US government health advisers say hospitals are ‘scrambling’ after Trump administration’s ‘abrupt’ change to Covid-19 data reporting requirements

August 14, 2020 steven

The letter, dated July 31, described hospitals as “scrambling” to determine how to meet new daily Covid-19 reporting requirements to the US Department of Health and Human Services, and said retiring the older system jeopardized data integrity. One doctor who signed the letter said the new data system was marred by inconsistencies, rendering it “almost impossible” to use for real-time decisions during the pandemic.

“Moving forward,” the letter says, “it will be even more challenging to perform meaningful inter-state comparisons, and to understand which COVID-19 mitigation strategies were successul (or failed).”

The nearly three dozen current and former members of the Healthcare Infection Control Practices Advisory Committee shared their concerns in a letter intended for HHS and obtained by CNN. The committee is an independent group of experts that provides guidance to the HHS and the US Centers of Disease Control and Prevention on infection control practices and strategies.

When asked by CNN, HHS did not confirm if it had received the letter. Members of the committee said that the CDC, which is part of HHS, was informed of the letter.

In a memo on the HHS website last month, the Trump administration ordered hospitals to report all Covid-19 patient information to HHS, rather than to the CDC and HHS, as they had been doing.

The Trump administration said the change would streamline the data collection process, but it swiftly drew criticism from public health officials.

Former CDC Acting Director Dr. Richard Besser said at the time that rerouting hospital data was a “step backwards” for the country’s coronavirus response.

“It’s another example of CDC being sidelined. Not only should the data be coming to CDC, but CDC should be talking to the public through the media every day,” Besser told CNN.

This recent letter shared similar concerns.

“We are extremely concerned about this abrupt change in Covid-19 reporting,” the letter said. Retiring the CDC system that was in operation would have “serious consequences on data integrity.”

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By removing the data collection from the CDC, the country would lose decades of expertise in interpreting and analyzing information about infectious disease and it would jeopardize the department’s goals of developing interventions that would improve public health, the letter said.

The letter said the system that had been tracking the information, housed in the CDC’s Division of Healthcare Quality Promotion, is not merely a software system. It is a complex patient safety and quality improvement system that is maintained by an experienced team of doctors, epidemiologists and infection prevention and control professionals.

The system, which was started in 1970 to track health care-associated infections, is the country’s most widely used system on the subject, according to the group. It also tracks flu vaccination rates, blood safety errors and more.

Hospitals have extensive experience sending crucial data to this system and trust that it appropriately tracks and analyzes the data, the letter said.

Since hospitals now have to change the way they report the data, they have had to rely on local public health experts or hospital associations to change reporting and management of data. Making the shift during a pandemic puts this important data at risk, the letter writers argue.

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“As past and present HICPAC members, we are troubled by the Administration’s unexpected decision to divert Covid-19 data reporting from CDC to DHHS,” the letter said. “We strongly advise that the CDC’s DHQP data experts be allowed to continue their important and trusted work in their mission to save lives and protect Americans from health threats.”

Dr. Vineet Chopra, chief of the division of hospital medicine at the University of Michigan, signed the letter and said the CDC’s National Healthcare Safety Network data is essential to the work hospitals do.

During the pandemic, the University of Michigan accepted the most inter-hospital transfers of patients compared to any other hospital in the state, Chopra said; the NHSN data served as an important warning system that helped the hospital understand how the pandemic was unfolding in real time.

“We knew how to input data, how to extract data, and we know how to access it for prediction purposes,” Chopra said in an email. “In contrast, the new data system has many inconsistencies,” including with cases reported, bed occupancy numbers and that data itself is often out of date.

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Many hospitals, he said, have struggled to understand how to us the new system and aren’t entering data consistently.

“In other words, the new system has made intelligent calculations to inform real time decisions almost impossible,” Chopra wrote.

Chopra said the committee and many of his colleagues felt pushed to write the letter.

“I think the core problem that bothers many of us is it’s unclear why this change was made,” Chopra wrote. “The system as we knew it worked very well and did inform us in the height of the pandemic. We see no real reason to change it and certainly no good appears to have come from it.”

In a statement to CNN, an HHS official said the CDC system “was unable to keep up” with the demands of the pandemic.

“Today, CDC has access to all the data it once had and more. The CDC’s NHSN was unable to keep up with the fast-paced data collection demands of the COVID-19 pandemic,” Michael Caputo, HHS assistant secretary for public affairs, said in an email. “Using this new, innovative and flexible collection mechanism, we have far more COVID-related real data, far faster, giving us increased capacity for life-saving projects like therapeutics distribution. And we are now poised to move to automated data collection for the use of every relevant expert at HHS, particularly the CDC.”

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