of Government Relations for Altera Digital Health and Chair of the Electronic Health Records Association’s Public Policy Leadership Workgroup.