Study: Confusing government COVID reporting requirements led to disparities in hospital data sharing

COVID-19
Hospital

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A Michigan State University–led study reveals significant disparities among nonfederal US hospitals and labs in COVID-19 public health reporting and electronic clinical data exchange due to inconsistent requirements in 2020 and 2022.

For the study, published this week in Health Affairs Scholar, the researchers parsed data from the  2020 and 2022 American Hospital Association information technology supplement surveys on hospital experiences in COVID-19 public health reporting, accessing clinical data from external providers for the care of infected patients, and successes in reporting vaccine-related adverse events to federal and state entities.

A total of 2,885 hospital chief executive officers responded to the 2020 survey, while 3,127 responded to the 2022 version.

Detailed reporting needed for continuous care

The study authors said that during the initial pandemic wave, public health reporting systems struggled to provide real-time data to key decision-makers, mostly due to data interoperability and analytical shortcomings.

"From March 2020 onward, both the Department of Health and Human Services and the Centers for Disease Control and Prevention mandated US hospitals to consistently report daily on COVID-19 cases," they wrote. "Concurrently, state and local health agencies set forth their data requirements, focusing on hospital capacities and supplies. These reporting obligations were instrumental for governmental monitoring, informed resource distribution, and public awareness."

One challenge was the efficient exchange of patient data for COVID-19 treatment, because amid patient surges, most patients were instructed to visit hospitals only if they had severe symptoms.

"Many had previously seen other health care providers for initial evaluations and treatments," the researchers wrote. "For hospitals, obtaining detailed electronic clinical records from outside sources was crucial for continuous patient care, particularly given the virus' acute nature and the rapid progression of symptoms in some patients."

Directives dissimilar among agencies

In 2020, 85% of survey respondents said they relayed their capacity and medical supply data to federal public health agencies, while 93% reported to state agencies, and 51% gave this information to local public health agencies.

But only 18% of hospitals found the directives to be consistent across government agencies. Most (66%) said the directives were only somewhat similar, and 16% reported that the directives from different levels were dissimilar, noting either obvious differences or a complete lack of comparability.

Tackling these challenges is pivotal for ensuring prompt and reliable data, bolstering future public health responses and rejuvenating trust in public health institutions.

John (Xuefeng) Jiang, PhD

A total of 59% of hospitals reported problems obtaining data when reporting to federal agencies, 57% experienced challenges at the state level, and 26% faced the challenges locally. Varying definitions of reporting elements posed significant problems, with 53% of hospitals mentioning this issue at the federal level, 50% reporting it at the state level, and 25% noting it locally.

Submission templates were widely unavailable, with 43% noting the lack at the state level, 31% encountering it at the federal level, and 23% reporting it at the local level. "Interestingly, across all challenges, reporting to local governments generally appeared to be less burdensome than at the state and federal tiers, highlighting a potential disparity in reporting standards and practices across these different governmental levels," the authors wrote.

Many hospitals (32%) continued to transmit data manually throughout the pandemic, although the proportion reporting automatically rose from 18% in 2021 to 23% in 2022. While large commercial labs relayed data to 17% of hospitals in a timely manner, clinic-based providers and emerging test providers did so only 12% and 9% of the time, respectively. A low proportion of hospitals reported problems recording COVID-19 vaccine-related adverse events.

Hospitals that provided telehealth services were more likely to use automated systems for reporting capacity and supplies data (21% vs 7% for hospitals not offering telehealth) and had more success sending vaccine adverse event reports (90% vs 85%). "These findings underscore the significant role of advanced technology adoption in enhancing hospital reporting efficiency, especially during the COVID-19 pandemic," the researchers wrote.

In a Michigan State University news release, lead author John (Xuefeng) Jiang, PhD, of the university's Broad College of Business, said the findings highlight the need for standardized reporting protocols, explicit directives, and an upgrade from manual to automated processes. "Tackling these challenges is pivotal for ensuring prompt and reliable data, bolstering future public health responses and rejuvenating trust in public health institutions," he said.

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