How Public Health Data Reporting Automation Supports Patient-Centered Care

When done manually, public health data reporting can take up a significant chunk of time. Dialysis clinics in a federal COVID-19 vaccine program have experienced that first-hand.

Once vaccines arrive at the clinics, providers administer them and document COVID-19 vaccination in the EHR. However, the responsibility of the network administrators doesn’t end there.

Every week, care organizations in the program must report aggregated facility-level vaccination and infection data for patients and healthcare personnel to CDC's National Healthcare Safety Network (NHSN). The network administrators must also report COVID-19 vaccine inventory each business day through various CDC platforms.

“If a clinic had one full-time employee doing nothing else but data entry and tallying of the data, it would take them about eight hours,” Emel Hamilton, vice president of government reporting and clinical informatics at Fresenius Medical Care North America, one of the vaccine program’s partner organizations, told EHRIntelligence in an interview.

To streamline efficiencies and give providers more time to deliver patient-centered care, Fresenius automated the public health data reporting.

"We submit and upload the data electronically," she explained. "It's extracted on the back end from various clinical and inventory management systems. We then apply special logic and massage the data to what CDC needs, and it's uploaded into the appropriate systems."

"It's a huge amount of savings when you look at 2,700 clinics across the nation for Fresenius Clinics," said Hamilton. "The electronic data submission and extraction has helped us meet these obligations readily."

Hamilton explained that facility-level data from network administrators allows CDC to calculate vaccination and infection rates, but it's not the government's only source.

"The federal government collects data through multiple surveillance systems and can use this data to improve care," she said. "On the back end, they can integrate and use big data to identify, mitigate, and address various public health threats."

For COVID-19 specifically, the government can look at information regarding hospitalizations, mortality rates, active cases, breakthrough cases, and comorbid conditions and then "slice and dice" the data to identify the impact of race, ethnicity, age, gender, and other social determinants of health.

Hamilton noted that big data can help stakeholders understand which patients develop serious illnesses and which populations are most susceptible to the virus.

Further, the government can layer geographic information on top of COVID-19 data to identify hotspots so it can launch appropriate mitigation strategies to address those individual circumstances.

Big data has other applications in healthcare, Hamilton pointed out. Healthcare professionals can used big data to address public health strategies for groups susceptible to health disparities, such as those with end-stage kidney disease (ESKD).

"More than half a million Americans diagnosed with end-stage kidney disease receive life-sustaining dialysis care," she said. "Due to underlying conditions that may compromise their immune systems, these patients are often at higher risk for COVID-19 infections. Once infected with COVID-19, they have a 50 percent hospitalization rate and 20 to 30 percent mortality rate."

"More than half of dialysis patients identify as ethnic minorities, and most of them are older patients," Hamilton added. "Because of these demographics around end-stage kidney disease, the situation also becomes a matter of health equity."

She noted that with rapid developments of various treatments and vaccines to combat COVID-19, stakeholders need to understand which ones are most effective at preventing severe disease in the ESKD population.

"It's really important to have access to aggregate data to study how COVID-19 risk can be mitigated in dialysis patients," Hamilton said.

Aggregate data from the federal dialysis partnership program provided deeper insights related to race and ethnicity.

Within three months of the program's inception, vaccination coverage among Asian and Hispanic patients exceeded that of White patients. Additionally, even though vaccination coverage among African American patients remained about two percent lower than White patients, African American patients' vaccination coverage jumped by nearly 18 percentage points from the baseline within three months.

"Not only was the Federal Dialysis partnership associated with a higher number of vaccines administered at dialysis clinics, but it also narrowed racial and ethnic disparities in vaccinations," Hamilton said.

"I anticipate that these types of insights that data brings forward will pave the wave for future national preparedness plans and perhaps prompt public health agencies and other policymakers to prioritize dialysis centers for federal vaccine allocations or onsite vaccine administrations," she continued.

While big data is valuable in informing current and future vaccination programs, Hamilton pointed out that it's equally important to focus on the other dimension of information sharing—patient-centered care.

Although federal and state regulations require reporting of COVID 19 data through their systems, individual health records remain siloed in many organizations' EHRs, Hamilton said.

To ensure COVID-19 data is available across the care continuum, Fresenius added COVID-19 vaccination and infection information to its continuity of care document and leveraged its existing health information exchange (HIE) connection

Fresenius is connected to the nation's largest interoperability framework, Carequality, through CommonWell Health Alliance.

"The connection through CommonWell allows Fresenius to share important COVID-19 information where and when it is needed," Hamilton said.

"For those patients who have consented to share their data through HIE, it means their key healthcare information is available near real-time to the participating providers so patient care team members can deliver the best care, avoid unnecessary duplicate immunizations, and ultimately save lives," she emphasized.

Hamilton noted that the COVID-19 pandemic has underlined the importance of interoperability in the healthcare industry.

"The recent pandemic experience disrupted the traditional internally focused ways healthcare organizations look at data," she said. "Instead, it highlighted the importance of interoperability information sharing, and a collaborative approach to solving public health problems."

"It's extremely important that we continue to champion collaboration in the healthcare industry and aggregate data to inform clinical care, epidemiological studies, and analytics insights that will help us better cope with ongoing challenges or similar crises that might arise in the future," Hamilton said.