Op-ed: An Open Letter from the American Medical Informatics Association and the American College of Medical Informatics Regarding the A

Tuesday, July 21, 2020

The United States is a global leader in health care. When we face national and global threats to our public’s health, our most important defense is the fortitude and resilience of the American people, and the incredible ingenuity of our scientific experts – powered by data and information.  Just as radar continuously tracks airplanes in the control tower, real-time data about the pandemic are essential to ending it. We need data on all aspects of COVID-19, from the presenting symptoms to pathways of infectious spread to hospitalization and death rates. Data on infectious disease threats are essential to guide the policies needed to stop the spread of the current pandemic and to explore treatment and vaccine interventions.  

As health informatics professionals, we study and design the best way to gather, synthesize, analyze, and report on health-related data to improve health and health care. Given the current pandemic crisis, we write to offer recommendations to strengthen our national public health data infrastructure, not only to address our immediate needs in combatting COVID-19 but also to better equip our country to face certain similar threats in the future. The consequences of making an ill-advised decision are deadly.  

The actions to be taken must build trust, accuracy, transparency, and completeness.  We recommend an alternative action to that posed in the Administration’s July 10, 2020 memo, “COVID-19 Guidance for Hospital Reporting and FAQ.” To avoid the unintentional disruption of the current flow of information from hospitals at a critical time during the pandemic crisis, we strongly recommend that hospitals continue reporting COVID-19 data to the Centers for Disease Control and Prevention (CDC) through the National Healthcare Safety Network (NHSN). The CDC has served as the nation’s trusted ‘control tower’ to manage the transmission of public health data for decades. The NHSN is the nation’s most widely used healthcare-associated infection tracking system, serving more than 25,000 medical facilities. Changing out a data system in the midst of a pandemic is likely to create data gaps as thousands of health organizations find they need to convert their data systems to the new one – one that is untested for this purpose. While we understand the motivation for updating the reporting system, this unplanned sudden change will likely distort key metrics in tracking the spread COVID-19. Any missing data or even changes in data format will interfere with the ability of our health experts to properly interpret and formulate an appropriate response to this rapidly changing pandemic.  

There is always a desire to collect more data, thinking that more is better. But the more data that is requested, the higher the level of effort and time it takes to collect it, format it, and transmit it to various organizations who want it in different formats. The data elements the CDC collects are carefully managed to get the most value with the least amount of effort. In response to a request by the Administration in March 2020, for example, work has already been conducted to automate the reporting of COVID-19 data elements, addressing long-standing issues in response to the crisis. Building on this effort will improve the accuracy and completeness of the data.  

There is not a minute to lose. Streamlining and building upon what exists – the existing data connections and existing trusted relationships – will be faster and safer than abruptly bypassing the current public health information system. Disrupting the flow of critical clinical data during an escalating pandemic could be catastrophic. With a steadfast commitment to transparency and accountability, we can shore up the existing infrastructure to regain control over the nation’s health and safety during the current pandemic and to lay the groundwork for the robust infrastructure we need to protect the nation’s health from pandemics yet to come. We are in it for the long haul.