April 16, 2020
Maverick’s Update
Only What Matters on Health Information Policy
Maverick Health Policy is looking at the data and technology needed to make possible the evolving plans to re-open parts of the country by reducing C19-related restrictions.
The White House plans to release guidelines on April 16, 2020 to inform states on how to relax C19 restrictions and reopen businesses, but will leave the decisions to governors and mayors to make decisions that is best for their communities. Business leaders told President Trump this week that a dramatic increase in C19 testing was necessary for a re-opening, which echoed what Dr. Fauci, the head of the National Institute of Allergy and Infectious Diseases, said a day earlier.
Test, Trace, Isolate. An analysis by the Johns Hopkins Center for Health Security found the country may need 100,000 contact tracers, which would cost an estimated $3.6 billion. Contact tracing is a process, explained by this helpful NPR article, designed to halt the chain of transmission of an infectious pathogen.
CDC Director Robert Redfield is working on a “very aggressive” contact tracing plan, but the first step (again) is to expand testing that provides rapid testing results. Dr. Redfield’s “very aggressive” plan echoes the ideas in a “surveillance roadmap” published by former FDA Commissioners Scott Gottlieb and Mark McClellan and former ONC leader Farzad Mostashari on April 7th, that emphasizes the need for rapid electronic reporting and interoperable data sharing. This NPR article helps explain exactly how contact tracing would work.
This is an amazing list of the technologies being used by health organizations, governments, and digital health vendors to address COVID-19 issues, like the Apple-Google announcement of their contact tracing app, Facebook’s news alert services and health tracking maps, and start-ups that are helping to track the disease.
One Thoughtful Paragraph
If we assume that the linchpin of these re-open America proposals is sharing nation-wide lab results ASAP, then the “create a digital short form and make all labs report their test data on it to the CDC” suggestion by Harvard and Yale public health experts (in this April 14th Health Affairs blog post) is particularly timely. They say that every private, academic, and public lab doing C19 testing should use the electronic form -- which will at least gather the relevant social and clinical data -- to make a public health surveillance system possible. Makes sense. What’s interesting, and kind of terrible, is that the CDC was all over this and reported what it was doing on January 27, 2020 at the annual ONC meeting. The CDC Chief Public Health Informatics Officer reported on the RWJF-funded Digital Bridge collaboration project to improve public health data exchange. The CDC Entrepreneur in Residence was excited because the Public Health Data Modernization Initiative got $50 million from Congress late in 2019 to make sure the CDC gets “data that can move faster than the disease.” One CDC public health analyst, after spending a few years of his life updating the CDC database that maintains all the public health surveillance systems, registries tools, and data assets, reported his findings, saying that a standardized FHIR API like the one proposed in the ONC interoperability rule would make surveillance and reporting so much easier. He concluded that “public-driven health care reporting is complex.” Right, and it costs a lot more than $50 million to make it better.