How might we enable hospitals across the country to work as one?
To effectively prevent, treat, and monitor public health, different types of data — from individual health records and infection rates to hospital capacity and strategic supplies reserves — must be easily shared. This data currently lives across multiple settings — from physician offices and hospitals to laboratories and pharmacies — and even within some hospital systems, there’s no common infrastructure to pull disparate streams of information together in a meaningful way.
Despite advances in electronic health information exchange over the past decade, progress has been inconsistent across regions and states. Several issues persist: a lack of standardized data and interface technologies, limited interoperability across care teams, and uncertainty about privacy- and security-related requirements under the Health Insurance Portability and Accountability Act (HIPAA). And furthermore, in a healthcare system that includes both private and nonprofit hospitals, data-sharing may be perceived as a competitive risk.
The government is already working on solutions. The Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access final rule, published in May, is a big step forward. This implements certain provisions of the 21st Century Cures Act, giving patients better access to their health information and improving interoperability by requiring all hospitals to send admission, discharge, and transfer notifications to primary care and other downstream providers.
But public health requires more than just individual patient records; other types of data — such as hospital capacity, infection rate, and equipment inventory — are needed for a coordinated response effort. In an unprecedented move, New York State set up a central command center to coordinate the movement of staff and medical resources across all of its 200 public and private hospitals — prioritizing cooperation over competition. New York State also established an online portal to connect hospitals and healthcare facilities with volunteer healthcare workers.
The United States also has a national tracking system to identify and remedy specific problems: The CDC’s National Healthcare Safety Network (NHSN) was initially established to track healthcare-associated infections among a few hundred hospitals; 25,000 medical facilities participate, and it has expanded to track data such as blood safety errors and healthcare personnel influenza vaccine status. Most recently, the NHSN added the COVID-19 Module, enabling hospitals and long-term care facilities to report daily counts related to case numbers, hospital capacity, healthcare worker staffing, and healthcare supplies.
Challenges with information exchange and interoperability are not new, but the current crisis provides an impetus to reconsider what data is collected and how it is shared. State-level coordination and expansion of existing national networks will help us address the coronavirus pandemic in the short term and serve as the foundation for better health outcomes beyond the pandemic.
We invite the public to comment on the following opportunities.
- How might we make use of existing efforts, such as health information exchanges or national tracking systems? Which systems have the greatest potential? How might we modernize or adapt for both pandemic and “peacetime” use?
- How might new tracking and surveillance systems complement or improve on existing efforts?
- To ensure interoperability, what standards must providers, software developers, payers, hospitals, and other healthcare organizations agree to adopt?
- How do we incentivize adoption of data sharing while protecting both individual privacy and organizational needs?
- How can we engage public and private stakeholders to collaboratively improve reporting on national progress toward interoperability and information sharing?