- Health information exchanges have fueled interoperability and demonstrated how leveraging analytics can help respond to the COVID-19 pandemic.
Coronavirus cases in the United States show no signs of slowing. Limited testing capacity in March made it challenging to fully understand the number of individuals infected. As testing capabilities have increased, more individuals have been tested and more cases identified.
But this has led many to falsely suggest that increased testing is the sole reason for the country’s rise in cases. Re-opening efforts, challenges with enforcing mask laws, and a lack of social distancing are also contributing to the rise in cases.
Studies continue to prove the efficacy of this, as public health experts advocate for increased testing in order for the country to get a handle on the coronavirus. But minimal information at the start of the pandemic and a lack of data transparency are hindering efforts.
A large factor in the lack of information is linked to the healthcare industry’s consistent data silos. Each state is responsible for its own coronavirus response, so there was no one single source of truth. Even today, death rates vary based on where the information is sourced.
For example, the CDC reported 135,991 deaths, compared to the 135,053 deaths reported by the World Health Organization, as of July 15, 2020. Discrepancies between large agencies only begin to hint at potential gaps at a state level.
Without a unified understanding of the impact of COVID-19, it begs the question: How can the country successfully combat the disease?
Improved Interoperability, Data Exchange
Thankfully, regulatory flexibilities and robust resource allocations to the COVID-19 response have taken steps towards interoperability and improved data exchange.
“We have improved the number of information systems and processes that have been put in place to illuminate the situation better,” Brian Dixon, PhD, director of the public health informatics program at Regenstrief told EHRIntelligence.com.
Information exchanges and centralized data reporting have played a critical role. Once public and clinical health experts understood what information needed to be captured, they were able to work to streamline collection methods and reporting.
Health information exchanges (HIEs) also play an important part in this effort.
“With that already existing infrastructure, it allowed us to rapidly add the information needed for the pandemic,” said Kim Chaundy, senior director of Keystone HIE (KeyHIE). “There are organizations still today that have not chosen to connect to an HIE. Not having the infrastructure of the HIE would be very difficult to an executive leader.”
All organizations participating in the HIE share data with other HIE members. But those who are not part of the HIE don’t have access to this data. As a result, there’s a large blind spot, creating pockets where it is impossible to see certain information.
Particularly when coordinating a state- or county-level response, this is a major barrier as it’s impossible to capture a complete picture of the outbreak.
“Cleaning up the whitespace and getting everyone connected is only going to make interoperability more effective and efficient,” Chaundy elaborated.
It is not just hospitals and physician clinics that create whitespace. Skilled nursing facilities (SNFs) were particularly vulnerable to disease outbreak and also unlikely be a part of HIEs, which means there are multiple levels of care that need to be considered, Chaundy explained. This includes patients, as an increase in data exchange contributes to more effective and timely care.
During the pandemic, HealtHIE Nevada increased its patient data exchange by 36 percent.
“We wanted clinicians to not have a barrier to access patient data, so we decided that [it was] one of the things we could do to give access to providers who had not yet signed up for service,” explained Michael Gagnon, executive director of HealtHIE Nevada.
Providers not a part of the HealtHIE Nevada prior to COVID-19 were able to participate in the information exchange and the organization’s e-case reporting initiative. When a patient tested positive for COVID-19, HealtHIE Nevada packaged the patient’s clinical information to the provider to allow the provider to track comorbidities and other factors that could impact a patients’ recovery. Without a facilitated information exchange, COVID-19 lab test results may not be shared with a patient’s primary care physician. If patients are diagnosed in the emergency department, urgent care, or pop-up testing site, the patients are responsible for sharing their test results with their primary care provider. Further, it’s unlikely that relaying this information to a primary care provider is top of mind for a newly diagnosed patient. But not having a primary care physician involved might limit their ability to receive proper care or resources during isolation.
“We need to have data flowing into a central location, something we’re calling a health data utility,” Gagnon said.
In the same way that other utilities like electric or gas systems are centralized, this data should be as well, argued Gagnon.
“It’s a sole source and then available to all treating providers and public health professionals or whoever might need that information,” he furthered.
Fueling Analytics, Predictive Models
Not only does a centralized system help with immediate care, but it enables further analytics as well. The more robust a data set, the easier it is to use that information for predictive models.
KeyHIE used their data to help predict rising hotspot areas throughout the region. They could then confidently suggest to the state where pop-up treatment and testing sites should emerge.
“We had our analytics team work with doctors and the state to identify codes and trends,” Chaundy explained. “We needed to bring in some specialized folks when it came to analytics. But when it came to the notifications and notifying who needed to be aware, the infrastructure was there. We just needed operations to confirm that. It was a lot of working collaboratively with multiple teams.”
A single source of truth would enable deeper analytics abilities and allow for upstream predictions, perhaps identifying susceptible patients before they fall ill.
These methods, though, do not require innovative technology or costly tools. As the COVID-19 response articulated, advancement required optimizing existing resources.
“A lot of our time was spent on optimizing and capitalizing on our existing connections and bringing in new connections to look for opportunities to improve workflow for our providers and our healthcare team members,” Chaundy articulated. “It wasn’t any new technology. It was capitalizing on the opportunity to utilize what was already in play.”
If the tools and resources are present, development can be expedited. Building on existing infrastructures will be critical as the country continues to fight COVID-19 and prepare for the next disaster.
“Data that public health should have at its disposal in a natural disaster or endemic should become routine reporting,” Dixon argued. “There’s really no reason why the public health department doesn’t need to know about capacity during normal times anyway.”
There are many state and national routine data collection methods from public reporting to annual surveys. These tools capture data and information organizations might need in order to respond to disasters.
But as the COVID-19 pandemic has made clear, this information has gaps. Even information exchanges meant to centralize data have challenges with adoption and provider buy-in.
“A lot of the data that we need are just not routinely captured and reported by healthcare systems to public health departments, in terms of bed counts and capacity and number of ventilators,” Dixon explained. “What we learned is that public health authorities were not getting this information and reporting it on a regular basis. We’ve had to set up methods for reporting that information.”
“The future is looking pretty bright because this has brought forward how health data isn’t shared in a more efficient way. The public health folks have their job to do. And it’s super important that they do that well,” Gagnon emphasized. COVID-19 shone a light on effective and ineffective systems. The industry should take lessons learned to build on the existing infrastructure and technology to prepare for the next health emergency, including the need to streamline health data exchange.
If healthcare and public health systems are going to be transformed for the better as a result of the coronavirus, the industry will need to take these lessons learned, which can have implications for diseases beyond the coronavirus, to improve the nation’s response to the next disaster.
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