The blog of the Urban Institute
April 21, 2020

Six Opportunities to Improve Health IT Infrastructure to Address a Public Health Crisis

On March 29, Vice President Mike Pence sent a letter to hospital administrators (PDF) requesting hospitals to email the number and results of COVID-19 tests performed each day to the federal government. Without the national IT infrastructure to automatically track tests performed in hospital laboratories, self-reporting by hospitals was the best solution, even though it will likely result in slowed and incomplete data.

Test tracking is just one example of how the COVID-19 pandemic has revealed an opportunity to improve the United States’ health IT infrastructure to address a public health crisis. We identified six additional opportunities for improvement from the health IT literature:

1. Information exchange with public health registries

Health information exchange brings improvements in care delivery as well as cost reductions, but there are still many barriers to efficient flow of information between health care and public health entities. Connecting health care providers and public health systems, such as disease or immunization registries, often comes at a high cost, partially because regulations vary by state and require connections outside of a provider’s health care system. Information sharing between health care and public health does not happen automatically, which complicates real-time tracking of COVID-19-related diagnostic testing, morbidity, and mortality. 

2. Data exchange within the health care system

Competition between health care systems and between health IT product vendors  make it challenging for hospitals to access outside information on patients admitted during the pandemic, and variation in data standards hinders the usefulness of the information exchanged. For vulnerable patients with underlying conditions, information exchange is critical so hospitals can coordinate care with patients’ regular providers. 

3. Ease of use by clinicians

Many providers point to challenges integrating electronic health record (EHR) use into their workflows, including significant time demands and burnout. Counterintuitive design and limited provider training can make needed information, such as lab results, difficult to find and interpret. With surges in demand for health care, these difficulties could slow clinicians who need to efficiently order tests, provide treatment, and access relevant lab results and other patient information. 

4. Telehealth

Interest in telehealth has increased because of COVID-19, yet there is evidence that the demand for telehealth services might not be met by the current telehealth capacity. Given shortages of health care providers in rural areas, telehealth capabilities have been an important bridge for health equity. Telehealth has now become critical to the general population by allowing people access to care while staying at home. In addition to the technology needed to provide telehealth services, mobile and remote access to EHRs can allow clinicians to provide care across multiple locations. 

5. Clinical decision support

As understanding of COVID-19 develops and shortages in medical capacity continue, EHRs can provide alerts with clinical guidelines and identify particularly at-risk patients. Clinical decision support systems have shown significant contributions in identifying and treating other diseases. These alerts can support evidence-based care and help providers make difficult decisions in prioritizing use of resources.     

6. Data analytics and population management tools

These tools were previously used to help health systems succeed under value-based payment. Data from health information exchange can be used in population management, especially during a public health crisis where people might seek care from different providers because of higher stress on the health care system. Additionally, they may also be used to track medical supplies and identify areas of greatest need, informing how best to distribute medical equipment, such as ventilators

Improvements in these health IT capabilities, whether initiated by the government or private sector, will make our nation’s health IT infrastructure more effective both for regular care and public health crisis response. The COVID-19 pandemic has brought to light some limitations in our nation’s capacity to share and use health information, and improving our ability to use real-time data to address a public health crisis is critical.

A nurse using a computer at Mount Sinai Medical Center. (Photo by: Jeffrey Greenberg/Universal Images Group via Getty Images)

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