Since the beginning of the pandemic, hospitals, and public health organizations across the United States have struggled to keep up with systemic disruptions related to COVID-19. Governmental regulations related to the pandemic have been changing as quickly as our understanding of the disease itself. Due to the long-term projected impact of the pandemic, healthcare systems and public health agencies must coordinate efforts now to maintain data integrity and accessibility.
Frequent changes to requirements, such as the new data reporting requirements to the U.S. Health and Human Services instead of the Centers for Disease Control and Prevention (CDC), compound the burdens already placed on the hospitals and state public health agencies. Creating such a complex regulatory environment, without adequate financial support, causes inconsistent application of the new regulations from organization to organization.
Hospital and public health data exchange, interoperability, and accessibility are vital to fighting a pandemic. A recent study reports that about 40 percent of hospitals indicated that their associated public health agencies are not technologically equipped to receive patient data. Public health professionals cannot accurately report and respond to COVID-19 without adequate funding and resources, with limited capacity to collect the data.
According to the CDC, racial and ethnic minorities are excessively impacted by COVID-19, both in deaths and positive cases. Another study conducted in the five boroughs of New York City, COVID-19 mortality and morbidity rates exemplify these health disparities. The study shows that the Bronx, with the highest proportion of black or African Americans and the lowest median household income, had the highest morbidity and mortality rates.
Data collection on race, ethnicity, and other social determinants of health has been severely disrupted during the pandemic. Many states did not report the COVID data by race and ethnicity. The collection of this data at the point of contact with patients has always been inconsistent due to a lack of training and high attrition rates in these low-paying jobs. Further down the cycle, clinicians unreliably record social determinants of health in electronic health records that were not originally designed to capture this information or thought that it was their responsibility to document it. Finally, coding social determinants of health takes a back seat to more lucrative diagnostic and procedural data tied to provider revenue cycles.
Before the pandemic, data collection and reporting were already a challenge for healthcare organizations, especially community hospitals with limited resources. Today, many providers have faced steep declines in patient volume and revenue, leading to tremendous furloughs across healthcare organizations, making it even harder. Those affected by furloughs were often administrative support staff responsible for coding and reporting data that is dependent on identifying different levels of health risks, needs, and outcomes.
On a local, state, and federal level, public health agencies depend on this data to formulate an appropriate response and allocate resources where they are needed most. As the data is becoming our primary tool to fight against the Coronavirus, we must strengthen our data collection efforts to understand the pandemic's true impact. Without accurate and timely health data, both at the hospital and the population level, efforts to fight this pandemic are like taking a proverbial shot in the dark.
The CDC had previously taken center stage during the COVID-19 pandemic, leading data analytic efforts to provide the information to policymakers and healthcare organizations. The CDC provides COVID-19 surveillance information via the COVID-19-Associated Hospitalization Surveillance Network, a population-based surveillance system that collects data on laboratory-confirmed COVID-19-associated hospitalizations. This surveillance data is limited to the 250 hospitals in 14 states participating in the Emerging Infections Program and the Influenza Hospitalization Surveillance Project. Inhibiting the data even further, much-needed information about COVID-19 tests, infections, admissions, and deaths is not readily available in some regions due to economic concerns and political pressures.
Without appropriate coordination between public health agencies and hospital systems, technology, and financial support, COVID19 data collection and reporting will remain profoundly inadequate. Collectively, we must be willing to invest in cultural and organizational change that prioritizes public health. Legislative reforms are needed to adequately fund and support public health organizations so they may proficiently contribute to population health initiatives. It is incumbent upon our healthcare system and public health leaders to combine their efforts and improve population health data integrity, reporting, interoperability, and accessibility.
The federal government must commit to continued transparency and sharing of COVID19 data. Government agencies must be held accountable for complete and accurate data that provides an authentic representation of COVID-19. By making these commitments, we still have time to win this war and learn its lessons for future pandemics and other natural disasters.
Amber Owens, RHIA, CICA, CCS is President of the New Jersey Health Information Management Association and the Director of Health Information Services in the New Jersey Hospital Association- Healthcare Business Solutions
Soumitra Bhuyan, PhD, MPH Soumitra S. Bhuyan, PhD, MPH, is an Assistant Professor of Health Administration at Edward J. Bloustien School of Planning and Public Policy at Rutgers University