Barriers to hospital electronic public health reporting and implications for the COVID-19 pandemic: the authors’ reply

“We agree that the current level of interoperability between hospitals and public health agencies is not at an ideal level, even under normal circumstances, and critical infrastructure gaps have been laid bare as a result of the COVID-19 pandemic.

[..] We suspect that, when citing barriers to public health receipt of data, hospitals are not referring specifically to the pure technical capability (which the letter indicates exists at a broad level). As with any interoperability effort, functional interoperability requires the technological capability to send and receive data alongside the nontechnical factors such as data governance, incentives to share electronically, a clear onboarding and testing process, and more.

[..] We suggest that 1 possible strategy going forward is for public health agencies and hospitals to publicly list their electronic exchange partners, similar to how health information exchange organizations publicly list participants. This may help both clinical and public health organizations better understand who is successfully sharing data, enable both parties to engage in peer learning and best practice dissemination, serve as an accountability mechanism for all parties, and allow researchers to differentiate between stated ability to send and receive data electronically and actual connectivity in practice. Secondarily, national surveys of public health agency informatics infrastructure and capabilities should seek to capture more detailed data than they have historically, which has thus far prevented insight into such basic questions as regional variation in capabilities, much less the geographic or proportional scope of connectivity for a given public health agency.

We applaud public health agencies’ hard work on building electronic case reporting capabilities through platforms such as AIMS [Association of Public Health Laboratories Informatics Messaging Services]. However, it’s important to note that the AIMS service is primarily facilitating data exchange between public health laboratories and public health agencies, not from hospitals or other clinical exchange partners. This underscores the complex nature of interoperability for public health surveillance, which frequently involves local and state agencies establishing and maintaining bidirectional interoperability with multiple exchange partners of many types.”

Full authors’ reply to a letter to a critique of the authors’ original article published in June 2020. Holmgren AJ, Apathy NC and Adler-Milstein J. JAMIA 2020.10.1