by Rachel Shepherd, specialist, Informatics
When COVID-19 cases began hitting the United States at a rapid rate in early 2020, public health was faced with an immediate and urgent need to expand testing capabilities while simultaneously trying to comprehend the ever-growing outpouring of testing data across the country. As more and more pop-up testing sites opened and testing became more widespread at nursing homes, prisons, meat packing plants, schools and medical providers, one thing became clear: CDC could not accommodate the receipt of tens of thousands of different types of reports from around the country. The daily cobbling together of disparate data—including requested reports from every single hospital in the country—was overwhelming, chaotic and incomplete. Data had to be managed and had to be current to be useful. The solution rested with state health agencies, who would have to compile and standardize testing data from within their borders into a single report every day.
For agencies trying to corral results from such a wide variety of institutions, the challenges were two-fold—the volume, first and foremost, as well as the disparity in reporting capabilities. Agencies were required to report results to CDC electronically, but were suddenly receiving data from organizations that, in some cases, had never before submitted data, much less electronically. Agencies had to start onboarding hundreds of entities within their states, all the while trying to set up the infrastructure with CDC to report everything—the spreadsheets, the faxes, the phone calls—they were receiving. The data entry required was non-stop, and everything collected had to be entered into a single report for CDC. In some cases where the National Guard was deployed to assist with response efforts, it was to help agencies with data entry.
APHL worked with all of the agencies (50 states and six territories) to develop messaging standards and infrastructure to enable the electronic reporting of COVID data rapidly. To date, millions of messages have been sent from agencies to CDC through AIMS, APHL’s messaging platform.
So how exactly is the data used?
- Informing the Public: The foundation of the information shared with the public comes from the data sent by agencies to CDC who then uses this dataset to update its COVID Data Tracker daily. Visitors to this site can find case and death count by state and county. They can look at transmission rates, compare against other localities, view laboratory testing statistics, infection among unique populations, and case count by type of location. These data are also shared with and released on CMS.gov to understand community transmission across nursing homes by county.
- Government and Policy: Submitted data are used to generate daily status updates and briefings to the Whitehouse COVID Task Force and senior leadership. The information is pulled together to create community profile reports to monitor changes in test positivity and identify hotspots, determining where action and deployment is needed.Data are also used to generate situational awareness reports to state leadership, typically shared with the office of the governor. By monitoring closely and changes in state information—increases or decreases in community positivity rates, access to testing, state leadership can assess what restrictions are needed or can be lifted.
- Research: While the data submitted to CDC are used as a valuable tool in decision making—it is such a large volume of information—it also has great potential for research uses. Data being used for research purposes include looking at data for school aged children and changes in positivity rates over time. Hospitals are using the data for forecasting and modeling.
Each and every message sent through AIMS represents a lot—a person, their loved ones, hopes and fears. In a single day, hundreds of thousands of messages are pieced together to paint a picture of our country—community prevalence, risks, needs to shutdown, possibilities for re-opening. While the COVID-19 situation is more dire than ever before, there is some relief to be had in the fact that, unlike at the start of this crisis, there are now systems and infrastructure in place. We have access to information and can use that knowledge on a national, state-wide, and personal level to make decisions about the way we live and what is safe.
Learn more about electronic laboratory reporting (ELR) and APHL’s work to strengthen ELR for COVID-19.