By Minakshi Tikoo
Our nation’s COVID response is a failure of the U.S. public health system. Last Friday, the pandemic reached a grim milestone: 700,000 coronavirus-related deaths have now been reported in the U.S.
I happened to be in New York during the pandemic, working as the Assistant Commissioner of the New York City Department of Health and Mental Hygiene (DOHMH), and experienced the failure of our health system firsthand.
As COVID-19 ravaged across the U.S., fragmented and inaccessible data led to an infrastructure bottleneck, resulting in degraded health information, gaps in care coordination, medical errors and highly-burdensome workflows. Lack of comprehensive, accurate medical data impaired our response at local, state and national levels. The virus not only exposed interoperability issues, but also the need for accurate patient matching and identification.
With the pandemic still at large, faults in the ability to accurately match patient records are obstructing the road to recovery. Providers need access to the full picture of every patient they treat, and epidemiologists need to consolidate data from multiple sources to track the spread of the disease and determine where more aggressive containment strategies need to be employed.
What most surprised me during tenure at NY DOHMH, was just how little our nation’s public health departments know about their populations—despite the fact that they have registries for birth, death, diseases, immunizations, and vaccinations. Difficulties in testing, tracking and tracing could have gone a lot smoother if we had a way of unifying data and identifying individuals in a uniform way, through an Enterprise Master Person Index (EMPI).
The demands of COVID-19 have amplified the need for having robust identity management solution in place to seamlessly match and unify data across a technologically diverse healthcare environment. An EMPI aggregates and organizes critical health information to empower providers with a longitudinal patient record for coordinated and informed care decisioning.
Let’s try to enumerate how an EMPI could have assisted in mitigating the technology failures associated with COVID response, from testing and vaccinations, to contact tracing and mapping community spread. At the base of any healthcare interaction is an appointment or registration system. Simply put, an individual must schedule an appointment to obtain a service, such as a test or a vaccine. Public health systems need to ensure that the right person shows up at the lab or care provider, that we administer the correct test or service, and capture the data accurately.
At the end of the day, we want to report accurately in verifiable ways how many people were tested and how many vaccines were administered. We also want to report counts of people served and stratify our reports by race, gender, ethnicity, type of vaccine, no. of doses, race, age-group, zip code, etc. Somehow, after living through the embarrassment of failing to register people at the exchanges ten years later, we are still unable to register people in a logical manner and our systems do not work.
For example, NYC created multiple appointment and registration systems that did not talk to each other so there was no way of knowing if people had booked multiple appointments and consequently had taken multiple slots, thus impacting the efficiency of the system. The test-based alert system sent over 20 reminder messages that were unclear and confusing, they had a helpline that was unhelpful. Initially, almost 50 percent of the demographic data was missing, that improved over time as NYC DOHMH decided to require reporting of demographics from all partners that were involved in administering the vaccine. NYC DOHMH does not have a standards-based immunization registry.
How can the largest public health department in US not have a standards-based immunization registry and lab systems? If they had had a functional EMPI, they could have used it as an integrator so that all the data for an individual would have been linked, and later facilitate the issuing of a vaccine credential or passport. Additionally, the EMPI could have consumed data from the DMV, NYC ID system, and other public and government systems to create a comprehensive list of all New Yorkers that needed vaccinations—as aggregation and matching are key capabilities of an EMPI solution. Getting proof of vaccination can be a challenge if a person loses the paper-based handwritten card with the CDC logo as many systems do not have easy mechanisms to reissue a card as not all information made it into the system. Even today data is missing about what vaccination was administered to whom. All this could have been averted if instead of creating clucky IT solutions, we had used a stable EMPI solution to locate people and spent our energy on planning for a better service experience for our citizens.
Also, the social media campaigns to promote vaccine uptake are mostly ineffective and we continue to use techniques and strategies that are not working. Despite the needle moving very slowly on vaccine uptake, we continue to waste public funds by using messaging channels and running social media ads that are making little to no difference. Again, if we had an EMPI we would be able to deliver individual and person-centered messages that might work better, as EMPI captures address and point-data Above all we should be evaluating all these approaches to assess whether the person-centered approaches worked better than the large media campaigns.
Lastly, we learned that people do not trust the government and agencies of government services. This diminishing trust in governments is not just a US, but a global phenomenon, based on a recent study published in Health Affairs based on data collected in 2018. Given that the trust in governments was low in 2018 with no COVID pandemic in sight, it is important for public health departments to evaluate their strategy for vaccine messaging. Federal, state, and city governments are spending a large proportion of their COVID budgets on public health messaging that is wasteful and does not demonstrate a return on investment. These funds can and should be targeted strategically, and an EMPI can help appropriately target messages to the unvaccinated, while also delivering on the mission of public health, to “prevent disease, prolong life, and promote health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.”
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