COVID-19 and the Need for a National Health Information Technology Infrastructure | Electronic Health Records | JAMA | JAMA Network
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COVID-19: Beyond Tomorrow
May 18, 2020

COVID-19 and the Need for a National Health Information Technology Infrastructure

Author Affiliations
  • 1School of Biomedical Informatics, University of Texas Health Science Center at Houston
  • 2Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
JAMA. 2020;323(23):2373-2374. doi:10.1001/jama.2020.7239

The need for timely, accurate, and reliable data about the health of the US population has never been greater. Critical questions include the following: (1) how many individuals test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and how many are affected by the disease it causes—novel coronavirus disease 2019 (COVID-19) in a given geographic area; (2) what are the age and race of these individuals; (3) how many people sought care at a health care facility; (4) how many were hospitalized; (5) within individual hospitals, how many patients required intensive care, received ventilator support, or died; and (6) what was the length of stay in the hospital and in the intensive care unit for patients who survived and for those who died. In an attempt to answer some of these questions, on March 29, 2020, Vice President Mike Pence requested all hospitals to email key COVID-19 testing data to the US Department of Health and Human Services (HHS).1 The National Healthcare Safety Network, an infection-tracking system of the CDC, was tasked with coordinating additional data collection through a new web-based COVID-19 module. Because reporting is optional and partial reporting is allowed, it is unclear how many elements of the requested information are actually being collected and how they will be used. Although the US is one of the most technologically advanced societies in the world and one that spends the most money on health care, this approach illustrates the need for more effective solutions for gathering COVID-19 data at a national level.

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    1 Comment for this article
    Leveraging EMR data
    Richard Ferrans, MD, ScM |
    Thank you for your thoughtful perspective on the overarching issues, I will add my perspective from 25 years in informatics and internal medicine, as well as national and state level policy advisory work:

    1. Over 34 billion dollars was allocated for Meaningful Use, much of it has been spent.
    2. The regulatory barriers you mention are formidable
    3. The leading EMR vendors are cloud-based but have legal challenges in pooling even de-identified data across their customers without customer consent.
    3. The President issued a directive this week authorizing a waiver of rules impeding economic recovery
    4. All stakeholders
    should urge the Secretary of HHS to enable pooling of data across vendors for use by the NIH-led Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) partnership. Vendors should have waiver of liability (including contractual and HIPAA) and turn data over to the NIH collaborative in a cloud-to-cloud manner. This is NOT a technology issue. The Secretary should mandate this as a requirement of meaningful use certification until the pandemic has ended.
    5. Practical questions can be answered with a large dataset:
    a. What is a more precise quantitative definition of risk?
    Given age and comorbid conditions, what is the risk conferred by severity of comorbidity or protection offered by level of control? Does the risk for Type II DM differ by HbA1C recorded prior to infection, and does the risk change linearly or in other fashion? What about GOLD criteria for COPD or ACC/AHA classification of HF or CVD?
    b. How does risk increase with multiple comorbidities?
    c. Given any set of results, what patients should be deemed highest risk in a PCP panel and what achievable target should be set for control to reduce risk in advance of the anticipated second wave of SARS CoV-2 pandemic this fall?
    6. The goal of this effort should be to give primary care physicians actionable information to reduce risk in their panels given limits on resources and move to telehealth.
    7. CMS can use this data to align payment incentives in ACOS and under MIPS/MACRA.
    8. I urge the AMA and other organizations to support this request so that the entire primary care infrastructure can be efficiently mobilized to focus on prevention of severe covid among the broadly defined high risk cohorts. If successful, this effort can reduce mortality while vaccine trials are underway.
    9. These data can also enhance the precision of admission risk-of-mortality models which will facilitate optimal use of rationed therapeutics such as remdesivir.
    10. Congress should appropriate additional funding for this effort.