The Need for Modernizing Public Health Data in Responding to COVID-19

October 08, 2020 | Jeffrey Ekoma

Public health data collection and surveillance systems by health departments are in dire need of modernization. Though the public health community began developing a path to modernization over the last decade, attention to this issue from policy makers has sharply increased with the current response to the COVID-19 pandemic. Not only are current systems siloed, they rely on labor intensive processes to detect and facilitate a response to various public health threats.

A recent example of how public health data is used for decision making can be found from the latest announcement from the Department of Health and Human Services (HHS) and the Department of Defense to distribute 150 million rapid, Abbott BINAX NOW COVID-19 tests to states and territories through the end of the calendar year. This long-awaited release from the Trump Administration raised concerns from state and territorial health officials and epidemiologists about how data from the tests would be shared with state and territorial health departments, who use the tests to monitor the spread of the coronavirus within their respective jurisdictions.

Some challenges in some, but not all, health departments include:

  • Data collection and the processing of information submitted from states to the Centers for Disease Control and Prevention (CDC) are time consuming.
  • Urgent care data from emergency departments are not properly flagged and identified for emerging public health matters, such as the coronavirus.
  • Deaths caused by illnesses are not linked to other types of data (ex. clinical or medical examiner data) or case reporting systems.
  • Often, data are not sent to public health departments, who use the data for case investigations.

Just like the U.S. Census dictates representation in Congress and allocation of many federal resources, public health data can dictate allocation of federal resources for health threats. And, if data is delayed or inaccurate, it can impact how much of a drug will be allocated to a jurisdiction. A noteworthy example of this is the distribution of Gilead’s Remdesivir—a drug to treat COVID-19—to state and territorial health departments. Earlier in the response to the pandemic, Gilead donated vials of the drug to the federal government, who then subsequently provided the drugs to health departments. Specific allocations to health departments were based on each jurisdiction’s share of hospitalized COVID-19 patients, determined by data submitted into a new system managed by HHS (TeleTracking portal). This meant that any delays or inaccuracies in submitted data were also likely to impact a jurisdiction’s allocation of the drug at a time when there were very few therapeutic interventions available for treatment.

The House Science Subcommittee on Investigations and Oversight recently explored the use of data for decision making during the pandemic and future public health emergencies. Expert witnesses at the hearing discussed:

  • Concerns with the recent switch in data reporting from the CDC’s National Healthcare Safety Network to HHS’s TeleTracking portal.
  • The value in accurate, real-time public health data reporting.
  • The importance of public health surveillance to vital health intelligence.
  • The need for additional resources to compliment efforts to modernize data surveillance.

Janet Hamilton, the executive director of the Council of State and Territorial Epidemiologists (CSTE), highlights the “Data: Elemental to Health” campaign. The overall goal of the campaign is to secure $1 billion in new funding for public health surveillance, through support for the CDC, over a ten-year period. Although the campaign began prior to the emergence of the coronavirus, the need for an improved public health data infrastructure continues. Another report to note from CSTE is their white paper that seeks to make the case on the need for a “public health data superhighway” to detect and respond to global health challenges. Specifically, it calls for a shift from manual data sharing methods to the development of a core public health data infrastructure that can simplify an interoperable data exchange.

In recognition of this and through advocacy from public health stakeholders such as ASTHO, CSTE, Healthcare Information & Management Systems Society (HIMSS), National Association of County and City Health Officials (NACCHO), and National Association for Public Health Statistics and Information Systems (NAPHSIS) Congress provided $500 million in funding through the Coronavirus Aid, Relief, and Economic Security (CARES) Act for CDC’s Data Modernization Initiative. It’s important to note that this investment represents an enterprise level commitment and additional funding, on an annual basis, remains vital to ensuring that the CDC can formulate its data modernization initiative.

The COVID-19 pandemic has raised the stakes on the urgent need to improve our public health data collection and surveillance systems. Not only is this information significant to improving the overall health of our nation, its similarly important to advancing our nation’s response to the pandemic. Investments by Congress on this issue are important and represent a win for all public health advocates. However, there is a need for continued advocacy to ensure that funding is sustained over time. ASTHO will continue to monitor legislative activity and highlight the importance of modernizing our public health surveillance infrastructure.