key: cord-0888530-eyg15k2m
authors: Holmgren, A Jay; Apathy, Nate C; Adler-Milstein, Julia
title: Barriers to hospital electronic public health reporting and implications for the COVID-19 pandemic: the authors’ reply
date: 2020-10-01
journal: J Am Med Inform Assoc
DOI: 10.1093/jamia/ocaa192
sha: 92fbff51d4360145e38271f4034a6b6d9e379d65
doc_id: 888530
cord_uid: eyg15k2m

nan

We appreciate the productive discussion about our article, Barriers to Hospital Electronic Public Health Reporting and Implications for the COVID-19 Pandemic, which serves to advance efforts to strengthen information sharing between hospitals and public health agencies. The letter by Staes et al raises important considerations and contributes to a useful dialogue regarding the current state and barriers to hospital-public health agency electronic data sharing as well as opportunities to increase knowledge of extant public health capabilities and foster more comprehensive utilization of those capabilities. We agree that the current level of interoperability between hospitals and public health agencies is not at an ideal level, even under normal circumstances, and critical infrastructure gaps have been laid bare as a result of the COVID-19 pandemic. 1 Our findings should not be interpreted as evidence of fault or sole responsibility on either the hospital or public health side for barriers that impede effective information sharing. Indeed, we are careful to focus our discussion on the likely roots of current challenges, which we trace to federal incentive programs that have focused almost entirely on health care delivery organizations, rather than the public health agencies and other community partners that play a critical role in emergency preparedness, disease monitoring, and efforts to improve population health. Instead, we believe the value in our findings comes in prompting better coordination between public health and clinical partners to address current shortcomings and ensure that robust electronic data exchange is meeting the needs for both clinical and public health organizations.

The first step towards this coordination is better understanding of how the other side views the issues. We suspect that, when citing barriers to public health receipt of data, hospitals are not referring specifically to the pure technical capability (which the letter indicates exists at a broad level). As with any interoperability effort, functional interoperability requires the technological capability to send and receive data alongside the nontechnical factors such as data governance, incentives to share electronically, a clear onboarding and testing process, and more. Surveys like the AHA IT Supplement shed some light on where the sticky points may lie but isn't able to home in on and separate one from another.

Given these constraints, the key insight from our study is that 1 side of the exchange-namely, the Chief Information Officers or Chief Medical Information Officers who typically respond to the AHA IT Supplement-perceive some aspect of public health agency ability to receive data as a barrier to effective electronic exchange. Regardless of whether that barrier is technical in nature or related to a socio-technical process such as data governance, public health agencies should be aware that nearly 40% of potential exchange partner hospitals view their ability to receive data electronically as a barrier to effective exchange. Awareness of this perceived barrierespecially if it is inconsistent with barriers perceived by public health agencies-is a critical first step towards resolving outstanding issues and clarifying any misunderstandings.

We suggest that 1 possible strategy going forward is for public health agencies and hospitals to publicly list their electronic exchange partners, similar to how health information exchange organizations publicly list participants. 2 This may help both clinical and public health organizations better understand who is successfully sharing data, enable both parties to engage in peer learning and best practice dissemination, serve as an accountability mechanism for all parties, and allow researchers to differentiate between stated ability to send and receive data electronically and actual connectivity in practice. Secondarily, national surveys of public health agency informatics infrastructure and capabilities should seek to capture more detailed data than they have historically, which has thus far prevented insight into such basic questions as regional variation in capabilities, much less the geographic or proportional scope of connectivity for a given public health agency. 3, 4 We applaud public health agencies' hard work on building electronic case reporting capabilities through platforms such as

Bottleneck for US coronavirus response: the fax machine

ASTHO Profile of State and Territorial Public Health

AIMS. However, it's important to note that the AIMS service is primarily facilitating data exchange between public health laboratories and public health agencies, not from hospitals or other clinical exchange partners. This underscores the complex nature of interoperability for public health surveillance, which frequently involves local and state agencies establishing and maintaining bidirectional interoperability with multiple exchange partners of many types.Most importantly, we wholeheartedly agree with Staes et al that increasing support for public health agencies to build a more robust informatics infrastructure is a critical policy goal to ensure accurate, reliable data exchange.