Nearly every aspect of our health care system – from risk identification to delivery to government policies to our health IT infrastructure – are all undergoing major changes as a result of COVID-19. Regulatory relaxation and updated compliance demands as a result of the Coronavirus Aid, Relief, and Economic Security Act (CARES), other federal legislation, federal executive orders, state governors actions, and state 1135 Medicaid waivers have created complexities and intricacies that providers, payers, government, researchers, consumers and other health care stakeholders have had to respond to very quickly. To execute effectively, we need actionable information, the basis of which is accurate, reliable data and the infrastructure by which to collect, analyze and disseminate that data in meaningful ways.
We need data and health IT infrastructure to address the who, what and how during these current unprecedented times and as we enter our new “normal.”
The who must include data on those infected, those at risk, and those testing negative
The COVID-19 “risk” population must be identified and tracked for social distancing, testing and other prevention measures, including segmenting those who have been exposed and those who have not. Those who have COVID-19 need to be identified and tracked for tracing, treatment, confinement, and to identify longer-term health impacts that are not yet known. Non-COVID-19 patients need to be identified and tracked to provide future immunizations and other prevention measures. As the pandemic evolves over time, previously uninfected individuals may also become infected, complicating identification and tracking strategies. And all individuals need to be identified and tracked to address health care needs that have been delayed or forgone as a result of the pandemic.
The what must include new treatments, new payment policies, and new data linking capabilities
From an operational perspective, current data infrastructure – with its gaps and limitations – must be expanded to accurately cover new treatment modalities and new interpretations of what is within the scope of services for various public and private payers– particularly in the realm of telehealth. Implementing new payment rules for additional types of services requires new coding (beyond the new COVID-19 ICD-10 code) and new data elements to be incorporated into payer and provider systems. Data and infrastructure are needed to link, analyze and potentially pay for services in context of social and clinical determinants relevant to the health of the individual and population. For example, in the case of COVID-19, social and clinical determinants include age, current medical status with specific diagnoses, location, and other data that must be examined together rather than separately.
The how must incorporate new data use and governance policies
New entities and old entities in new ways have become involved in the delivery of care with a growing emphasis on supply chain management, logistics and resource management. At the federal, state, community and organizational level, infrastructure to support data collection and use is required to validate and accurately document how well individual and population needs related to access, quality and financial oversight were addressed. We have changed how we deliver care. “Care at a distance,” remote monitoring, and consumer tools are rapidly becoming part of the healthcare landscape. COVID-19 has accelerated the move by Medicare and private insurers to pay for video and telephone visits and for many providers and patients these changes are celebrated. Thus payment and licensure barriers must be addressed – not for just the COVID-19 response – but for the new normal that will follow.
All of these changes will both require and result in new data sources as well as new uses of old information sources such as public health, claims, clinical, and administrative data. This will in turn require new techniques for data extraction, curation, liquidity, analysis, and use. With the abundance of this new data, mobile applications and other digital technology will be needed. Data will need to be aggregated and analyzed, applying business intelligence technology and made available for business and clinical operations, intelligence as well as public health surveillance and research uses. Finally, data must be transformed through visualization and be disseminated in ways that a broad range of users, including the public, can use it.
The “who, what and how” data and infrastructure needed to address our strategic and operational clinical and business COVID-19 demands are immediate – and need to sustain beyond COVID-19. Each element must be addressed individually and as inter-connected pieces of a bigger data ecosystem puzzle in terms of content, context and completion.