Data Modernization is Key to Meet U.S. Healthcare Challenges

During the ONC annual meeting, state health officers call for boosting public health data infrastructure investment.

A practicing emergency medical physician, who is also the chief medical officer of Alaska, led calls for data modernization in U.S. public health at the recent annual meeting of the Office of the National Coordinator for Health Information Technology (ONC).

"When someone shows up in my ER with four different wristbands on, and that's how I figure out that they've been at another ER and gotten a recent CT scan, that's a problem," said Anne Zink, MD, chief medical officer for the state of Alaska, speaking on a panel about public health data modernization during a pandemic.

"There are real costs, not just financial costs, but human life costs, to not doing this integration and doing it well," Zink said. "Honestly, that's what drove me into public health, was seeing my patients having the system fail them again and again."

Zink proposed that the federal government pass additional legislation modeled after the Emergency Medical Treatment & Labor Act (EMTALA) in 1986.

"EMTALA said to every hospital, if you're going to receive federal dollars to care for a patient, you're going to do emergency stabilization and treatment," Zink said. "We need the same thing for [healthcare] IT. If you're going to get federal dollars to do any healthcare, you integrate. That means these systems work together because there is real cost to not doing it."

Until such legislation puts real pressure on companies that have "proprietary desires to stay siloed off for all sorts of reasons," providers will be challenged to respond adequately to pandemics, improving overall life mortality, and moving forward, Zink said.

Tiberius Vaccine Allocation System Provides a Model for National Data Modernization

Zink pointed to Tiberius, an IT system developed in 2020  that updates vaccine allocations by state on a weekly basis. "This is an example of how nationalization needs to happen," Zink said. "I can put out a lot of reports as a public health department, but that means nothing if it's not going to help the clinician [who] needs to know if a patient was vaccinated."

Such information is critical to help physicians in the midst of a pandemic pivot their vaccine response to the neediest patients, Zink said.

Zink's comments were echoed by another panelist.

"In the next couple of years, we have to really work hard on retooling the systems that we have," said M. Norman Oliver, MD, MA, state health commissioner at the Virginia Department of Health. "Our data, our surveillance systems, our electronic lab recording, case reporting and other things need to be just worked on a great deal, because they have been limping along throughout this pandemic," Oliver said. "I'm amazed that our system hasn't crashed more than it has this past year."

Adequately trained public health personnel will be essential for data modernization success

Statewide and other public health departments face another challenge: recruiting personnel trained in public health informatics, Oliver said.

"The days of having someone who's an epidemiologist morphing themselves into being a health informatics person, we need to get beyond that," he said.

Public health still faces the double challenge of getting the right data to perform analysis on outbreaks, but then also figuring out the best way to present that data so that it is used appropriately and becomes actionable information for public health practitioners, Oliver said.

Despite these obstacles, Virginia has made some progress. "We linked up the EHRs of every emergency department in the Commonwealth, all 129 of them on a common platform," Oliver said. Virginia undertook this project in response to the opioid epidemic "to keep track of people who are utilizing the EDs in a way to train on narcotics, but we've built upon that as a way to effectively talk to each other about some of the health-related social needs of these patients."

Oliver said his ideal would be a patient identifier, not only to assist each patient get the right care, but also entire populations. "That obviously means standardizing the way that we take data and figuring out ways to ensure that that data is actually collected."

As an example, Oliver pointed to North Carolina, which mandated that vaccinators must collect race and ethnicity data.

Public health more typically collects such data from 60% of the population, according to Marcella Nunez-Smith, MD, MHS, director of equity research and the innovation center at the Yale School of Medicine.

"We are seeing inequity in the vaccination space, but we're limited by incomplete data," Nunez-Smith said.

North Carolina, by contrast, currently has 98% of race and ethnicity data in its vaccination records, Oliver said.

For its part, the Centers for Disease Control and Prevention (CDC) has a roadmap for its data modernization initiative, according to Daniel B. Jernigan, MD, MPH, acting deputy director for public health science and surveillance at the CDC.

Jernigan says funding from the CARES Act, signed into law in 2020, has been set aside for the first stage of this modernization.  "We need to get to the next step of implementation planning at CDC," Jernigan said.