In the middle of a worldwide health crisis, the significance of effectively trading electronic health records between medical centers and public health associations is more pressing than ever before. CMS has established regulations that make it mandatory for hospitals to meet public health requirements in order to take part in the Promoting Interoperability (PI) program, with the intention of providing public health agencies with timely and complete data for increased disease surveillance.

The goals of this aim to involve handing in, and in certain scenarios, obtaining data for immunization registries, syndromic surveillance notifications, case notifications, and health registry notifications. This data brief utilizes survey results from the 2019 American Hospital Association (AHA) Information Technology (IT) supplement to analyze the difficulties experienced by hospitals with regard to public health reporting in the year before the pandemic.

It breaks down the type and amount of impediments, as well as examining how they contrasted based on the state and specific hospital features. This review looks into potential issues that have remained or even gotten worse during the pandemic regarding the exchange of medical information between hospitals and public health departments. It provides an understanding of how prepared hospitals were before the pandemic to aid with vital public health endeavors.

• In both 2018 and 2019, half of all hospitals reported a lack of capacity to electronically exchange information with public health agencies.
• In 2019, seven in ten hospitals experienced one or more challenges related to public health reporting.
• Small, rural, independent, and Critical Access hospitals were more likely to experience a public health reporting challenge compared to their counterparts.
• The types of public health reporting challenges experienced by hospitals varied substantially at the state-level.

Why This Is a Challenge

The Department utilizes increasing volumes of confidential data to fulfill its purpose and engage in its activities. Accurate, current, and prompt information can help guarantee the Department’s and its initiatives to be effectively managed, as well as support responsible program observation. Likewise, the medical care system in America is gradually more reliant on technology for medical information (health IT) and the electronic swapping and utilization of medical records.

IT for well-being, such as digital medical records (EHRs), has possibilities for greater patient care, better management of practices, and enhanced public health overall. Despite the many benefits from having a great deal of information available, the Department faces major obstacles in this data-abundant setting.

Ensuring Privacy and Security of Information. Protecting confidentiality and guaranteeing data protection are, and should stay, foremost concerns of the Department. The Department is responsible for safeguarding the information it produces and maintains.

It is also essential to guarantee appropriate security for medical data when examining and enforcing regulations concerning the incorporation of health IT and the transmission, storage, and application of digital records related to health. The number of considerable data leaks has shot up dramatically, which can have dire repercussions for the healthcare sector, the organization, and for those receiving assistance from the company.

The repercussions can include identity fraud, which can have a detrimental impact on the health care delivered to patients and bring about wasteful, fraudulent expenses of public funds.

Weaknesses that are often seen include not having sufficient gain to control access, failing to keep programs or software current and up-to-date, not properly securing data through encryption, and susceptibility to hacks on websites held by the Department, medical services providers, and any other entities that take part in dealings with the Department. The vulnerability could lead to the potential for somebody to get access to confidential details without permission.

Improving Information Flow. Utilizing the advantages of the increasing quantities of data in the healthcare sector requires the availability of data, along with the necessary privacy and security measurements when and where needed.

Making sure that data is able to be exchanged and allowing people to use it easily is something that the Department still struggles with. Several factors may impede the flow of information. Some of the reasons why the use of health IT is difficult include issues concerning technology, compliance with governmental regulations, the expense of acquiring IT, and outlooks and trustworthiness in regards to how information is shared.

The President’s Precision Medicine Initiative is just one of the many initiatives that will be aided by an increase in efficient dissemination of healthcare data. Without a proper exchange of data, those participating in the efforts may find it difficult to collaborate in providing care and achieving objectives.

Barriers to exchanging information can also pose a risk to patient safety. A patient might require further intrusive examination that wouldn’t have been necessary if information which had been saved by another provider could have been distributed.

The exchange of knowledge is also significant between the Department and other entities, such as providers. Data managed, stored, or sent through EHRs and other health IT are used to guarantee precise Medicare and Medicaid reimbursements, such as those related to value-based payments.

People involved in specific projects are given information from the Department to help them improve the service they provide. Moreover, the Office is increasingly using and distributing data in the course of its program processes and activities to ensure program accuracy. It is absolutely essential that, as the transmission of data is enhanced, the data is comprehensive, precise, up-to-date, and securely safeguarded.

Ensuring a Return on Health IT Investments. The Department has made significant investments in health IT. Nevertheless, the Department finds itself struggling to make sure that the objectives connected to investing in the large-scale adoption and utilization of EHRs and other health IT are achieved.

In addition to making the exchange of information more efficient, the difficulties of making sure that the Department’s investments in technology for healthcare yield satisfactory results include avoiding making payment to people who do not meet the standards; guaranteeing that the advantages of EHRs such as convenience and improved storage accessibility are not exploited for unlawful activities; and making sure that there are real benefits when it comes to patient safety.

When addressing these issues, the Department must make sure that its own departments as well as other federal partners with associated roles in medical information technology are working together so that any potential policy and supervision lapses do not ruinthe advantages of these investments.

Half of hospitals reported challenges related to electronically exchanging data with public health agencies

FINDINGS

Hospitals have had the same two main difficulties with submission of public health data in both 2018 and 2019. These two problems have been related to connections and a lack of capacity to share electronically information between hospitals and public health departments.

Approximately twenty percent of medical facilities encountered difficulties when exchanging information owing to different terms used; a nearly equivalent portion of hospitals had difficulty getting the essential info out of digital health records.

The proportion of medical centres struggling with issues related to interfacing and the use of different terminology norms increased somewhat but was still significant between the years of 2018 and 2019.

Seven in 10 hospitals experienced one or more challenges when electronically reporting to public health agencies in 2019.

FINDINGS

The average number of difficulties reported by medical centers to public health institutions was 1.37 during 2019, which had not really changed from the number of obstacles encountered in 2018.

Around half of medical facilities across the country faced one or two issues with their reporting process, with fewer than a quarter having to battle with three or more setbacks.

Roughly 60% of hospitals that discussed only one concern related to public health reporting claimed they had difficulties either trading electronic information with their own body or a governmental health service, while 21% had boulevards related to applications.

Approximately one-fourth of hospitals declared that they had no noteworthy difficulties with public health reporting.

The most common public health reporting challenges hospitals experienced concurrently were issues with a lack of capacity to electronically exchange information and interface-related issues.

FINDINGS

Nearly one fourth of hospitals encountered both a lack of technical and personnel resources for electronic information sharing, as well as challenges with connecting to public health agencies which included expenses and complexity.

Hospitals that experienced trouble with exchanging data because of discrepancies in terminology guidelines also experienced issues related to an interface and a be deficient in of ability to swap information electronically (13%, respectively).

Around 12 percent of hospitals claimed to have had trouble with the EHR system’s face-to-face interactions and trouble gathering the necessary information from it.

Small, rural, independent, and Critical Access Hospitals were more likely to experience one or more public health reporting challenges compared to their large and urban counterparts.

FINDINGS

It appears that compared to their counterparts, small, rural, independent, and Critical Access Hospitals (CAH) had a more difficult time in areas such as interfacing, extracting the proper information from the EHR, and understanding where to direct the information for necessary reporting requirements.

Issues related to an inability to transmit data electronically were commonplace among hospitals, and the proportion of them facing this problem did not vary substantially according to various hospital characteristics.

Table 1: Percentage of non-government managed acute care hospitals which had difficulty with public health reporting in 2019.

Source: 2019 AHA Annual Survey Information Technology Supplement. The study only took into consideration non-federal acute care hospitals, but there were 72 of them (1.6%) that responded ‘no’ to any of the inquiries about public health. The category from the row below is substantially different than the one it’s being compared to (statistically significant at p<0.05). Please look at the Definitions part of this data brief to understand what each hospital feature means.

Hospital participation in a health information exchange is associated with a lower probability of experiencing certain public health reporting challenges.

FINDINGS

Hospitals which are involved in health information exchange networks set up on a state, regional, or local level are less likely to experience issues when trying to access necessary data from an electronic health record system, if we take into account any differences between the hospitals.

Hospitals that have joined an HIE seem to know what to do with the information they receive better than hospitals that have decided not to join one, even after controlling for different characteristics associated with the hospitals.

There were no issues with regards to public health reporting challenges, due to a lack of capability or interfaces, once the hospital characteristics were taken into account, in regards to hospital involvement with health information exchanges.

What Needs To Be Done

The Department must be alert to changing risks to data privacy and security. Although the Department has made advances in guarding its own data, as can be seen from the OIG research and a latest Congressional Report, there is still work to be done.

The Department should also utilize existing policy tools to address health IT safety and security difficulties, like utilizing the Electronic Health Record (EHR) incentive programs. The Office of Inspector General will keep its attention on the protection of privacy and security of HHS systems in order to back up the Department of Health and Human Services’ endeavors to lessen the occurrence of unlawful access to its delicate data.

The Office of Inspector General will concentrate on matters of safety and privacy in regulated sectors as well as connected institutions in order to allay worries about the same risks concerning health data. Possible future investigations may include researching the privacy and security challenges posed by the ongoing growth of the Internet of Things, for instance with regards to medical devices that are connected to the internet.

In order to reach the objective of the 10-Year Vision Paper and make the most of the already impressive $31 billion put towards the EHR incentive programs, the Department needs to facilitate better exchange of data through suitable privacy and security procedures.

As EHRs and health IT programs continually increase in financial investment, it is crucial to measure their successes in regards to the Department’s ambitions. These aims include improvements to healthcare and cost decline.

As the Department keeps on with the structure and usage of observable use stages and expects to actualize the significant utilization part of the Merit-based Incentive Payment System enrolled in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), it should keep on listening to input from partners to ensure that embraced approaches further the Nation towards the Department’s expressed objectives, while fittingly reflecting the changing wellbeing IT scene and finding an equilibrium among protection and security thought.

More precise guidance and support should be released to overcome any issues with the adoption of, utilizing effectively, and connecting with other systems, as well as ensuring program security. It is extremely important that mitigating factors like privacy, safety, and fraud deterrence remain the primary objectives of the Department, ONC, and CMS in terms of their use of health information technology.

An investigation conducted by the Office of Inspector General is still in progress to determine the validity of the monetary rewards given in Medicare and Medicaid for being able to effectively demonstrate successful use of Electronic Health Record systems. It might be a good idea for further study to look into the ability of healthcare information technology to connect different providers (including ACO participants), Health and Human Services departments, and providers and patients. Additionally, there should be an evaluation of the results emerging from investments in health IT.