COVID-19 Public Health Data Systems Reveal Interoperability Gaps

ONC’s Health Information Technology Advisory Committee (HITAC) recently held an expert panel hearing to investigate interoperability and public health data system performance during COVID-19.

In an ONC blogpost, Aaron Miri, MBA, FCHIME, FHIMSS, CHCIO and Denise Webb, MA, outlined several key takeaways from the hearing.

Dan Jernigan, MD, MPH, CDC deputy director for public health science and surveillance, gave opening remarks that highlighted the CDC’s sustainable approach to improve public health data systems in the long term, not just for pandemic relief efforts.

Tom Frieden, MD, MPH, president and CEO of Resolve to Save Lives and former CDC director, stated that an effective public health emergency response involves learning, adjusting, and adapting as the industry moves along.

In preparation for future public health disasters, healthcare professionals on every level will need to work together, Frieden explained. He noted pre-existing weaknesses of the public health ecosystem, including interoperability gaps between federal, state, and local public health departments.

To close these interoperability gaps, the industry must build systems that can be ramped up to seamlessly meet the needs of a public health emergency, Mark McClellan, MD, PhD, of the Duke Robert J. Margolis Center for Health Policy said.

“Our data systems have not been consistently connected or integrated across public health and healthcare,” he explained.

Linda Rae Murray, MD, MPH, an assistant professor at the University of Illinois School of Public Health, emphasized that policy and organizational roadblocks to seamless patient data exchange contribute to health inequities.

Information from economic systems, political systems, and faith-based systems could be integrated into public health data systems to give a more complete picture of individual and population level health, she noted.

“Issues we face around data systems are political science problems, not computer science problems,” added Michael Fraser, PhD, CEO of the Association of State and Territorial Health Officials.

Panelists also called on HITAC to promote partnerships across all sectors. President Biden’s recent Executive Order on Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats emphasizes on the importance of collecting and sharing COVID-19 data with state, local, tribal, and territorial authorities.

According to Karen DeSalvo, MD, MPH, MSc, chief health officer for Google Health and former national coordinator for health IT, addressing interoperability deficiencies requires a 21st century public health infrastructure. She emphasized the importance of open standards, not proprietary ones.

Panelists pointed out specific concerns regarding how outdated technology practices lead to interoperability issues during COVID-19.

In particular, Joneigh Khaldun, MD, brought up the issue of widespread spreadsheet use for information gathering at the height of the pandemic. In Michigan, data processing capabilities were “outdated” and had to be rebuilt while managing the response.

“New innovations and improved demographic data capture, especially for marginalized and underserved communities, that is integrated into public health data systems will be key to responding to the pandemic and future health inequities,” Mimi and Webb noted in the summary blog post.

Application programming interfaces (APIs), artificial intelligence, and cloud computing technology are set to bring the industry into its next digital iteration, the authors concluded.

“The 21st Century Cures Act and the information sharing provisions in ONC’s Cures Act Final Rule have enabled the first steps to making data available across the healthcare system,” Miri and Webb wrote. “Health IT developers, policy makers, providers, and patients will be able to securely access their information with the broader adoption of standardized APIs.”