OK Public Health Data Exchange Hindered COVID-19 Case Reporting

Oklahoma State Department of Health (OSDH) personnel had to manually enter COVID-19 case reporting data at the height of the pandemic due to antiquated public health data exchange infrastructure, according to reporting from Oklahoma’s KFOR News.

The time it took for OSDH officials to enter case reporting data reportedly slowed down contact tracing efforts.  

According to a February Oklahoma Legislative Office of Fiscal Transparency (LOFT) report, as new cases rose 205 percent, contact tracing reduced 65 percent.

Former state epidemiologist, Jared Taylor, DVM, MPH, PhD, DACVIM (LA), DACVP, told KFOR that OSDH’s systemic data exchange problems stemmed from the department’s outdated computer system, PHIDDO, or Public Health Investigation + Disease Detection of Oklahoma.

OSDH began using PHIDDO in the early 2000s. Taylor, who now serves as chief medical officer for the state, noted that the department was going to update its system going into 2020 before COVID-19 hit.

The flow of new COVID-19 cases during the pandemic’s first peak lead to computer crashes, KFOR reported.

Labs and healthcare providers faxed in test results, which required burdensome data entry processes, Taylor noted.

“When we got those flat files, when we got those faxes, when we got secure emails, we had our personnel going into PHIDDO entering the relevant data by hand, manually,” said Taylor.

Taylor said, one day in April, some 1,300 extra cases were announced that had fallen through the cracks in late 2020.

“We had some instances where those facilities simply were not reporting at all,” said Taylor.

A recent national Politico article noted that “state officials struggled to control the spread of COVID-19 because their outdated surveillance systems did not allow them to collect and analyze data in real-time.”

The Politico article noted that Oklahoma was not alone; dozens of other states had similar COVID-19 case reporting issues.

“Overall, I think it’s a fair characterization,” said Taylor. “We were struggling with technology. PHIDDO certainly was an extremely weak link. It was not set up to handle this volume.”

Jolianne Stone, MPH, state epidemiologist in Oklahoma, noted that after COVID-19 highlighted the state’s poor public health data exchange infrastructure, OSDH has rethought entire processes.

“Certainly, we have learned a lot of the last year,” Stone told KFOR. “We are driving change and we are updating our systems. We are doing everything that we can to ensure that we can stay ahead of this pandemic and even the next pandemic.”

Stone said that the department has overhauled computer systems with new Google health IT software. They have also pushed providers and labs to update case reporting practices, she added.

As the state sees an upswing in Delta variant cases, Taylor emphasized the importance of vaccine adherence and masking.

“We don’t need to have a system that can handle 4,000 or 6,000 new cases a day,” Taylor told KFOR.  “We need to avoid the situation where we have 4k or 6k cases a day. We need Oklahomans to do their part. We need them to get their vaccinations, practice social distancing, and wear a mask.”

Electronic case reporting (eCR) could help mitigate public health reporting issues.

A new FHIR application from Cerner streamlines case reporting through a cloud-based national information messaging platform, AIMS.

Developed by the Digital Bridge National Coalition and maintained by the Association of Public Health Laboratories (APHL), AIMS contains the decision support engine for trigger codes of more than a hundred conditions determined by the coalition, as well as the reporting requirements of all the state public health agencies.

If a patient is found to have evidence of one of the conditions, an Electronic Initial Case Report (eICR) document is created and sent to the AIMS platform. Then, with decision support, the platform decides if the data is reportable or not. If it is, the report is routed to appropriate public health agencies, and a reportability response goes back to the provider.

“Often, public health gets left behind the list of priorities, as does interoperability; things that benefit the greater good,” Harmon noted. “eCR will provide public health with much more complete, comprehensive, fast, electronic reports.”