How to Boost Data Exchange Infrastructure, Public Health Reporting

COVID-19 highlighted weaknesses in national data exchange infrastructure for public health reporting; primary care extensions could help the nation tackle COVID-19 and prepare for future emergencies, according to a recent Health Affairs blog post.

The post, written by Deborah J. Cohen, PhD, and Shannon M. Sweeney, PhD, MPH, of the Department of Family Medicine at Oregon Health and Science University (OHSU), particularly focused on the holes in data exchange infrastructure that beleaguered COVID-19 response.

In 2009, Kevin Grumbach, MD and James Mold, MD, MPH proposed the Healthcare Cooperative Extension which suggested that the government support and sustain small primary care practices through regional extensions. While the idea was included in statutory form in the Affordable Care Act, it never received funding.

In 2015, the Agency for Healthcare Research and Quality (AHRQ) funded EvidenceNOW, an initiative that aimed to implement patient-centered outcomes research around cardiovascular care. The $112 million project enabled seven grantees to implement regional extensions.

Overall, 160 extension agents, including practice facilitators, worked with 1,720 practices to support quality improvement efforts.

Cohen and Sweeney observed the EvidenceNow initiative over the past six years as part of the Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES) grant.

“We have watched teams build relationships among academic medical centers and practices, public health departments, and local community resources,” they wrote. “We have witnessed these extensions quickly build infrastructure to hire, train, and support agents to implement research translation and clinical quality improvements.”

The extension agents helped healthcare organizations in a variety of quality improvement efforts, Cohen and Sweeney noted.

In North Carolina, extension agents helped healthcare organizations connect to the state health information exchange (HIE). They also helped state leaders improve the data available to clinical organizations through the HIE, Cohen and Sweeney added.

Practice facilitators in New York City created patient education materials in dozens of languages for clinicians to have in their offices to boost heart health education.

In Oklahoma, the healthcare extension increased primary care practices’ awareness of, and access to, health-related resources. The extension grew to connect statewide public health organizations, local community organizations, and medical organizations.

“By supporting a network of relationships among primary care practices, academic health centers, public health agencies, and community resources, Health Care Cooperative Extensions create learning communities that share best practices and problem-solving strategies affecting the health of their communities,” Cohen and Sweeney explained.

“With the rising recognition of the need to renew essential US infrastructure, this statute could provide resources to meet the needs of both rural and urban medically underserved communities in each state,” Cohen and Sweeney wrote.

They hypothesized that if this extension infrastructure had been in place at the start of the COVID-19, the nation would have been able to address the pandemic more nimbly.

“Cooperative extensions would provide early surveillance, contact tracing, and trustworthy information on the basis of on-the-ground existing trusting relationships and central information sources,” they wrote. “They would guide acquisition and coordination of PPE, foster best practices, share learning, and aid in rapid ramp-up of telemedicine.”

“They would deploy and coordinate testing and then vaccination, rather than having to build crude new centralized infrastructures,” they continued.

Health Care Cooperative Extension is a much-needed data exchange infrastructure and could be a catalyst for change, Cohen and Sweeney expressed.

They also noted that the National Academy of Medicine has suggested the Healthcare Cooperative Extension infrastructure as a way to strengthen public health reporting for national emergencies.

“Health Care Cooperative Extension has been demonstrated to be a path toward a primary care and public health system capable of responding to future crises—and the everyday needs of communities—in a more coordinated, accessible, personal, and equitable manner,” Cohen and Sweeney wrote. “By funding the Health Care Cooperative Extension, we can live this experience instead of imagining it. Let’s act now.”