In Brief:
- Public health departments depend on accurate and timely data to guide their efforts to control the spread of disease.
- Full integration of information technology is the norm for other essential data systems, but a 50-state study by researchers at The Pew Charitable Trusts finds that this is not the case in public health departments.
- Policies and resources vary state to state and community to community. An inventory of existing data reporting practices and completeness is an important first step.
The primary purpose of public health departments is to prevent illness. Technology tools to gather, share and organize information essential to achieving this goal have never been more powerful, but a national study by The Pew Charitable Trusts reveals that they are seriously underutilized.
Pew researchers spoke to nearly 300 public health officials in 47 states about their information systems. This brought real-world context to a 50-state analysis of policies and practices that govern how public health agencies receive data from physicians, hospitals, laboratories and emergency departments. The analysis found that most states do not require data to be collected electronically, even though automated electronic data gathering is the best way to keep data accurate and updated. Many health departments have implemented electronic data gathering for certain kinds of reports, but Pew's analysis says they would benefit from greater adoption of these technologies.
The data speed, quality and standardization expected in sectors such as banking are important to public health efforts. “It may not be everybody’s top area of interest because of the complexity and time and investment it takes, but it’s essential,” says Kathy Talkington, public health director at Pew.
Digital Era, Manual Processes
Pew's research focused on management of four kinds of data: case reports from caregivers, results from lab tests, disease surveillance by emergency departments and immunization records.
Every state requires health-care providers to report cases with public health significance to health departments, such as communicable diseases, environmental illnesses or cancers. It’s the norm for health-care providers to digitize medical records. These electronic records can be used to generate electronic case reports (eCRs) that transmit reportable data to health departments automatically.
Pew found that no state requires automatic reporting of case reports. Only three require electronic reporting. Few require automatic or electronic reporting of the other types of data encompassed by the study (see chart). Too often, health departments rely on people-powered processes such as fax and phone for data collection to a sizable extent, the researchers found. This “creates administrative work, introduces human errors, and slows the analysis and use of information,” they said.
Mandates for electronic reporting of lab results, surveillance data and immunization are equally scarce, but the researchers found that in a significant share of jurisdictions, automated electronic delivery of these is the norm.
States have authority to set the ways that data is collected, but interviews made it clear that policy alone isn’t enough to drive technology implementation, says Margaret Arnesen, Pew’s senior officer for public health data improvement. Public health funding is characterized by boom and bust cycles and shifting priorities. A tech workforce can be expensive.
“Relationships were a surprisingly critical piece of this,” says Arnesen of what health officials told her about their data systems. “Public health relies very heavily on relationships with providers, with health-care systems, with hospitals.”
A phone or fax machine might be the only technology available to health-care providers in smaller communities. It could be hard for critical access hospitals (those in underserved rural communities) to invest in technology.
“We don’t want to discourage them from communicating and participating in a system of collecting information,” Talkington says. It’s most important that the information comes in, Arnesen says, even if it’s on the back of a napkin.
The report includes recommendations for improving data reporting, beginning with a survey of existing use of electronic records, and data completeness and timeliness.
Nuance and Opportunity
Public health departments in each state operate independently, guided by varying laws and regulations. The governing structures around public health vary as well, says Genna Cohen, a senior researcher at the nonprofit Mathematica. (Mathematica sponsored the Pew study.)
Because of this, there’s not one specific thing that will enable every state to build a comprehensive data system, says Arnesen. Progress depends on a nuanced understanding of the elements of a modern system, described in detail in the report, and an approach to putting them in place that builds on existing resources and relationships in a jurisdiction.
The urgent need to track COVID-19 infections during the pandemic led to a spike in the use of electronic data gathering and dissemination and showed the potential for it to be implemented widely and quickly. At the start of the pandemic, no Dallas County, Texas, hospitals were using eCR, says Philip Huang, the county’s health and human services director. Now almost all do.
This was possible because of an influx of funding. Huang is concerned that with the pandemic behind us, awareness of the importance of data systems and commitment to funding them may fade. (Sustained state and federal support is another element that Pew identified as critical to data improvements.)
For Arnesen, the years spent on the report have brought opportunities for improvement and innovation into view. She’d like to see epidemiologists and providers spend more time doing their jobs rather than manually entering data or making phone calls.
