Controversy: Researchers claim hospitals face barriers to public health data reporting

Dueling letters published this week in JAMIA take issue with the degree to which public health agencies are able to receive information electronically.
By Kat Jercich
02:23 PM
Healthcare worker in a mask at a screen

A research team from the Harvard Business School's Wyss House has doubled down on its findings from earlier this year that hospitals are perceiving public health agencies' ability to receive data as a barrier to effective electronic exchange.

"Regardless of whether that barrier is technical in nature or related to a socio-technical process such as data governance, public health agencies should be aware that nearly 40% of potential exchange partner hospitals view their ability to receive data electronically as a barrier to effective exchange," wrote the researchers in a letter published Thursday in the Journal of the American Medical Informatics Association.

The Wyss House team was responding to a challenge to its study, also published Thursday in JAMIA and put forth by Catherine J. Staes of the University of Utah College of Nursing and cosigned by James Jellison of the Public Health Informatics Institute, Mary Beth Kurilo of the American Immunization Registry Association, Rick Keller from the Altarum Institute's Center for Connected Health and Hadi Kharrazi from the Johns Hopkins School of Public Health.  

In that challenge Staes and her coauthors say that the Harvard team's study does not match the situation on the ground at public health agencies and that the authors had overgeneralized survey findings.  

"We are concerned the publication could lead to incorrect assumptions at a time when clinical and public health systems need to communicate more than ever and may discourage health care providers, leaders, and health IT vendors from engaging with public health agencies to avail themselves of existing data exchange capabilities," wrote Staes and others.   


The COVID-19 crisis has highlighted the need for hospitals and health systems to be able to seamlessly share information with public health agencies.

In the original study, published this May in JAMIA, the Harvard Business School researchers found that "more than four in 10 U.S. hospitals report that public health agencies are unable to receive electronic data."

"This finding may reflect the fact that substantial federal funding has been devoted to hospital information technology adoption, including the ability to send data electronically, without a concomitant investment in the ability of public health agencies to receive and act upon this data," researchers wrote in the May study.  

However, in 2018, "PHAs were able to receive electronic data," said Staes and her coauthors in the JAMIA letter, noting that "all relevant (50 states and 6 large cities, such as Los Angeles and New York City) PHAs were receiving laboratory data for electronic laboratory reporting."

Staes' letter continues, "In fact, these registries also provide data back to electronic health records and can report timely information about underimmunized populations at risk for outbreak."

Staes also argues that hospital CEOs, who responded to the American Hospital Association's annual survey question from which the Harvard Business School drew some of its conclusions, "may not be aware of their local and state PHA’s capacity to receive electronic health information, or even their own organization’s involvement with electronic reporting of lab results, immunizations, case reports or other data."

Staes and her coauthors refer to public health authorities' claims that health systems and providers are the ones that are reluctant to implement electronic reporting.

The Harvard Business School researchers, led by A. Jay Holmgren, say that Staes' letter raises important considerations. However, they say, their findings should not be interpreted as fault on the part of public health agencies or hospitals. Rather, they say, the likely roots of current challenges lie with federal incentive programs focusing almost entirely on healthcare delivery organizations.

"We suspect that, when citing barriers to public health receipt of data, hospitals are not referring specifically to the pure technical capability," they continue. 

"As with any interoperability effort, functional interoperability requires the technological capability to send and receive data alongside the nontechnical factors such as data governance, incentives to share electronically, a clear onboarding and testing process, and more," they say. "Surveys like the AHA IT Supplement shed some light on where the sticky points may lie but [aren't] able to home in on and separate one from another."  

Holmgren's team suggests that public health agencies and hospitals could publicly list their electronic exchange participants.  

"This may help both clinical and public health organizations better understand who is successfully sharing data, enable both parties to engage in peer learning and best practice dissemination, serve as an accountability mechanism for all parties, and allow researchers to differentiate between stated ability to send and receive data electronically and actual connectivity in practice," they write.  


Interoperability and patient data sharing have taken on a new urgency during COVID-19 – and the situation has been made more complex by recent maneuvers by the U.S. Department of Health and Human Services.   

In July, HHS threw reporting systems into "chaos" by directing hospitals, some with only a few days' notice, to bypass the CDC and report COVID-19 data directly to the agency. By August, many hospital associations told Healthcare IT News that they had successfully coordinated with their state departments of health to share that data – suggesting, as Staes writes, that synergy is possible. 

However, HHS threatened to upend the situation again this past week, reportedly planning to crack down on hospitals that did not fulfill reporting requirements while "moving the goalposts" of those requirements, as one association put it.  

"Complex and stringent data requirements, coupled with the feedback of inaccurate data and the lack of clear guidance, have set hospitals up to fail," said Missouri Hospital Association President and CEO Herb Kuhn in a letter to Centers for Medicare and Medicaid Services Administrator Seema Verma, shared with Healthcare IT News.


"There is no question that inadequate resources have been a limiting factor for public health agencies to receive data from health systems. This problem is exacerbated by the many-to-one (hospitals-to-public health agency) nature of population health activities, the variable nature of hospital data contributions, and the resources required to onboard and manage interfaces with multiple health systems," write Staes and her coauthors.

"We encourage clinical partners to work with public health agencies to improve surveillance of both clinical and public health outcomes and leverage information exchange to benefit communities. We recommend increasing support for public health agencies to enhance their ability to exchange (both receive and send) information while health care systems receive support to send data," Staes' letter continues.

On this, Holmgren's team agrees: "The current level of interoperability between hospitals and public health agencies is not at an ideal level, even under normal circumstances, and critical infrastructure gaps have been laid bare as a result of the COVID-19 pandemic."

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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