Policies to prepare for a future pandemic should center on interoperability between hospitals and public health systems, expert says

• Preparation for future pandemics should include funding to establish better interoperability between hospitals and the public health sector, according to testimony at a Senate committee hearing.
• Real-time predictive analytics are available from a technology standpoint but are not sufficiently incorporated on a systemwide basis.
• Lack of scale of electronic systems is another hindrance in efforts to respond to disease outbreaks.

The need to fund better interoperability between hospitals and public health entities is a crucial lesson of the COVID-19 pandemic, an expert said during a recent Senate committee hearing.

“One of the issues that we have from a public health standpoint is that our systems don’t talk the same language,” Les Becker, deputy secretary for innovation with the Washington State Department of Health, told the Senate Health, Education, Labor & Pensions (HELP) Committee on July 27.

In written testimony submitted for the hearing, Becker described the process of establishing WA HEALTH, a public-private partnership with Microsoft to provide actionable data for public-health and medical preparedness amid the pandemic.

“The first hurdle was the lack of digital bridges between public health and health system electronic health records (EHRs),” Becker wrote. “EHRs are generally not built to send data to public health systems automatically. Likewise, few public health departments participate in the CDC program to develop digital bridges due to lack of funding and capacity within health departments.”

Hospital participation in WA HEALTH is “labor-intensive,” Becker wrote, because it requires staff to run reports and send the data through to the public-health data system. Given the manual, time-consuming nature of the process, “It is feared that the hospital participation and associated data will likely go away” after the public health emergency ends.

Steps toward enhanced public health capacity

Optimizing efforts to detect disease outbreaks in advance requires the following steps, Becker wrote:

• Expand the number of hospitals participating
• Enhance reporting to other health system entry points such as urgent care centers
• Add predictive analytics and artificial intelligence to uncover changes in the occurrence of illness and injuries

Sen. Richard Burr (R-N.C.), the ranking member of the HELP Committee, posed a question to Becker during the hearing: “What if I told you that technology was available today, that through video, an algorithm could determine the pulse rate, the oxygenation level, the respiration rate of individuals in the video and could predict a potential outbreak of COVID in any given geographical area three days before somebody presented themselves to the emergency room for a test?”

Becker replied, “Real-time data analytics and the ability to predict things and catch them before they spread in the community are a fantastic thing. But the challenge is operationalizing that within the current system.”

Burr added, “The challenge is incorporating that in a layered surveillance system and a culture that says, ‘No, we just need a bigger computer that processes 10-day-old data faster.’”

Going forward, Becker stated in his written testimony, vendors should be “held responsible for standardization for transport protocols. Transfer protocols need to be built into contracts, which need to be standardized through granting agency requirements. In today’s world, interoperability is a bare necessity of a minimum viable product.”

Not just about interoperability

The capacity of electronic systems also needs to be improved, Becker said during the hearing.

“One of the issues that we had, for instance, in Washington state was [that] the electronic lab-reporting system, which was designed many, many years ago, could only handle about 350,000 cases per year,” he said. “And that’s about what we asked of it.

“In the pandemic, we were asking it to do that in less than a month. And it created slow systems that couldn’t respond, that frustrated [the] workforce. And that just leads to error and the lack of ability to respond to the immediate needs of the system.”

Viable solutions won’t be universal in scope.

“Each region faces different infrastructural problems, community problems, and we need solutions that address that from the beginning of the process to the end of the process at the CDC,” Becker said. “That’s going to be different in each community, whether it’s a broadband connection, whether it’s the lack of resources from a workforce [standpoint].

“We need everyone at the table from the local, state and federal level to help solve those problems and direct funding that can directly impact those problems.”

Hospitals certainly are in favor of investments and policy initiatives to bolster the public health system, said David Janz, MD, director of critical care services at University Medical Center in New Orleans.

“There isn’t a day that we don’t use data generated by public health experts to plan what we’re going to do in the hospital that day, the next week, the next month and over the next few months,” Janz said. “Public health infrastructure and data obtained in real time from these experts has been vital in our response to the current pandemic and any future pandemic.”