Massachusetts is renowned for its wealth of healthcare data and analysis, with a strong infrastructure in place to regularly collect information from providers. However, even this infrastructure was not designed for the unprecedented data demands of the pandemic.
Survey respondent: “While information management in the commonwealth has improved in the past two years (outpacing many other states in the U.S.), the road to get where we are has been long and tedious, and there is much work to be done to ensure preparedness for future events.”
KEY FINDINGS
Establishing common definitions requires close collaboration.
Given that existing systems were not designed to collect data at the scale and pace needed, the state worked closely with MHA and healthcare providers to standardize data definitions (such as specific bed types, staffed beds, and surge beds). This system became complicated by new reporting requirements from the federal government, making further adjustments necessary. To reduce the administrative burden on providers, the state served as a clearinghouse for the collection of data that went to the federal government on behalf of all organizations.
Nuanced data was difficult to convey.
Even with agreement on standard definitions, data collection did not enable facilities to capture and report their specific capabilities. Bed capacity measures cannot capture the difference in the skillset or care services available at each institution, such as extracorporeal membrane oxygenation (ECMO). These nuances can be critical to patients in need of specialized care.
Existing systems were not built for real-time data analysis.
Widely used platforms required manual daily data entry, placing a heavy administrative burden on staff — especially within smaller facilities. They also could not produce real-time data, which posed challenges in making urgent, dynamic assessments and decisions. In addition, a lack of regional dashboards and situation awareness tools made rapid decisions even more challenging.
Collection of health equity data is essential.
Within the initial wave, there was a need to track and report COVID-19 data by race, ethnicity, zip code, age, and other important categories. Both the state and healthcare organizations implemented these measurements into their regular reporting structures.
Tracking social determinants of health data, such as reliance on public transportation and the prevalence of multigenerational and multi-family homes, would have identified disenfranchised populations sooner and allowed for a more targeted response.
RECOMMENDATIONS
Invest in improved emergency data infrastructure.
Massachusetts needs to invest in a robust statewide information management system for data collection, analysis, and dissemination to rapidly support the healthcare system’s response to emergencies. Such a plan needs to be adaptable enough to address the full spectrum of possible public health emergencies, and simple enough to be meaningful in content, integrity, and value to stakeholders. The data elements needed to measure and manage the breadth of disaster events must be prospectively identified. Those elements must be built into data collection systems, and reporting capabilities must be capable of meeting the predictable needs of frontline and governmental leaders. Data collection efforts should be expanded beyond hospitals and health systems to the broader healthcare continuum, including long-term care facilities, home care, rehabilitation hospitals, and behavioral health facilities.
Establish a real-time situation awareness tool.
A robust, dynamic situation awareness tool to capture critical resource metrics would be ideal. Such real-time information would allow for rapid analysis, actionable insights, patient movement, and the allocation of resources. Core data elements that are applicable to a broad range of emergencies – like bed capacity and availability – could be supplemented with emergency-specific data elements and facility capabilities. These data are required for the effective functioning of medical operations coordinating centers (MOCCs). MHA and its members are currently exploring potential tools to support such a system.
Funding is required to tackle the uphill battle of implementation, security, sustainability, and interoperability with varied electronic health records. Accordingly, investments in training, resources, and capabilities across the care continuum are needed to better prepare for the next public health emergency.
Standardize definitions at the state and federal level.
Coordination is needed between the federal government and all states to establish critical standard definitions for reporting purposes. Organizations should familiarize themselves with such definitions and seek to align their internal vocabulary with the broader consensus. Nuances in terminology across the care continuum and for specialized facilities should be recognized and highlighted.