White House to hospitals: Bypass CDC, report COVID-19 data directly to HHS
[Updated: This story has been updated to add input from an HHS spokesperson on hospitals' participation in the system.]
The Trump administration has directed hospitals to stop reporting COVID-19 data to the Centers for Disease Control and Prevention's National Healthcare Safety Network.
Instead, starting Wednesday, they have been told to send capacity and utilization information – including patient numbers, remdesivir inventory and bed and ventilator usage rates – to the U.S. Department of Health and Human Services through the new HHS Protect system.
On a press call Wednesday, CDC Director Dr. Robert R. Redfield said that the change had been made with the CDC's support.
"We at CDC know that the lifeblood of public health is data," said Redfield, adding that collecting and disseminating data "is our top priority and the reason for the change."
He emphasized: "No one is taking access or data away from the CDC."
Readfield noted that about 1,000 CDC experts will continue to have access to the raw data from hospitals. "This access is the same today as it was yesterday," he said.
The American Hospital Association, meanwhile, has told its members to report the information to HHS as requested.
In a special bulletin, AHA "strongly" urged hospitals to review the new processes and "report the data to HHS as requested."
AHA noted that "HHS stressed in the announcement the importance of reporting the requested data on a daily basis to inform the Administration’s ongoing response to the pandemic, including the allocation of supplies, treatments and other resources.
"In addition, the agency notes it will no longer ask for one-time requests for data to aid in the distribution of remdesivir or any other treatments or supplies. This means that the daily reporting is the only mechanism used for the distribution calculations."
According to an HHS spokesperson, participation in the data sharing is voluntary for hospitals.
As reported by The New York Times, the new data submission expectations appeared in a little-noticed document with COVID-19 guidance for hospital reporting and a list of FAQs, dated July 10 and uploaded to the HHS website.
WHY IT MATTERS
According to HHS Chief Information Officer José Arrieta, HHS Protect has been aggregating data since April, with much of that information coming from the CDC.
"During the pandemic it became clear that we needed a central way to make data visible to first responders," said Arrieta during HHS' Wednesday press call. "The reason we established the ecosystem is so the folks that work for Dr. Redfield ... can log into one system and get access to four billion data elements."
Now, the administration's new guidance asks hospitals to send daily reports bypassing the CDC-administered National Healthcare Safety Network altogether.
Hospitals can do this in one of several ways, according to the FAQs: They can publish data 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.
Health facilities can also submit data to the state for submission on their behalf, the FAQs read, if "they have received a written release from the State and the State has received written certification from their [Assistant Secretary for Preparedness and Response] Regional Administrator to take over Federal reporting responsibilities."
Some elected officials, such as Sen. Patty Murray, D-Washington, have raised questions about TeleTracking, a Pittsburgh-based data firm.
"In early April, ASPR issued a six-month contract for $10 million on a non-competitive basis to TeleTracking to create an alternate hospital reporting pathway to the Department of Health and Human Services (the Department)," wrote Murray in an open letter to Redfield and ASPR Robert P. Kadlec on June 3.
"The new system seems to create a second mechanism through which hospitals could report the same information already collected through NHSN," Murray continued.
"TeleTracking is just one of the collection components within the HHS Protect ecosystem," said Arrieta, who asserted that managing the data involves eight different commercial technologies. (The controversial data mining firm Palantir is among the companies also associated with HHS Protect.) Arrieta also claimed the contract with TeleTracking had been allocated in a "competitive" way via the business associate agreement process.
Arrieta said TeleTracking had been used to "close the gap" between the number of hospitals reporting their data to the CDC and the total number of hospitals in the United States. In turn, Redfield said, NHSN resources could be put toward tracking nursing homes "to provide the best surveillance that we can in our vulnerable population."
According to Arrieta, the biggest change hospitals will see is regarding additional data elements that may be collected or requested by HHS. HHS did not respond to follow-up questions regarding enforcement of the policy.
Neither Arrieta nor Redfield could offer a timeline for when the de-identified HHS Protect data would be broadly available to members of the public, including journalists; Arrieta said the priority would be to offer access to first responders and officials at the state level.
Both officials also stressed the importance of security, saying that every individual with access to HHS Protect is "authenticated."
Where testing is concerned, hospitals that perform "in-house" laboratory testing or that use certain commercial labs are asked to report using the HHS Protect System; to provide the data directly to their state, if their state has shared a written ASPR notification that reporting requirements are being met; or to authorize their health IT vendor or other third party to submit the data to HHS or the CDC.
HHS did not respond to follow-up questions about why submitting information to the CDC is still an option where testing is concerned.
"If all of your COVID-19 testing is sent out to and performed by State Public Health Laboratories, you do not need to report using the HHS Protect System," explained the FAQs.
A number of public health experts expressed their alarm in response to the initial announcement – airing concerns that putting COVID-19 data in the hands of the HHS meant that it would be inherently politicized.
"COVID-19 data collection and reporting must be done in a transparent and trustworthy manner and must not be politicized, as these data are the foundation that guide[s] our response to the pandemic," said Infectious Diseases Society of America President Thomas M. File on Tuesday.
"Collecting and reporting public health data is a core function of the CDC, for which the agency has the necessary trained experts and infrastructure," he added. "Placing medical data collection outside of the leadership of public health experts could severely weaken the quality and availability of data, add an additional burden to already overwhelmed hospitals and add a new challenge to the U.S. pandemic response," File continued.
"This decision to remove the CDC from its primary function and opt toward creating a duplicative, private federal contractor will halt the flow of crucial information," said American Psychological Association President Sandra J. Shullman in a statement on Wednesday afternoon.
"In recent weeks, state reporting had been improving with greater federal support. Now is not the time to change established processes that put this critical information into the hands of the nations’ premier public health experts," Shullman added. "COVID-19 data collection efforts must not be politicized and vital data pertaining to race and ethnicity must continue to be publicly reported.”
THE LARGER TREND
The COVID-19 pandemic has thrown the importance of cohesive data-sharing into sharp relief, with the White House requesting updates on hospital-based COVID testing starting in late March.
But the need for tracking of resources and patient numbers has conflicted with technological capacity: Public health agencies and systems often rely on manual processes to submit data.
"Every hospital is obligated to report daily their resources tied to COVID – how many patients are in ICU beds or on ventilators, for example. That's a big manual burden; every hospital I know is calculating this by hand, manually entering it into spreadsheets and sharing them with the federal, state and regional health agencies," said former U.S. Chief Technology Officer Aneesh Chopra in June. "Copies of spreadsheets are flying hither and thither."
ON THE RECORD
"The completeness, accuracy, and timeliness of the data will inform the COVID-19 Task Force decisions on capacity and resource needs to ensure a fully coordinated effort across America," read the FAQs.
"Doing so will also ensure that hospitals are not facing data overlapping requests from a multitude of Federal, State, Local, and private parties, so that they can spend less time on paperwork and more time on patients. Consistent reporting daily will reduce future urgent requests for data," they continued.
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.