Quick pivot to new HHS COVID-19 reporting rules meant 'chaos' for hospitals
A flurry of controversy erupted this past week following the publicization of a Trump administration directive to hospitals to bypass the Centers for Disease Control and Prevention when reporting COVID-19 patient data.
Public health experts and industry groups have expressed concerns that the process, which gives the reins to the U.S. Department of Health and Human Services, would lead to politicization of vital real-time information.
Last Wednesday, HHS and CDC held a joint press call in which they described their hopes for transparency and flexibility under the system. The American Hospital Association has told its members to report the information to HHS as requested, emphasizing that "the daily reporting is the only mechanism used for the distribution calculations" of remdesivir or any other treatments or supplies.
In other words, although reporting is technically voluntary, doing so will be vital in the future for health systems' access to COVID-19 resources.
But many hospitals on the ground describe a frantic rush to pivot, sometimes with only days' notice, to the new data-reporting requirement.
"We're moving away from the chaos induced by the transition," said Dave Dillon, vice president of media and public relations at the Missouri Hospital Association.
"Normally what you would expect is an onboarding period," Dillon said. "They'd do webinars to explain how to use the tools most effectively. It wouldn't be guidance issued on a Monday with a turnaround by Wednesday."
New data requirements
Per the new guidance, hospitals can report data to HHS in one of several ways. They can publish it to their website in a standardized format; they can ask their health IT vendor or other third party to share information directly with HHS; or they can submit data through the HHS Protect TeleTracking portal.
They can also submit data to the state for submission on their behalf, if the state has received written federal approval to do so.
In practice, this means the switch has looked dramatically different for hospitals around the country. Some, in states such as New Mexico, already reported their data to the state department of health to pass along.
"We've been fortunate to have a good working relationship with our department of health," said Jeff Dye, president and CEO of the New Mexico Hospital Association. "For some time, we've been reporting [our data] through EMResource, which is a state requirement."
The new reporting requirements include dozens of additional data elements, which means existing systems still have to be modified.
"With this new reporting process the state had to get some approval from the federal government, but we understand that the final certification hasn't been given yet," said Dye. In the intervening week, hospitals have had to report their data both to their state department of health and to HHS.
"We're thankful and grateful that the Department of Health has EMResource to begin with and is … maximizing the usefulness of that," he said. "We're a small association and wouldn't have been able to stand up that reporting process on behalf of our members."
Similarly, "Tennessee hospitals report on a daily basis to the Tennessee Department of Health, and the Tennessee Department of Health in turn submits the data to HHS," said Kelly Insana, VP of marketing and communications at the Tennessee Hospital Association.
"So the only change we will experience is that Tennessee hospitals will be reporting some additional data elements which are newly required by HHS," she said.
And in Florida, as of July 17, the state Agency for Health Care Administration had updated its online reporting system to incorporate the new data fields.
"AHCA sends the information from Florida’s hospitals daily to HHS Protect, thus reducing the need for double reporting," said Crystal Stickle, interim president of the Florida Hospital Association.
"Normally, what you would expect is an onboarding period. They'd do webinars to explain how to use the tools most effectively. It wouldn't be guidance issued on a Monday with a turnaround by Wednesday."
Dave Dillon, Missouri Hospital Association
Other associations said their state department of health reporting practices would not be enough to satisfy the mandates of the new system.
"Maryland hospitals will need to duplicate daily reporting and report a greater amount of data each day. Before the change, Maryland hospitals reported to the state daily, and then the Maryland Department of Health repackaged the data to meet federal requirements and submitted to the CDC’s National Healthcare Safety Network," explained Bob Atlas, president and CEO of the Maryland Hospital Association.
"Occasionally, Maryland hospitals would need to attest to specific data points in order to access federal funding or the drug remdesivir, but that included [six] data elements or fewer," he said. "Now, Maryland hospitals will have to report daily data to the state and satisfy the new daily HHS requirements, which are more than double the state’s demand."
"These changes will significantly alter the reporting process, as the state will not be able to align the EMResource data collection with what HHS has requested," agreed Colorado Hospital Association director of communications Cara Welch. "Hospitals will have to enter duplicate data on a regular basis."
She said Colorado hospitals "were notified of the change to the reporting requirements on July 13, with the first data for the priority fields due on July 15" – a turnaround time that was frequently cited by hospital associations.
Still others said they were hoping for their state departments of health to shoulder some of the load.
"The fact that our hospitals are having to report separately to both the state and federal governments is an administrative burden," said Becky Schnur, director of communications for the Maine Hospital Association. "We’re hoping that the state of Maine will assume responsibility to the U.S. Department of Health and Human Services."
"In our case, Idaho had not been certified for our resource-tracking system," explained Brian Whitlock, president and CEO of the Idaho Hospital Association. "So the state at this point could not upload all the data."
"The reasoning and the justification for why HHS changed platforms and what they would ultimately like to get from TeleTracking – all of that makes perfect sense," Whitlock continued. "The challenge is implementing all of that in such a short time frame."
Some health systems have faced steep increases in the sheer amount of time it takes to upload the data each day.
In New York, "hospitals have needed to rewrite queries, carefully analyze the data pulls and expand the list of data elements that they are submitting to comply with the new questions and format," said Janae Quackenbush, director of public affairs and media relations at the Healthcare Association of New York State.
"Some hospitals have invested in the development of data scripts to mine data from several resources, such as materials management, lab, pharmacy, electronic health records, and admission and discharge systems, and then convert these reports into the required file format for submission," said Quackenbush. "Others manually enter data into spreadsheets to meet the reporting requirements."
She added: "It can take multiple hours daily for each portal to which data is submitted."
"The fact that our hospitals are having to report separately to both the state and federal governments is an administrative burden."
Becky Schnur, Maine Hospital Association
"Hospitals are compiling data from various information systems, including their electronic medical records, but it varies from hospital to hospital," explained Jim Lee, Michigan Health and Hospital Association vice president of data policy and analytics. "Some may use analytic and reporting tools, while others are simply using Excel spreadsheets to compile the information."
"As for time, we haven’t had a chance to conduct a detailed review of the work required by hospitals. Anecdotally, one health system has spent over three business days reworking their data extraction and integration process to meet the new HHS data requirements," Lee said.
Several associations pointed to the fact that TeleTracking doesn't currently support backdating – meaning that a person needs to be tasked with entering information on Saturdays and Sundays too.
This can be a particular challenge for rural or smaller hospitals, particularly those that don't have any COVID-19 cases.
"We have a lot of frontier facilities, [in areas with] fewer than six people per square mile," said Rich Rasmussen, president and CEO of the Montana Hospital Association. "Does it make prudent sense for them to fill out a system that might have as many as 100 questions, if they have no incidents in their county?"
"Many of the hospitals in Nebraska are rural, with just enough staffing to cover their patient needs," said Nebraska Hospital Association Vice President of Quality and Data Margaret Woeppel.
"COVID required reporting has changed numerous times since March both on a national and state level. Our hospitals are feeling both the burden of reporting and also keeping up with the ever-changing requirements," she said.
Anna Adams, vice president of government relations at the Georgia Hospital Association, said member hospitals have encountered technical snags with the new portal.
"One of the problems that I do know they're having is the HHS – and whoever's in charge of sending out the TeleTracking information – they have the email for one person [at the hospital] who may not be doing the data tracking for that facility, and then it's impossible to have it reset," she said.
"All of this is taking the very valuable and precious resources" needed to fight COVID-19, she said – especially vital at a time when cases are spiking in the Sun Belt.
Multiple associations described hospitals sending reports to HHS, only to receive messages that their data was still outstanding.
An HHS spokesperson said that a few states had reported similar technical difficulties, but the agency had found that the error was on the part of the state or the third-party vendor it had contracted with.
Hospital associations reported a mixed bag with regard to transparency and information access.
"The core issue for us is that it's left the state of Missouri basically in the dark for local data," said Dillon.
Although the situation with data access has started to improve, he said, "It's worth mentioning that as we moved toward this change we were approaching the number that would have met or exceeded the maximum hospitalization we'd seen during the virus."
"We went dark at the same time we were getting close to what our previous peak was," he continued.
"Moving from a known platform that all of the individuals could easily manipulate … has harmed our ability to have that situational awareness, certainly in the short term," Dillon said.
He also noted that the newly revealed HHS Coronavirus Data Hub appears to reflect inaccuracies as to which hospitals are being listed as without reports.
"While the portal is easy to use and to access historical data, hospitals’ ability to access and manipulate county-level and statewide data – and its ultimate impact on patient care – is unclear," said Sari Siegel, vice president for research at the Hospital and Healthsystem Association of Pennsylvania.
"We remain concerned that this will present a significant burden for smaller hospitals that do not have a robust capacity to enter data into multiple platforms," Siegel said.
"Because drug allocation, personal protective equipment, and funding decisions are made based on this data, accuracy and consistency is critical," said Kim Hoover, chief operating officer at the Mississippi Hospital Association. "To date, we have not seen consistency in state and federal COVID-19 data reporting."
Other associations, such as those in New York, Michigan and Idaho, said they did not anticipate a change in hospitals' ability to access information.
"It does not appear that the federal reporting change will in any way affect the COVID-19 data available to various stakeholders," said Jeff Tieman, president and CEO of the Vermont Association of Hospitals and Health Systems.
The 'new normal'
Virtually all of the hospital associations that spoke with Healthcare IT News said they were recommending members work to adhere to the new HHS requirements.
"Data sharing, especially in a pandemic, is very critical to ensure appropriate and effective preparedness and response planning occur," said John Palmer, director of media and public relations at the Ohio Hospital Association.
"This is a worn-out phrase: 'This is the new normal,'" said Dilllon, "We're going to need to effectively report into this system – not only to meet the requirements of the federal government, but to get back to the degree of situational awareness we need … [It] requires that we use this platform. We need to be adaptable and flexible and have the ability to change," said Whitlock.
"We have been thrown curveballs by coronavirus since March 13, when we had our first case," Whitlock continued. "Our little tiny hospitals and our large health systems keep swinging away, and I have to say that our on-base percentage is pretty high."
"This is just another curveball in the second inning," he concluded.
This month, we look at lessons from the COVID-19 pandemic on how data is put to work informing patient care decisions and population health.
Kat Jercich is senior editor of Healthcare IT News.
Healthcare IT News is a HIMSS Media publication.