Improving public health through data exchange
As public health resources shift away from the pandemic response, jurisdictions now seek ways to modernize their public health infrastructure to avoid previous challenges such as data fragmentation, incompleteness of health data, and lack of interoperability. Agencies, community leaders, and health professionals look to lessons learned and best practices from the COVID-19 pandemic as a starting point. For example, agencies stood up new solutions, augmented their epidemiologic data with other data sources, or looked to their local Health information Exchange (HIE) for support. In this blog post, we highlight four states where innovative HIEs are using Amazon Web Services (AWS) to help public health agencies overcome their data challenges.
Reducing burden on public health with single-stream electronic reporting
Public health jurisdictions conducting syndromic surveillance—public health surveillance of symptoms designed for early detection of disease clusters or outbreaks—support data exchange connections with each participating clinical organization. The Michigan Department of Health and Human Services (MDHHS) solved this problem of too-many-connections by working with the Michigan Health Information Network (MiHIN) built on AWS. The Michigan Syndromic Surveillance System (MSSS) sends alerts to state public health officials when unusual increases in symptom presentations are detected. This allows MDHHS staff to analyze findings, investigate further, and contact local public health agencies and providers for further investigation when warranted.
In California, Manifest MedEx leveraged their AWS-based technology infrastructure to create the Surveillance and Public Health Information Reporting and Exchange (SaPHIRE) in July 2022. Instead of managing more than 400 individual connections with laboratories and other clinical entities, the California Department of Public Health (CDPH) partnered with Manifest MedEx to integrate that data from 20 million-plus total messages, as of June 2023, into SaPHIRE. SaPHIRE transforms the data into a format that CDPH can ingest, perform rapid analysis on, and then distribute to local health departments (LHDs) for use.
This crucial work helps CDPH improve the efficiency of monitoring activities and the early detection of public health events through the collection of complete and timely lab result information on a statewide basis. This allows for 24/7/365 reporting and receipt of notifiable conditions. LHDs and CDPH have access to disease and laboratory reports in near real-time for disease control measures, public health investigation, and case management activities. “Supporting CDPH with continuous high-quality lab data to inform their efforts to keep Californians safe now and into the future is one of the many ways that we see HIEs serving the role as a health data utility for the state,” said Erica Galvez, CEO of Manifest MedEx.
Prescription drug monitoring to improve care
CyncHealth, the HIE supporting Nebraska and Iowa and built on AWS, administers the Prescription Drug Monitoring Program (PDMP) on behalf of the Nebraska Department of Health and Human Services (DHHS). The PDMP is a program traditionally focused on tracking prescriptions for controlled substances. Nebraska is the first state to expand its PDMP to include all prescriptions. This provides a comprehensive medication history that may be used to inform policy, address quality measures as approved by state or federal agencies, improve patient quality for research initiatives, and statistical or educational purposes. Expanding the PDMP to include all medications was made possible by CyncHealth’s status as a non-government organization (NGO) and CyncHealth’s ability to go the last mile to include data from small local pharmacies as well as large national chains.
Including all medications in the PDMP dramatically increased the complexity and data volume of the program. CyncHealth receiving data from every pharmacy requires the ability to receive data in numerous formats, clean and normalize it, and connect it to the correct longitudinal record. CyncHealth’s expertise in managing these types of clinical data accelerated the implementation process. Now, with an approximately tenfold increase in the amount of data compared to reporting of controlled substances alone, there is more information for providers to make better-informed treatment decisions for their patients. “Epidemiologists in public health departments now have more data to monitor and analyze for syndromic surveillance, immunization monitoring, chronic disease surveillance, and medication compliance purposes,” said Kevin Borcher, Vice President of PDMP and Pharmacy Programs for CyncHealth.
Leveraging existing data connections and data to accelerate public health action
VITL is Vermont’s HIE and supports the Vermont Department of Health (DOH) with access to the VITL clinical portal and two-way immunization data sharing solution. These tools minimize the back-and-forth phone calls between the Health Department and clinicians.
VITL’s clinical portal accelerates the Health Department’s case investigations by augmenting their existing data to fill critical information gaps that impede their ability to provide services to disadvantaged populations. For example, at the beginning of the pandemic, 73% of records were missing race information which improved to 8% unknown with use of the portal. To obtain these data, Health Department staff would have had to call clinicians’ offices or patients. After the height of the pandemic, VITL and the Health Department began identifying other ways to leverage this portal to share information available in the HIE that would otherwise have required back-and-forth communication. New use cases include providing clinical data to support continued enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), maternal and infant mortality reviews, and infectious disease surveillance.
Where can we go from here?
The examples in this blog post are only a handful of use cases from the broad portfolio reflecting public health’s expanded engagement with HIEs. Across the country, new models for data exchange are emerging: from the National Institutes of Health (NIH) for research ranging from basic sciences to clinical trials, from the Centers for Medicare and Medicaid Services (CMS) for value-based care, and from the Office of the National Coordinator (ONC) for Trusted Exchange Framework and Common Agreement (TEFCA).
TEFCA promotes and standardizes use cases for data exchange to improve repeatability and reduce the level of effort in implementing data sharing. This includes use cases for data exchange between clinical organizations and public health to improve timeliness and completeness of data received by public health for urgent issues. To be successful, HIEs and public health agencies must collaborate to define the data flows to ensure optimal benefit for both sides.
Improving access to data can improve an organization’s ability to address inequities, prepare for public health emergencies, reduce manual efforts, and improve decision making. But better access to data also comes with challenges regarding privacy, security, health IT standards such as the Fast Healthcare Interoperability Resources (FHIR), and avoiding bias, to name a few. Overcome these challenges by taking advantage of the resources available to you.