What GAO’s Work Shows
GAO’s prior work identified three broad challenges to public health data management and recommended actions for improvement.
- Common Data Standards
To ensure that information can be consistently reported, compared, and analyzed across jurisdictions, public health entities need a standardized data format. Due to the lack of common data standards, information reported by states about COVID-19 case counts was inconsistent. This in turn complicated the ability of the Centers for Disease Control and Prevention (CDC) to make comparisons. Public health representatives also noted challenges in collecting complete demographic data. This made it difficult to identify trends in COVID-19 vaccinations and the number of doses administered. Although CDC had intended to implement data standards, its strategic plan did not articulate specific actions, roles, responsibilities, and time frames for doing so.
- We recommended that HHS establish an expert committee for data collection and reporting standards by engaging with stakeholders (e.g., health care professionals from public and private sectors). This committee should review and inform the alignment of ongoing data collection and reporting standards related to key health indicators.
- We recommended that CDC define specific action steps and time frames for its data modernization efforts.
- Interoperability among Public Health IT Systems
The inability to easily exchange information across data collection and other data systems creates barriers to data sharing and additional burdens on entities that collect and transmit data. During the early stages of COVID-19, the lack of IT system interoperability caused health officials and their key stakeholders (e.g., hospitals) to manually input data into multiple systems. In addition, some state health departments could not directly exchange information with CDC via an IT system. This led to longer time frames for CDC to receive the data they needed to make decisions on the COVID-19 response.
- We recommended that, as part of planning for the public health situational awareness network, HHS should ensure the plan includes how standards for interoperability will be used.
- Lack of a Public Health IT Infrastructure
The timeliness and completeness of information that is shared during public health emergencies can be impeded by the absence of a public health IT infrastructure. During the early stages of COVID-19, some states had to manually collect, process, and transfer data from one place to another. For example, a state official described having to fax documents, make copies, and physically transport relevant documents. The official noted by establishing a public health IT infrastructure, such as the network HHS was mandated to create, errors would be reduced. To help mitigate challenges in data management for COVID-19, HHS launched the HHS Protect platform in April 2020. However, we reported that public health and state organizations raised questions about the completeness and accuracy of some of the data.
- We recommended that HHS prioritize the development of the network by, in part, establishing specific near-term and long-term actions that can be completed to show progress.
- We recommended that HHS identify an office to oversee the development of the network.
- We recommended that HHS identify and document information-sharing challenges and lessons learned from the COVID-19 pandemic…
