In early 2020, as they tried to fight covid-19 in two rural counties in North Carolina, Granville Vance Public Health employees had trouble relying on outdated technology to track the fast-moving pandemic. .
Lisa Macon Harrison, the agency’s medical director, said her nurses’ contact tracing process requires manual entry of case information into five data systems. One is decades old and complex. Another is made using an Excel spreadsheet. No system works well together or with systems at other levels of government.
“We used a lot of resources to put so much data into multiple systems that didn’t necessarily scale to communicate with each other or with the federal government,” says Harrison.
Poor interfaces between systems mean that employees often lack a deep understanding of what is happening elsewhere in the state and beyond. Harrison said employees rely on “watching the news every morning to get the latest and greatest updates from other levels of government.”
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The pandemic has killed more than 1 million Americans, highlighting the inefficient data infrastructure in the US health system, in a country home to some of the world’s most influential tech companies: Coronavirus case reports sent by fax. Complex technology to monitor vaccine distribution – and huge gaps in tracking who’s been vaccinated. State data is out of sync with federal data. Supply chain failures leave healthcare providers without the necessary protective equipment.
And Congress knew about the possibility of these problems long before covid. Lawmakers asked the Department of Health and Human Services to better integrate U.S. data management systems to allow stakeholders to better share information years ago, in 2006. — long before the pandemic.
Public health officials, data experts and government auditors say the problems caused by this communication error could be mitigated if federal health officials followed the order.
They said there were many reasons why the system was never created: complexity of the task and insufficient funding; the federal priority approach to health deprives state and local agencies of resources; project ownership in HHS is not clear; insufficient enforcement mechanisms to hold federal officials accountable; and little agreement on what data is even needed in an emergency.
And today, even after the lessons of the pandemic, experts fear that the ideal remains a distant dream given the number of stakeholders, lack of federal leadership and a divided Congress. turn.
Soumi Saha, senior vice president of government affairs at Premier. The technology and supply chain company works with hundreds of thousands of healthcare providers and contracts with federal health agencies.
The All Hazards and Pandemic Preparedness Act of 2006 charged federal officials with creating a system to track emerging health threats.
The law gave HHS two years to build a “public health awareness” network to detect and respond to “potentially catastrophic infectious disease outbreaks and emergencies.” other public health issues originating at home or abroad”.
Congress re-authorised the law in 2013 and gave HHS two more years to build up the network. The law was updated in 2019 to become the Pandemic and All-Threat Innovations and Pandemic Preparedness Act, again calling on HHS to build the network — and check progress in three years.
According to a report from the US Government Accountability Office released in June, HHS has yet to create a network or develop a roadmap for doing so.
Report author Jennifer Franks, director of information technology and cybersecurity at the GAO, said: “Three laws below, they don’t take any penalties.
Franks said agency leadership never even figured out which executive department would take the lead, so no one did.
Capabilities include the Centers for Disease Control and Prevention, which already manages several health threat monitoring systems, and the Strategic Preparedness and Response Administration. ASPR was established as the Office of the Assistant Secretary of Preparedness and Response in 2006; it was upgraded last year to an executive division, putting it on par with the CDC.
Lauren Knieser, who worked at ASPR under the Obama and Trump administrations, says combining public and private data systems into a single national system is a colossal task even It is even more difficult without a single vision of what the network will look like. She currently runs emergency preparedness and response programs at PointClickCare, an IT company that processes data for hospitals, aged care facilities, and government agencies.
“If you ask 10 people, you will probably get 10 different answers, because there is no consensus,” says Knieser.
In addition, different hospitals often use different electronic health record systems, so it is often not possible to share patient data with each other, much less with the federal government.
Federal officials should start by deciding what data they want in an emergency, Knieser says, and then figure out the tools they already have — and the tools they need — to collect and share. that data.
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The White House should run the effort, she said, because it requires so many parts of the government to “play nice with each other.”
The aggregate spending bill passed in late 2022 established the Office of Pandemic Preparedness and Response Policy, a new center of power in the executive branch that could begin operations.
But state and local public health officials are wary of top-down solutions, even as they acknowledge holes in the nation’s health data system.
Karen Landers, chief medical officer of the Alabama Department of Public Health, said the sudden directive in late 2020 to use a new tracking system specifically for the covid vaccine could make her department sick. it slows down.
Her state already uses the CDC’s Vaccine Tracking System to manage vaccine supply and “probably would be more effective” if they continued to use it.
“We needed a little more local input to say, ‘Hey, you know, I think this is actually going to work better. If you want us to use the system, we will, but don’t do it in the middle of a pandemic,” Landers said.
Lori Tremmel Freeman, Executive Director of the National Association of County and City Health Officials, said local health officials have even more difficulty with the system.
They only have access through government channels, she said, and “as a result, it’s not easy for them to see where vaccines are going in their communities, even with partners outside the agency.” public health.”
Officials say that means more work for local health authorities, making it much harder to make quick decisions.
When contacted for comment, ASPR officials first directed KHN to CDC. CDC officials directed KHN to HHS.
HHS told KHN it is “committed to protecting the nation’s public health and is working to update the GAO on our progress and will have more information to share publicly in the near future.”
HHS also told the auditors that they were “working to increase the public health awareness network by defining roles and responsibilities” to ultimately create the preparedness system that has already been established. long awaited.
But there could be a major roadblock to HHS’s efforts: Much of the 2019 bill that mandates the creation of a data-sharing network expires in September, and a reauthorization of the law could be a big deal. challenge in a divided Congress where House Republicans have announced their intention to test the US response to the pandemic.
“Congress now has the opportunity to build the public health system,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “What are they doing? Undermining public health legislation, smearing public health officials. We’ve learned almost nothing.”
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
