At the onset of the COVID-19 pandemic, it became clear that existing public health tracking systems needed more insight into the healthcare system to effectively track the transmission of the virus. Experts weighed in on how to best support this cross-sector data exchange, and syndromic surveillance was brought to the forefront of the conversation.
According to the Centers for Disease Control and Prevention (CDC), syndromic surveillance provides public health officials with a timely system for detecting, understanding, and monitoring health events. Syndromic surveillance emphasizes the use of near real-time pre-diagnostic data by tracking symptoms of patients in emergency departments, before a diagnosis is confirmed.
Syndromic surveillance data helps public health officials monitor and respond quickly to public health threats and events. For example, syndromic surveillance data is currently leveraged as an “early warning” mechanism for response to other health concerns, such as opioid overdoses and lung injuries associated with e-cigarette and vaping products.
At the most crucial time when the pandemic began rapidly spreading in spring of 2020, health information technology tools, called Admit, Discharge, and Transfer (ADT) feeds, were leveraged for public health use to provide more insight into health trends, utilization, and community transmission. Beyond enhanced visibility and care in the everyday setting, improved access to real-time data for syndromic surveillance and public health reporting impacts how community leaders respond to health trends, while providing adequate attention to underserved communities.
This blog will provide an overview of expert recommendations for using ADT feeds for syndromic surveillance data and how health information technology has pivoted to further support syndromic surveillance, care transitions, and public health reporting for COVID-19 patients.
How ADT Data Can Be Used to Initiate Hospital Alerting for Syndromic Surveillance
State and county public health departments often receive syndromic surveillance data feeds from hospitals and urgent care centers. However, these feeds may not fully capture the syndromic and diagnosis information needed for an effective response. The COVID-19 pandemic highlighted a need for more cross-sector collaboration and data exchange to quickly modernize an outdated syndromic surveillance system. To do this, healthcare and public health professionals have recognized the functionality of ADT technology used in everyday healthcare settings, to provide real-time clinical information and inform surveillance and tracking efforts.
While ADT data has primarily been used to support care coordination needs for individual patients, its versatility also supports public health use cases, such as the ability to identify potential outbreaks of COVID-19 through an influx in hospital and emergency room (ER) admissions. ADT feeds send data elements—including presented symptoms, diagnosis, sending facility, patient age, gender, race, city, and zip code—which can be crucial for syndromic surveillance efforts when detecting and characterizing unusual activity.
The topic of ADT feeds is not a new one, and the COVID-19 pandemic brought another reminder of the need for real-time data. As noted in a Health Affairs article, many hospitals only recently adopted and built ADT feeds over the last 5 to 10 years. If this adoption had occurred earlier, the authors noted that “local providers and public health agencies would be better able to track and coordinate local ER and bed utilization amidst a COVID crunch.” As the healthcare and public health sectors seek to improve syndromic surveillance, there has been innovative conversations about how health IT can better support the COVID-19 pandemic and future public health emergencies.
As early as April 2020, a report from the Duke Margolis Center for Health Policy, titled “A National COVID-19 Surveillance System: Achieving Containment,” proposed recommendations for more effective public health programs and syndromic surveillance efforts. Recognizing that the transmissibility and virulence of COVID-19 necessitates an increased capacity for timely and efficient surveillance, the report called for ongoing coordination between healthcare providers and local public health authorities. To achieve this, the report proposed utilizing timely electronic data, like ADT feeds, to expand syndromic surveillance data systems and monitoring to create more specific groups, with clinical observations, hospital admissions, ICU transfers, and extended surveillance of age and symptom distribution. The report notes that modernizing syndromic surveillance using electronic health data like ADT feeds would align with the CDC’s vision for a modernized public health surveillance system and support ongoing, systematic testing using advanced molecular testing for a broad range of conditions to ensure rapid response capabilities throughout the United States.
Additionally, in the “State Strategies to Advance Health Data Interoperability” whitepaper published in March 2021, the National Governors Association (NGA) suggests leveraging ADT feeds to inform public health authorities when influenza-like symptoms appear. According to the NGA, this would support ongoing monitoring, which could serve as an early warning of potential increases in emergency room visits, urgent care visits, and symptoms that may appear in nursing homes.
Utilizing electronic health data and electronic health information technology to support public health and other sectors like emergency preparedness is becoming increasingly applicable. For unique situations like the COVID-19 pandemic that require cross-sector collaboration on local, state, and national levels, the intersection of health information technology and public health is a necessary step towards better health security.
How ADTs Enable Better Public Health Reporting
In reports and recommendations, the use of ADT feeds for syndromic surveillance has been talked about in an abstract manner, as the way healthcare and public health systems should communicate and facilitate the collection of data. This was due in part to a lack of specifics or use cases early in the pandemic. Despite the stress placed on the healthcare and public health systems, the evolution of health information technology has allowed ADT-based solutions to fill a critical gap for local, tribal, state and federal public health departments to better communication and respond.
During the pandemic, Audacious Inquiry has experienced more demand for reporting and data sharing with health departments and federal agencies where response time is critical. Using the ADT-based Encounter Notification Service® (ENS®), public health departments receive supplemental clinical data, such as underlying diagnoses, for known and suspected patients with COVID-19. They can also elect to receive real-time alerts regarding the health care utilization of these patients to better understand the progression of disease and track patient encounters within the health care system.
All Audacious partners were able to quickly utilize ENS in their COVID-19 pandemic responses to improve syndromic surveillance systems and update public health, state, and federal officials with real-time alerts regarding the health care utilization of COVID-19 patients. The examples below illustrate some of the ways that ADT data has been used throughout the pandemic.
Chesapeake Regional Information System for our Patients (CRISP): The Chesapeake Regional Information System for our Patients (CRISP) used ENS to provide COVID-19 hospitalization data to the Maryland Department of Health, notify providers of patient COVID-19 testing results, and inform daily statewide understanding of hospital volume by delivering up-to-date hospital utilization data.
Louisiana Hospital Association: The Louisiana Hospital Association was another partner that Audacious supported in their COVID-19 response through ENS. The service transmitted real-time notifications for positive tests or hospitalizations after initial diagnosis to providers and public health officials, in addition to tracking admit, discharge, and transfer events. ENS also helped Louisiana Hospital Association access 120-day prior utilization history of positive patients, allowing for better informed care and faster transfer decisions without having to go through prior-authorization for transfers to skilled nursing facilities—thereby freeing up inpatient beds. As a result, Louisiana Hospital Association and public health officials were able to better understand healthcare utilization patterns and conduct disease investigations.
ADT and Syndromic Surveillance Data: Companions in Combating COVID-19 and Future Crises
Tools used in everyday care coordination, like ADT feeds, can play a much larger role in public health than originally anticipated. As the United States prepares to continue to combat the COVID-19 pandemic and future public health emergencies, the need to facilitate and encourage cross-sector innovation will help to better prepare state, local, tribal, and federal entities to be able to conduct syndromic surveillance and mitigate the next public health crisis.
About the Authors:
Michelle McCoy is a creative communicator that has worked with technical B2B companies for over a decade. She supports Marketing, PR, and Design for Audacious Inquiry, a national industry-shaping health IT company. You can connect with her @NxtLvlBranding on twitter.
Diana Bauza is a content writer based in the Greater Philadelphia area. She writes about products and services in the health and technology industries, with the goal of empowering consumers with quality information to help them make decisions that best serve their needs.
Donner-Klein previously worked as an Associate at Sirona Strategies where she focused on a variety of health policy issues including Medicare and Medicaid, value-based care, health information technology and interoperability, telehealth, and the social determinants of health. In addition to her policy and regulatory work, she worked as the communications manager to redesign and run coalition websites, strategic communications campaigns, and thought leadership through events and newsletters.