December 22, 2020
Last week health care workers and long-term care residents began receiving the Covid-19 vaccine. Within months, the vaccine will reach nearly every jurisdiction in the country. It’s a historic public health mobilization, but also a rare opportunity to strengthen our health infrastructure.
If we take advantage of this opportunity, the country will not only be better prepared for the next health crisis, but more effective in addressing persistent health system challenges, such as disparities in outcomes and quality and affordability of care.
There are many areas where action is needed, but three stand out for the benefits they can bring to the vaccine distribution effort now and to the health system over the long term.
The importance of conveying accurate and timely information to providers has rarely been more clear. Clinicians need to understand how to store the vaccine, administer it, report on it, integrate it into their workflow and electronic health record systems, and communicate about its effect so patients know what to expect. And they need to do much of this work within a few short weeks.
Yet information and support channels for providers aren’t only needed in times of crisis. As federal and state governments continue advancing initiatives to curb costs and improve quality, these channels become increasingly important, especially for small to mid-size independent practices, which are less likely to have assistance keeping up with complex regulatory and administrative requirements from different sources.
The solution is to leverage networks at the state level who serve as trusted advisors to providers. Such local networks, which are often quality improvement organizations with local knowledge or regional extension centers affiliated with government health agencies, are effective in conveying this information through direct provider outreach, professional association outreach, online portals of information, peer-to-peer sharing, and direct technical assistance.
These resources are currently deployed for specific initiatives, but they are a necessary part of a robust health infrastructure that advances overall quality of care and efficiency and effectively responds to public health crises. And in the current Covid crisis, they could also be helpful in collaborating with local public health and state immunization programs.
The country currently has a strong system of reporting immunization data. Each state has an immunization registry where information about who has been vaccinated is reported from local pharmacies and health systems up to the state. This is due to years of work and commitment at the federal and state level to build, connect, and maintain these systems.
While the immunization registries aren’t perfect—for example, they may be limited in the level of detail they can report and data often isn’t shared across state lines—they can reliably and quickly report the most critical information, such as an individual’s consolidated immunization history and a set of personalized recommendations of needed vaccines.
But the same isn’t true for broader public health reporting. The HITECH Act and Promoting Interoperability programs have led to wide adoption of electronic heath records, but we’re still behind in overall interoperability needed to quickly and reliably report important public health data. This was clear at the beginning of the pandemic where we saw limited electronic case reporting; that has since improved, but we need to extend that much further, such as to vaccine adverse event reporting.
The solution is a standards-based interoperable system. Too many smaller labs, pharmacies, provider practices, and long-term care facilities are still unable to efficiently report data to states because of inadequate funding, lack of technical assistance, and slow adoption of existing standards. Some of these entities are even reporting data via fax or telephone.
Federal agencies should encourage the development and implementation of detailed standards for exchanging electronic health information, such as FHIR standards and the Electronic Case Reporting or eCR standard, and support states through funding to carry out the work and maintain the systems.
As the vaccination operation unfolds, it will be important to monitor its roll-out to ensure equity in how the vaccine is distributed across populations; evaluate and assess gaps in information and vaccine distribution; and understand what is working, under what context, for whom, and where.
If we formally institute evidence-based evaluation methods in the health system, we can be more effective in addressing the deepest health disparities and challenges, from substance use disorder and diseases of despair to maternal mortality and chronic conditions of our aging population.
All three of these actions—provider education, public health interoperability, and evaluation—also reinforce each other. If providers are better equipped with information, they can spend more time delivering high-value care and less time on administrative and reporting functions. If health systems are interoperable, they can coordinate care and obtain data needed to inform evaluations. And with strong evaluation methods, we can pinpoint where interventions are needed most.
This crisis presents an opportunity to formalize these systems. If we act, we can finish building a system that will improve public health and health care—particularly for those most at-risk and disenfranchised—for generations to come.
Vice President, Population HealthAreas of Expertise
Tara Fowler leads Altarum's population health work, including in the areas of community health, applied research and analytics, and delivery systems transformation. She has led a variety of multifaceted quantitative and qualitative research projects that deliver insights to leaders of government health agencies, from the Defense Health Agency to the Health Resources and Services Administration. Her recent work includes an evaluation of a HRSA-funded program implemented in 16 states to improve oral health of low-income pregnant women and infants. Tara holds a PhD in public health from the University of South Florida.
Vice President, Proposal and Opportunity ManagementAreas of Expertise
Anya Day leads Altarum’s proposal and opportunity management unit. In this role, she leads a team of business development professionals that work collaboratively with others across the organization to support identification of business opportunities, strategic partnerships, development of high-quality proposal submissions and pursuit of contract vehicles. In addition to this role, she continues to lead quality improvement projects and is the principal investigator for two AHRQ-funded projects: the Michigan Sustained Patient-centered Alcohol-Related Care (MI-SPARC) Trial and Healthy Hearts for Michigan, an AHRQ Evidence NOW: Building State Capacity award. Anya previously served as the director and board chair for a seven-state collaborative to implement CMS’s Quality Payment Program across the Midwest.