We have been watching the statistics for greater than weeks now. We watch with a way of disbelief, horror, sorrow, hope, disgust, and impatience. We hear about the variety of exams carried out, optimistic exams, adverse exams, confirmed circumstances, variety of people who’ve recovered, and deaths. We have heard new phrases like social distancing, flattening the curve and second wave. We hear statistics from the Centers for Disease Control, Johns Hopkins, our state public health departments and the World Health Organization.
We additionally hear what we should do to defeat the virus. The “weapons” in accordance to famend infectious illness specialist Jim Yong Kim, considered one of the founders in Partners in Health are described in his current article in the New Yorker. The 5 weapons to fight this, and any pandemic, are social distancing, testing, contact tracing, isolation and coverings. But considered one of the weapons I believe that he missed is correct, well timed data.
How can we all know if social distancing is working, when it may be relaxed, the actual variety of contaminated people, and the way to contact hint, or who to isolate or deal with if we would not have correct and well timed take a look at outcomes and diagnoses? To defend health care suppliers, it’s vitally essential to know if somebody who walks into their clinic has ever examined optimistic for COVID-19 at the emergency room, an area hospital, and even at a drive via testing website.
You could also be shocked to study that though almost all hospitals and medical doctors use digital programs of their services, until these suppliers select to join to a health community akin to a health info exchange, that info isn’t routinely shared. They could have one or two connections to different suppliers, however the data isn’t shared with all suppliers who deal with that affected person. You may additionally be stunned to hear that the data collected for all the public health statistics, like lab outcomes, are not shared with all the affected person’s medical doctors or despatched to the health info exchange.
To perceive how we may enhance doctor entry to correct and well timed data we must always describe health info exchanges. HealtHIE Nevada is the non-public non-profit know-how group that runs the state-wide health info exchange in Nevada – a extremely safe and personal community that addresses the hole of sharing medical info that presently exists between hospitals, physician’s places of work, nursing houses, laboratories, imaging facilities and all different health care organizations on sufferers that they’ve in widespread.
Think of an HIE as a kind of health care public utility. For instance, in case you have been just lately admitted to an area hospital with a analysis of COVID-19? After you get better and through your discharge you’ll be instructed by hospital employees to get one other X-ray at the imaging heart and schedule a observe up go to together with your major care supplier.
If the hospital, imaging heart, and first care supplier have been all linked to an HIE then while you went to your observe up go to together with your PCP the lab outcomes, medicines, and physician notes out of your hospital keep plus your X-ray could be available to your PCP. Access to all this info improves the high quality of care, ensures that medicines are correct, and reduces the likelihood that the PCP would wish to repeat exams thus saving you cash on deductibles and copays.
So why aren’t all hospitals, physician’s places of work and all different health care organizations in the state linked to the HIE? And why aren’t the public health community and the HIE linked? The reply lies in state and federal laws, public coverage, and the approach we pay for health care.
Except for a handful of states, laws don’t require suppliers, hospitals, and different medical services to share data with their statewide HIE community. Some of those services enable medical doctors who are not affiliated with their group to entry their data, however these are singular connections from one facility to one other and both require the supplier to login to a portal or solely share data between the two services; hardly a community of all suppliers.
The approach we pay for health care additionally creates barriers to sharing data amongst suppliers who are treating a affected person. Most health care organizations are nonetheless paid solely once they carry out a service for the affected person. They are not reimbursed to share their data with different suppliers, and thus they’ve little incentive to share data. Even although virtually all suppliers have digital health data programs, their distributors cost them an extra payment to develop the software program interface to ship data to the HIE.
This payment could be vital, typically round $5000 or extra. Plus, to maintain our HIE we additionally cost suppliers a subscription payment of $25 per supplier monthly. While the clear majority of suppliers need to do the proper factor and share medical data, the paradox they face is that once they pay to share their info, the worth accrues to another person. They will solely derive worth themselves if everybody else additionally pays to share their data.
At the federal degree, laws have created a community for public health referred to as the National Notifiable Diseases Surveillance System, or NNDSS. This system, coupled with laws from the Centers for Disease Control require that suppliers, hospitals, and labs ship data to their state or native health departments. Even although it’s not necessary, all states ship medical info and lab outcomes for notifiable ailments and circumstances on to the CDC for public health reporting and evaluation.
The CDC maintains an inventory of those notifiable ailments and circumstances and revises it periodically. While this method is essential to public health, it has been designed to be a “non-public community” with a restricted scope of what it collects. This system doesn’t share data with the whole medical neighborhood. If a health care provider orders a COVID-19 lab take a look at on considered one of their sufferers, the physician would get the lab consequence and it could be despatched to the NNDSS system. But if that affected person later developed worsening signs and ended up in the emergency room, these medical doctors wouldn’t have entry to the lab outcomes until each the authentic supplier and hospital have been linked to the HIE.
And the data received’t be collected by NNDSS until the illness or lab take a look at is on the notifiable record upfront. Because COVID-19 was novel (model new) it was not a notifiable illness, so data weren’t collected by NNDSS till the outbreak was properly underway. Both points may very well be prevented if the data first have been despatched by the lab into the HIE, making this data accessible to all treating suppliers after which to the NNDSS system.
Out of this disaster we’ll seemingly see extra funding for public health, medical readiness, stockpiling of non-public protecting gear and different measures to help our brave front-line health care employees and our public health system. All of those are essential areas that we should fund as a nation.
But we should additionally change our pondering that typically views public health as separate from the remainder of our healthcare system. Local and state governments and the federal authorities have created this silo of health data, however the info in that silo isn’t linked to the higher healthcare system via our statewide HIE. If this was to happen, then treating suppliers would have entry to COVID-19 take a look at outcomes and a lot extra info to present wanted care quicker. If new investments in public health simply create larger and higher silos of knowledge we could have missed the mark on actually bettering our healthcare system.
Instead let’s put money into an interoperable health data system that connects all suppliers, hospitals, nursing houses, insurance coverage firms, state and native governments, public health, and sufferers who want entry to medical data. Let’s create public coverage that requires that all healthcare suppliers, labs, imaging facilities, and all different healthcare organizations ship their data to our state-wide health info exchange system so that it may be securely shared with these suppliers who want it. And by all means let’s fund that system so when the subsequent medical disaster happens we could have data prepared to fight the disaster.
Michael L. Gagnon, is government director of HealtHIE Nevada, its statewide health info exchange. He is the former chief know-how officer of Vermont Information Technology Leaders, the state HIE in Vermont. Michael additionally serves as the Chair of the Western Member Council of the Strategic HIE Collaborative’s Patient Centered Data Home initiative.