The Duke-Margolis Center for Health Policy released short-term steps to improve data interoperability and exchange as states prepare to re-open.
The center convened multi-stakeholder working groups to identify feasible healthcare data interoperability recommendations during the COVID-19 pandemic. The expected surge in testing through point-of-care devices may further challenge reliable public health access to timely and complete information on laboratory-positive COVID-19 cases.
“Containment strategies across the country depend on effective collaboration of public health authorities with health care providers, laboratories, and community-based organizations to conduct testing, support effective contact tracing, quickly discern new patterns in health care use plausibly related to COVID-19, and identify ways to improve all of these activities over time,” the center noted.
Public health agencies must tackle the challenges associated with accessing critical data from participants in the containment efforts. The recommendations were guided by two key policies, including focusing on the next 30 to 90 days and use existing systems rather than build new systems.
Immediate need calls for immediate solutions, the center stressed. There are many time constraints and availability of substantial pre-existing infrastructure, so solutions must be implemented through existing systems to avoid the work that would be needed for new data flows.
As part of the COVID-19 containment effort recommendations, the center reported three immediate steps to ensure public health programs work more effectively for not only healthcare providers but clinical laboratories and healthcare partners as well.
The first recommendation is to improve commercial lab reporting. This means that contract tracing and electronic test reporting systems must be expanded to include demographic information. The standard reporting should include commercial laboratories, point-of-care testing manufacturers, and test implementers, the center said.
CMS and other payers should implement payment adjustments and incentives to allow the entities processing COVID-19 tests to receive and provide any missing information.
The second suggestion is to supplement case investigations with clinical data. State and local health officials should leverage their authority to define the necessary data for COVID-19 containment “use case” as a routine part of onboarding into data exchange.
“The trust framework governance entities that oversee secure data exchange should adopt policies necessary for universal responses to authorized public health queries, in a manner that is fully transparent to all participants and fully auditable,” experts said.
“State and local public health officials should evaluate and choose a portal-based connector as an “on-ramp” to access data, ensuring they meet key functional and security criteria.”
The third recommendation is to enhance use of the national syndromic surveillance program (NSSP). Federal, state, and local public health officials should agree on a set of protocols regarding which data from NSSP state “lockers” can be used for Federal surveillance and how the data can be leveraged effectively.
“The Federal Department of Health and Human Services Office of the National Coordinator for Health IT (HHS ONC) and the CDC should convene a joint working group with state, territorial, and local health officials and syndromic surveillance managers to conduct a focused review of the Syndromic Surveillance Messaging Guide and produce updated guidance for COVID-19 related syndromes,” the recommendation stated.
The center stressed that the revision should expand the use of the admission, discharge, and transfer (ADT) transactions for syndromic surveillance by encouraging activation of inpatient ADT feeds and sending of additional ADT message types. These messages include change of outpatient to an impatient, among various others.
“This Duke-Margolis resource on COVID-19 response policies is intended to inform and help guide policy makers addressing the evolving COVID-19 pandemic in the United States and around the globe, and will be updated as the pandemic and response capabilities change over time,” the center concluded.
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