While the public health emergency in the U.S. will draw to a close in May, the pandemic remains far from over. Hospitals are set to continue reporting COVID-19 data until at least April 2024, though some aspects could sunset some of these reporting requirements sooner if health officials deem it appropriate.
"The end of the PHE does not mean the end of CDC’s emergency response to COVID-19. … CDC COVID-19 data activities are not necessarily affected by the PHE," a spokesperson from the agency told Becker's. The agency, "along with jurisdictional partners, is assessing ongoing surveillance needs and potential revisions to surveillance systems to efficiently continue tracking COVID-19 after the PHE ends and will share more information when available."
The extended reporting period for hospitals is intended to stretch insights into how the virus evolves as other public health emergency mechanisms end or shift. But reporting COVID-19 data on a national scale is something that has shown cracks since it was established. Hospitals, physicians and other officials criticized agencies such as the CDC for antiquated systems and processes that took more time than many had hoped to gain clarity into how the pandemic was evolving on U.S. soil.
Now that the nation has navigated one modern-day pandemic and with potential threats looming, leaders from the American Hospital Association and infectious disease physicians are discussing what could work better next time.
"At the beginning of the pandemic, there wasn't a great infrastructure for getting those data. It effectively had to be created as the pandemic was unfolding," Akin Demehin, senior director for quality and patient safety policy at the AHA, told Becker's. "So it is fair to say that the initial rollout of the reporting process was messy in a number of ways."
Unearthing the issues
At the beginning of the pandemic, the government and health officials across agencies had a vested interest in setting up reporting structures that would allow for more visibility into the virus's spread as it evolved to understand which regions were most affected, direct where supplies needed to be sent and to communicate with states.
Early on, the CDC set up a process through its reporting tool known as the National Healthcare Safety Network, which is used by hospitals to report infection data, Mr. Demehin said. In time there were requests to move away from that tool to one that was more robust, so HHS then asked hospitals to report data via a portal led by a company called TeleTracking. TeleTracking was contracted to help collect data through the HHS Protect Public Data Hub. Initially that system was used on a voluntary basis, but the AHA was aware of high numbers of hospitals participating. Then CMS and HHS made it a condition of participation that required hospitals to report data in this way, which is still the current system.
However, amid the shifts and pivots, there was overlap with the data that states and the federal government were asking for, and it required time to work through the de-duplication efforts, Mr. Demehin said. But redundancy of data was not the only issue hospitals faced in the early days of COVID reporting.
"One of the tough conversations we had to have early on was we were talking to our hospitals about whether they were reporting their data in, and they were telling us pretty uniformly — 99.9 percent of them — were saying, 'Absolutely, yes, we're reporting the data in, but it was not being received at the federal level,"' Nancy Foster, AHA’s vice president for quality and patient safety policy, told Becker's.
After several conversations with the agencies about where hospital data was coming from and how it was being reported up the chain, better mechanisms were put into place, she said. After the government looked further into some of the issues with missing data, it found that in some cases, local data collectors did not have the systems to properly transmit that information to the federal level.
"It was a very complicated, cumbersome process that had significant flaws," Ms. Foster said regarding sorting out the layers of information.
Getting a consistent picture of the data at local, state and federal levels took time and, ultimately, a lot of communication.
Understanding certain differences that hospitals were able to report versus what was being asked after switching to the TeleTracking system also caused difficulties for hospitals and physicians as they were navigating the crisis.
"When TeleTracking took over, they did not have a strong history in collecting this kind of data, so some of the data definitions were hugely problematic," Ms. Foster said. "For example, they were asking hospitals, 'How many beds do you have?' Well, that may sound like an easy question, but hospitals have all sorts of different ways to count beds. It required getting very specific about what they wanted and getting people to understand the complexities of hospitals and how they track data."
In response to the above, a TeleTracking spokesperson shared the following statement with Becker's: "From the beginning, the CDC was asking hospitals to report ‘available beds’ and TeleTracking was instrumental in educating leaders on the nuanced definition of bed types. Part of the value TeleTracking provided was in fact a robust understanding of hospital operations garnered over 32-years focused on bed management logistics and operational workflows in healthcare. TeleTracking also worked with the federal and state governments to harmonize their definitions of key data elements, to better normalize data reporting. HHS chose to extend the contract with TeleTracking in January 2022 for an additional 12 months based on the success of compiling and validating approximately one million distinct data points from over 6,000 hospitals, 3,000 therapeutic sites and multiple state agencies. More than 70 percent of the submissions being done through an automated channel, thereby streamlining the process for care locations and public health departments."
Achieving a consistent picture
Even when confusion and complexities were cleared up with hospitals, the "less-than-perfect" reporting systems in place presented other challenges for physicians.
Andrew Pavia, MD, chief of the division of pediatric infectious diseases for Salt Lake City-based University of Utah Health, told Becker's earlier this month that "one of the big issues that emerged was just being able to track bed availability" amid some of the larger COVID-19 surges.
"Hospitals were overwhelmed, and we had to on the fly develop a way of providing accurate daily information on where there were beds, where there were ICU beds and where there were staff to take care of people in those beds," Dr. Pavia said. "That system needs to be beefed up, and we need that on a national level to make local decisions."
Javeed Siddiqui, MD, infectious disease physician and chief medical officer at TeleMed2U, underscored Dr. Pavia's concerns, explaining that not enough of the right information was in place to really help physicians on the ground day to day.
"I think our public should demand better public health resources and availability than what we currently have," Dr. Siddiqui told Becker's. "There should absolutely be systems in place so that we know how many and where there are available beds in towns, regions and cities. We should know how many ventilators are available. We should have that type of important resource allocation information, and we just don't because we don't have a national system to do that. We really lack that leadership."
Both Drs. Siddiqui and Pavia worry that not enough focus is being placed on strengthening these mechanisms after the PHE ends and ahead of a possible future pandemic.
"I am concerned that our already less-than-perfect reporting system will decline further," Dr. Pavia said. "I'm also concerned that without standardization across states, we'll see some states turn off more reporting systems and provide less accurate data, so our picture of what's going on in the country as a whole will become even less accurate."
Faster, better, stronger systems — can the U.S. get there?
Another pandemic with similar strength and effects as COVID-19 is in the realm of probability, research has shown. As such, refining reporting efforts ahead of that should be prioritized, the experts who spoke with Becker's said.
Investing in technologies such as automation to improve these systems is something that could be key going forward — and tools like these could also free up hospital workers who were charged with reporting the data, so their attention could be back on day-to-day priorities amid the ongoing healthcare workforce shortage.
Automation is the biggest thing Mr. Demehin said would help ahead of another health crisis.
"Being able to automate aspects of the reporting could be enormously helpful," he said. "There are certain data that one could imagine you may be able to draw down from an electronic health record, an admission discharge or transfer system that's inside a hospital that instead of requiring the download into a spreadsheet, and then upload into a portal that we had to do during this pandemic."
Ms. Foster added that what will also be key for hospitals working with health officials is to identify what officials really need to know and build the data infrastructure to capture that on both a public health and an organizational level.
"I think we often talk about the need to modernize surveillance and the data reporting systems for public health, but it needs to be reiterated," Dr. Pavia said. "This is a real call to arms to really invest in improving it not just for COVID, but for all communicable diseases, so we're ready for the next emergency."
Ultimately, many of these improvements come down to funding and prioritizing certain areas of the healthcare system, which Dr. Siddiqui said is a troubling proposition.
"How much bigger do we need to have a global pandemic be to realize how important this is? If we don't see it now, I shudder to say I don't know what it will take for the world and for our country to recognize that we need to invest in public health," he said. "We have an opportunity — one that we've all almost missed for a number of reasons — but we still have an opportunity to continue to reinvest and grow our public health sector because that's what is going to help us in the future related to all types of infectious diseases."
Editor's note: This story was updated at 5:04 p.m. CT March 28 to include a statement from TeleTracking Technologies.