Over the last several years, our public health IT infrastructure has made great strides and improvements by tracking EHR data and using it to improve public health reporting and surveillance, disease prevention, and communication between providers and public health officials. However, as the world continues to experience epidemics like SARS and ZIKA, and now the COVID-19 pandemic, it’s clear there are still gaps within the digital infrastructure we have currently in place, and the industry needs to make a collective effort to address these gaps.
To take public health IT to the next level, we can use the existing infrastructure to address public health crises (like the coronavirus) in new ways. We must also work together as an industry to develop new standards and processes for sharing different types of data, such as health system capacity, that historically has not been tracked.
Tracking COVID Test Results and Hospital Capacity
At the moment, we’re already using public health infrastructures to report on infectious diseases (like flu A/B), but we haven’t been tracking situational awareness data such as hospital capacity — available beds, ventilators, and staffing levels — to handle increased patient volume.
The biggest issue right now is managing the inventory of required materials. If health organizations began to share and aggregate this type of health data across healthcare systems, public health officials could use it more efficiently to deploy resources.
A Stop-gap Solution
To address this, the White House Coronavirus Task Force in late March began requiring hospitals that have in-house laboratories to begin reporting COVID test results to federal agencies (commercial labs were already doing so). The task force also began requiring hospitals to report on capacity and availability — such as available beds, ventilators, and staff — to help FEMA and CDC in their efforts to support states and localities in responding to the virus.
The directive is for hospital administrators to submit this data to FEMA and the CDC daily via a spreadsheet. It’s a stop-gap solution to the problem, but it works for now. Meantime, health leaders are innovating to create better ways of aggregating and sharing data in the future.
The SANER Project: Creating Standards to Report Data
While our health system doesn’t currently have a standard for reporting situational awareness data, an ambitious initiative is working to solve this. It’s called the Situation Awareness for Novel Epidemic Response (SANER) Project, which can be found on the government’s Interoperability Proving Ground site. SANER is an industry-wide collaboration that is working to revolutionize unreliable data-sharing processes to improve real-time situational awareness of health care system capacity in the COVID-19 pandemic and future public health emergencies.
One goal of the SANER Project is to establish a well-accepted standard based on HL7 FHIR to report situational awareness data. We likely won’t have this solved for the current outbreak, but when there's a future pandemic, this data-sharing process will already be up and running. (We’re proud to have Sean Zitello, Director of Lyniate’s Co-Creation Lab, participating in SANER, and we plan to publish updates from the SANER project regularly.)
A large focus has rightfully been placed on getting reliable data from the providers and storing it in common FHIR servers where it can be accessed by public health and other interested actors. "The key role that integration plays,” Sean says, "is reducing the cost and complexity of implementation. The provider need only create that CSV. Integration can handle the rest. And where systems find creating those first-stage reports difficult, integration can often fill that role too.”
What Else Could We Track to Address the Pandemic?
In addition to lab results and hospital capacity, our health system should also be tracking and aggregating information about patients with convalescent antibodies. This is mission critical as these antibodies have the potential to treat current patients and save lives. If we were using our existing infrastructures in a way that maximized its abilities, we could be reporting on the supply of antibodies or the number of willing donors in a community.
Additionally, using data sharing to track information about symptoms, recovery times, and efficacy of treatments from disparate locations would help to identify further insights into the disease as health experts across the globe look to better understand, treat, and develop a vaccine for COVID-19.
Data sharing and the use of existing and new IT infrastructures are critical in managing pandemics like COVID-19. In order to course correct, health leaders around the globe must take advantage of the untapped potential of the existing infrastructure — and create new solutions — to address the gaps and challenges associated with public health reporting, which have been made apparent by the current COVID-19 crisis.