COVID-19 Proves Need for National Health IT Infrastructure

COVID-19 Proves Need for National Health IT Infrastructure

The spread of COVID-19 illustrates the need for a national health information technology infrastructure, according to an article published in JAMA.


To help curb the pandemic, health organizations and researchers need timely, accurate, and reliable health information.


Specific to the current case of coronavirus, researchers need to know how many individuals tested positive for COVID-19, demographic data from those individuals, the number of individuals who are seen at health facilities, how many were hospitalized and how they were taken care of, and the length of the hospital stay.


Vice President Mike Pence and the Centers for Medicare & Medicaid Services (CMS), requested hospitals report COVID-19 testing data directly to the US Department of Health and Human Services (HHS).


Since private and commercial laboratories already report their findings, Pence asked all hospitals that are performing “in-house” or onsite testing to report testing data to HHS each day.


However, because the reporting is optional and can be partially completed, the collected information is not entirely accurate.


This is why study authors, Dean F. Sittig, PhD and Hardeep Singh, MD, said the US needs a national health information technology infrastructure.


First, Sittig and Singh said the pandemic raises questions about healthcare in the US. Furthermore, the data the government needs can only be obtained through data collection, aggregation, and analysis.


“This comes with a price, in terms of financial considerations and trade-offs involving significant changes to the nation’s existing health information technology (IT) and legal infrastructure to gather and analyze data,” they wrote. “Most of these changes are technically possible but currently illegal or socially unacceptable.”


“Will the COVID-19 crisis change current expectations for privacy, confidentiality, continuous monitoring of individuals’ locations and activities, and strategic but focused government intervention?” they asked.


Next, the two experts touched on the need for a robust national health IT infrastructure. This need is especially apparent during public health emergencies, such as COVID-19.


“In 2001, an effort was made to design the National Health Information Infrastructure, a comprehensive, knowledge-based system capable of providing critical information to make sound decisions during emergencies,” they explained. “However, this vision was not fully operationalized. Such an infrastructure would involve a collection of interconnected health care nodes, with each node representing a health care organization using an electronic health record (EHR).”


Sittig and Singh noted that with more than 95 percent of hospitals currently utilizing EHRs, and the prevalence of both state and regional health information exchanges (HIEs), the ability to develop a nationwide data collection infrastructure is greater than ever before.


However, the authors said that there are many legal and social obstacles that the country must defeat before implementing this infrastructure.


Sittig and Singh explained how many HIEs are opt-in, and some health systems are resistant to joining an HIE due to concerns about losing patients and that revenue stream. These privacy concerns make it difficult for HIEs to gather data at a community level.


The lack of a national patient identifier, which would assign each citizen a unique number to be used across the healthcare system, leaves health organizations reliant on potentially unreliable patient information to find patient data.


Accessing and gathering accurate patient health information from every health organization would help manage a country-wide pandemic, such as COVID-19. However, individuals would need to trust the government with their data to make this happen.


“A national health IT infrastructure with a revised set of rules, regulations, and social norms could enable collection of real-time patient-level data from health care organizations across the US,” said Sittig and Singh.


“Currently, data from a limited number of anonymous individuals with internet-connected thermometers are being used to create a national map of ‘fever levels’ to look for trends, and cautious estimates are being made from the influenza surveillance system of the CDC,” they continued.


“Neither of these efforts are likely to be accurate and reliable COVID-19 illness–reporting systems.”


A national IT infrastructure would also be beneficial by:

  • Giving real-time information on a need for hospital resources, such as personal protective equipment and ventilators
  • Potentially identifying new or enhanced therapies based on facility-specific factor
  • Identifying hotspots and showing where social distancing should occur based on local, state, or regional data sets
  • Linking clinical data to cell phone-based location data, which would identify infected individuals and see where they were on a map
  • Proposing national surveillance system capabilities to curb the spread of the virus


Government officials might only utilize the most intrusive features during a national health crisis in an effort to maintain trust with constituents, explained the authors.


“With a sharp focus on maximizing benefits of scarce resources, treating everyone equally, and prioritizing efforts to save lives while maintaining trust and confidentiality, a national health IT infrastructure could meet the highest ethical standards,” Sittig and Singh concluded.


“It is time to make some difficult decisions and exploit and enhance existing technical capability to build and deploy these solutions. Given the severity and immediacy of the COVID-19 pandemic, the US should no longer rely on outdated laws, social norms, or potentially inaccurate modalities to obtain timely, accurate, and reliable health information essential to save lives.




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