Hospital Public Health Reporting Hiccups Common Before COVID-19

Just prior to COVID-19, 71 percent of hospitals experienced public health reporting challenges, according to a new ONC data brief that highlights flaws in the national data exchange infrastructure.

This information comes following a public health crisis that demonstrated the disastrous impacts of poor public health reporting and data exchange infrastructure. Public health reporting has always been hard, and the medical industry saw the consequences of that when COVID-19 broke out.

The brief analyzed nationally representative survey data from the 2019 American Hospital Association (AHA) Information Technology (IT) supplement.

Among public health reporting challenges, hospitals most commonly reported a lack of capacity to electronically exchange data (50 percent) and issues related to interfaces (40 percent).

Additionally, 17 percent of hospitals reported difficulties extracting relevant health information from their EHR system and 19 percent noted data exchange issues related to differing vocabulary standards.

The researchers found that these public health reporting challenges varied widely by geographic location.

For example, the percentage of hospitals experiencing interface-related issues spanned from seven percent in South Dakota to 94 percent in Utah. Additionally, hospitals in Wyoming, South Dakota, or North Dakota reported no data exchange issues related to differing vocabulary standards. On the other hand, 81 percent of hospitals in Arkansas reported data exchange issues related to differing vocabulary.

The data brief also revealed differences in data exchange challenges by hospital characteristics. For instance, small, independent, rural critical access hospitals were much more likely to experience difficulty extracting relevant information, interface related problems, and confusion about where to send data compared to large and urban hospitals. The authors noted that these findings are consistent with previous data briefs.

Adjusting for hospital characteristics, the ONC researchers found that hospitals participating in HIEs were less likely to report difficulties extracting relevant information from the EHR or not knowing where to send data.

“While it is possible that hospitals experiencing issues with data extraction and reporting were less likely to connect to HIEs, our findings suggest that HIE participation may be helpful in mitigating certain public health reporting challenges,” ONC officials noted.

“Studies have shown that HIEs can support hospitals and public health agencies by addressing gaps in missing information, supporting public health reporting and monitoring, and providing other data services to help enable exchange,” they continued.

In September 2020, ONC awarded funding through the Strengthening the Technical Advancement and Readiness of Public Health via Health Information Exchange Program (STAR HIE Program) to strengthen HIEs in support of public health reporting in communities disproportionately affected by COVID-19.

The program aimed to leverage HIEs to develop solutions that will equip public health agencies to respond to future and ongoing public health emergencies.

ONC officials noted that variation in the number or types of challenges reported by hospitals may reflect underlying differences in rates of electronic public health reporting. For instance, as more hospitals engage in electronic public health reporting, they may experience more challenges compared to hospitals that don’t engage in these activities.

In addition, this data brief only represents the perspective of hospitals. ONC officials suggested that future research should examine public health agencies’ perspectives on barriers to health information exchange.

“Understanding both hospitals’ and public health agencies’ experiences with sending and receiving public health data is critical to improving their ability to exchange,” the data brief authors wrote.

ONC officials also noted the need for future research on hospital capabilities to perform specific types of public health reporting, such as the processes in place to facilitate exchange with state, local, and federal public health agencies. This may help provide insights to inform the role of EHR developers, HIEs, and other entities involved in enhancing data exchange.

“Collectively, these insights can help identify and prioritize areas for improvement in public health reporting so that public health agencies are well-positioned to respond to future public health emergencies,” ONC officials concluded.