“You can interface with a single health department and work with their data and work with the experts there, but then just even going from one health department to another, it could be a very different scenario,” says Goldstein. Trying to understand trends across state lines can be a nightmare—and the virus does not discriminate on the basis of borders.
New testing platforms will exacerbate these problems. There’s no guarantee at-home test results will be reported to the state unless people who take those tests go out of their way to engage with the health-care system. The varying accuracy of these tests means not all results carry the same weight—and ought not to be counted in the same way.
So how do we solve this mess? The good news is we don’t have to invent something new—we just have to stretch out the solutions we have. Many health-care systems already use a standard for managing and presenting health record data, called Fast Healthcare Interoperability Resources (FHIR). The CDC has a new FHIR-based tool that can automatically generate covid-19 case reports using new test results and electronic patient records. The tool could send those reports to health departments on its own, without human oversight. An initial version is already available.
Erich Huang, the assistant dean for biomedical informatics at the Duke University School of Medicine, says it’s vital for different health-care computer systems to be able to work together. The nonprofit Logica has put out an open-source interoperability platform designed to make it easier to collate and organize all covid-related clinical data for all health systems. “I think people should embrace that, and start mapping their data into that format,” he says.
What is important, Miri emphasizes, is that these platforms be flexible enough to handle regular updates and changes: “As we continue to learn more about covid-19, we’re learning more about what critical data ought to be reported.” The CDC, for instance, just added 15 new elements to its covid-19 case reporting form. “We need to be ready to build the plane in flight, so to speak,” he says.
Other solutions are more simple. Donald Thea, a professor of global health at Boston University, suggests you could theoretically use a smart device that tracks PCR tests as they happen and sends results straight to the local or state health department as soon as they are in, without the need for a human to read that information and enter it manually. Any clinics that haven’t already adopted cloud-based electronic health records ought to do so—and if they’re nervous about such a drastic move at such a chaotic time, they could limit it to covid-19.
Eric Perakslis, a biostatistician at Duke, led efforts in West Africa during the Ebola outbreak in 2014 and 2015. He says the biggest lesson he learned was that “getting on the ground sooner with something smaller was more valuable than waiting for something bigger later.” Even if you’re left trying to standardize testing data with pen and paper and just a few people, that’s better than holding out for a “killer app” to hit the market in several months.
Most experts agree that in an ideal situation, the federal government would lead the management of public health data for a crisis like this—but that is highly unlikely to happen. Given that some models suggest we’ll need to implement response measures against the pandemic into 2022, though, Miri doesn’t think it’s too late to push forward a national initiative. It’s just a matter of funding such measures, and persuading states to accept more oversight. That’s not always an easy sell, but the pandemic’s effects may have softened state officials up a bit.
“It may take us 24 to 36 months,” says Miri. “But if you don’t start today, when the next thing hits we’re still going to be sitting here like we did during Ebola—in which a portion of people have reasonable processes, and half are using Excel. We can’t do this anymore. We have to get our act together.”