Latest / The SHEA Podcast / COVID-19: The Current State of Data Reporting, 9/04

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COVID-19: The Current State of Data Reporting, 9/04 · The SHEA Podcast

• 0:09
  SPEAKER_02: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:26
  SPEAKER_02: I'm Dr.
• 0:27
  SPEAKER_02: Cindy Prince and I'll serve as your moderator.
• 0:30
  SPEAKER_02: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:40
  SPEAKER_02: Shay is excited to launch this episode of the podcast, The Current State of COVID-19 data reporting.
• 0:47
  SPEAKER_02: Our speaker today is Dr.
• 0:48
  SPEAKER_02: Kristen Dascombe, Medical Director Infection Prevention and Employee Health at Intermountain Healthcare.
• 0:55
  SPEAKER_02: I'd like to turn it over to Dr.
• 0:56
  SPEAKER_02: Bannock to get us started with a brief news and guidance update.
• 1:01
  SPEAKER_00: Thank you, Dr.
• 1:02
  SPEAKER_00: Prinz, for the introduction.
• 1:03
  SPEAKER_00: Now we'll go through an update and guidance and some research that's come through over the past week.
• 1:09
  SPEAKER_00: In terms of overall numbers, in the United States, we are surpassing six million cases of COVID-19 as a country, and as of today, over 185,000 deaths in the United States.
• 1:22
  SPEAKER_00: And over the last seven days, we've had 288,000 cases of COVID-19 in the U.S.
• 1:28
  SPEAKER_00: So over the past week, the CDC has put out guidance on several different areas, one of which includes guidance for the use of rapid antigen testing, which is an area that has been of great interest.
• 1:40
  SPEAKER_00: The CDC provided broad guidance as well as more specific guidance in certain areas, like the use of rapid antigen testing in nursing homes.
• 1:48
  SPEAKER_00: What the CDC does report is that antigen testing is advantageous and that it's relatively inexpensive, can be used as point of care with a rapid turnaround time.
• 1:57
  SPEAKER_00: In terms of the overall use or considerations for use, the recommendation is that rapid antigen testing can be most helpful in early stages of SARS-CoV-2 infection when viral load is generally the highest.
• 2:09
  SPEAKER_00: Rapid antigen testing can also be helpful in situations in which there is a known exposure to a confirmed case of COVID-19, and the CDC guidance also supports their use for screening testing in high-risk congregate settings, which can allow for rapid identification of individuals with SARS-CoV-2 infection, which can be used to inform infection prevention strategies in a congregate setting.
• 2:33
  SPEAKER_00: There has also been some publications and interest surrounding immunity and moving into the area of vaccine development.
• 2:43
  SPEAKER_00: A study that was published in the New England Journal this past week from Iceland evaluated individuals who have recovered from SARS-CoV-2 infection and found that the serologic positivity, that is the presence of the antiviral antibodies against SARS-CoV-2, did not decline in four months after diagnosis.
• 3:02
  SPEAKER_00: And this included a study of 1,700 persons who recovered from SARS-CoV-2.
• 3:07
  SPEAKER_00: So I think that's brought a lot of optimism to the potential durability of the humoral immune response in SARS-CoV-2, at least in the short term.
• 3:15
  SPEAKER_00: And this allows us to transition into discussions about vaccines.
• 3:18
  SPEAKER_00: So at this point, as of today, there are three vaccines that are currently in phase three clinical trials.
• 3:25
  SPEAKER_00: And the CDC and HHS just issued a letter.
• 3:31
  SPEAKER_00: The director of CDC, Dr.
• 3:32
  SPEAKER_00: Redfield, sent a letter to leaders of state health departments urging them to initiate preparations for the ability to be operational for vaccine distribution by November 1st.
• 3:44
  SPEAKER_00: I think this is all working towards accelerating the availability of a potential vaccine in the upcoming month.
• 3:51
  SPEAKER_00: So those are our news and guidance updates for the past week.
• 3:54
  SPEAKER_00: And now we'll transition into the moderated discussion.
• 3:58
  SPEAKER_02: Dr.
• 3:58
  SPEAKER_02: Dascom, with regard to reporting, what are your roles and responsibilities at your institution?
• 4:04
  SPEAKER_01: I am Kristen Daskam and the Medical Director for Infection Prevention and Control and Employee Health for Intermountain Healthcare.
• 4:10
  SPEAKER_01: So I interact frequently with our teams in quality in our computer services folks, our data managers and statisticians, all of which support our quality reporting, our NHSN reporting, and our external public reporting, along with all the other sort of and how all that interacts.
• 4:30
  SPEAKER_01: So I'm a part of all of that for the 25 facilities Intermountain Healthcare.
• 4:35
  SPEAKER_02: And we're going to talk obviously about some more recent reporting, but what have you observed about health quality data reporting over the last several years?
• 4:44
  SPEAKER_01: Well, initially, we were a part of NHSN's surveillance.
• 4:48
  SPEAKER_01: It started out as a surveillance of multi-drug-resistant organisms and how we can potentially reduce infections.
• 4:54
  SPEAKER_01: This transitioned rapidly to pay for performance and then ultimately to external public reporting, all of which gathered the interest not just of the infection preventionist and those who were supporting patient safety, but ultimately the administrator for money reasons.
• 5:14
  SPEAKER_01: Now these measures were impacting their fees for service.
• 5:20
  SPEAKER_01: It was also impacting their public reporting and their public relations to the exterior world.
• 5:26
  SPEAKER_01: And so suddenly it was a huge part of their managerial roles and became a much bigger part of administration of a hospital in general.
• 5:36
  SPEAKER_01: It's definitely evolved rapidly over the past several years.
• 5:40
  SPEAKER_01: Further with the increase in the C diff epidemic, it's developed a lot more with interactions with antimicrobial stewardship, all of which has really put patient safety at the forefront and accelerated the importance of infection prevention and stewardship, which has been wonderful.
• 5:55
  SPEAKER_02: Yeah, I agree.
• 5:56
  SPEAKER_02: I think that was a really positive change for a lot of hospitals to really have to be accountable for what's going on.
• 6:03
  SPEAKER_02: So can you tell me a little bit more about how some of that quality data collection has changed how healthcare is delivered at your institution?
• 6:11
  SPEAKER_01: Yeah, we were 25 hospitals sort of in a collective prior to this.
• 6:17
  SPEAKER_01: And because of reporting and the requirements made, and really that the strategies required to combat, for example, C diff are similar, whether you're a large facility or a small one.
• 6:29
  SPEAKER_01: You may apply them in different ways, and you may find that your particular facility has a unique issue that you have to deal with.
• 6:36
  SPEAKER_01: But many of the basic principles are quite similar.
• 6:39
  SPEAKER_01: So we chose to centralize our infection prevention with an infection preventionist at each facility, but that all reported up, and there were central strategies, both in antimicrobial stewardship and infection prevention, that really served all the facilities to ensure that we were doing those most basic infection prevention interventions in a systematic and consistent way.
• 7:06
  SPEAKER_01: And from our hospitals, anyway, it has served us very well in terms of really ensuring that we're accountable for our patient safety, that we are implementing these strategies to our best degree, and we can monitor that over time and see where we're having problems.
• 7:23
  SPEAKER_01: And so being supported by consistent data like our reporting to NHSN, and we do whole house surveillance for all our facilities has really been an outstanding way for us to consistently see those changes over time.
• 7:40
  SPEAKER_02: And what about then the support that you get for this?
• 7:43
  SPEAKER_02: So, you know, there's a collection on the hospital's end or the healthcare facilities end of getting that data together, but how well are state and federal governments supporting health quality data collection and utilization, or are there investments where they need to be, or can we do better?
• 8:00
  SPEAKER_01: Consistently, the CDC, for my reading, has not had its funding as it's needed to for NHSN.
• 8:08
  SPEAKER_01: And unfortunately, I think that's been a suffering point for them.
• 8:13
  SPEAKER_01: I think we've had a very strict and cumbersome security portion to it, which makes it difficult to use, makes it more difficult sometimes to interact both with CDC and changing data and those sorts of things.
• 8:28
  SPEAKER_01: But overall, it's been exceptionally well validated, it's been exceptionally well managed and safely managed so that our patient data has not had any problems.
• 8:39
  SPEAKER_01: And even more importantly than that, our state and our federal entities, CDC, use those data effectively to really help us feedback to us to say, here's what we know about Clostrium difficile or central line infections, here's what we know where they are, where we're seeing places that we can intervene, like dialysis, like what are the new frontiers in C diff, and it really is being effectively communicated back to us so that we know where we can target and we can make further strides to change things.
• 9:13
  SPEAKER_01: So while they haven't necessarily been supported in terms of the technical aspects, and I think there could be a lot more we could do to support that, I think the overall process of state and federal delivery of care and support of the public health system, despite that, has been quite impressive.
• 9:35
  SPEAKER_02: Of course, we have pre-COVID-19 times and we're in the midst of COVID-19 now, and hopefully before long we'll have some post-COVID-19 to look forward to.
• 9:45
  SPEAKER_02: But what did data collection look like at your hospital at the onset of the pandemic?
• 9:50
  SPEAKER_01: As I mentioned, we did already have NHSN full house surveillance that we were doing reporting.
• 9:58
  SPEAKER_01: And for us, as we learned that we would be doing reporting, not that it surprised us, but we knew we would have to expand that.
• 10:06
  SPEAKER_01: It was not a difficult process for us to expand.
• 10:09
  SPEAKER_01: We already had we have a CERN system in place for our electronic medical record.
• 10:13
  SPEAKER_01: We could easily expand that to the given fields.
• 10:17
  SPEAKER_01: And we learned very quickly which fields they were interested in, were able to identify those fields, and then we're able to input that data with a similar platform.
• 10:29
  SPEAKER_01: It wasn't a lot of adaptation.
• 10:32
  SPEAKER_01: Again, the only issue we've had with NHSN is the cumbersome security system, but beyond that, it got both to our state and our federal level reporting and was an efficient way for us to get that done.
• 10:46
  SPEAKER_01: So it really didn't, it added a few fields, but it wasn't terribly cumbersome.
• 10:51
  SPEAKER_01: And we felt like it was important for obvious reasons.
• 10:55
  SPEAKER_02: And how were you able to work with public health officials then on interpreting the COVID-19 data to help inform some decision making and to also help with the response to cases in your area?
• 11:08
  SPEAKER_01: Yeah, I think our state did a really nice job of interpreting them.
• 11:12
  SPEAKER_01: And there's a recent MMWR article from Angela Dunn's group demonstrating how they did use it.
• 11:19
  SPEAKER_01: We had several outbreaks in various sectors of our economy in the workplace, and they utilized that data very effectively to really be able to target appropriate groups, feed that data back to us as a facilities, and say, how are we going to use this not only for planning for your facilities to ensure you know where the target spots are, but they identified that certain our in our population, it was our Hispanic population, were really having a disparity in their own care because while let's say 20% of the population of the workforce might be Hispanic, over 80% in an outbreak would be.
• 12:33
  SPEAKER_01: So there was a lot of changes that we could make with those data feeding back to us.
• 12:38
  SPEAKER_01: And I feel like both in the state and the local level, those were really used effectively.
• 12:43
  SPEAKER_01: Nationally, we are still able to get data from various sources, all mostly translated by the CDC.
• 12:51
  SPEAKER_01: And because it's validated data, we know how it's collected, we know it's confirmed in multiple ways from the laboratory to the hospital infection preventionist transmission of it, that we know we have a lot of confidence in the quality of those data.
• 13:07
  SPEAKER_01: And then when we go to do changes in our strategies, we know we're responding to appropriate data.
• 13:15
  SPEAKER_01: I think that's where, and I know one of the issues that we're going to talk about shortly is teletracking and the change to HHS reporting.
• 13:22
  SPEAKER_01: I think that's where a lot of the concerns come from, is that we don't have that level of confidence in this new system.
• 13:30
  SPEAKER_02: Yeah, so I think it's really important to talk about that.
• 13:34
  SPEAKER_02: And so for you, what happened when you received that notification that the COVID-19 data reporting had to be switched from NHSN to the teletracking system within HHS Protect?
• 13:46
  SPEAKER_01: Ours was a story of a bit of drama because I think we got that, as I recall, on a weekend, and we're told we had to have it ready for a Monday, which becomes very difficult in a very short amount of time at a time when fewer folks are in facilities.
• 14:04
  SPEAKER_01: And so it was an all-hands-on-deck really need, big need to approach this systematically and quickly.
• 14:13
  SPEAKER_01: And so we had to not only get our infection preventionists, but also our expert data analysts.
• 14:21
  SPEAKER_01: And it took a good five of them to really ensure that we had our data collected for the fields that they needed, and then validated ourselves to ensure that it was the correct data, and then ensure that we could submit it properly.
• 14:37
  SPEAKER_01: And these were it was creation of new fields, new data types, as well as new fields.
• 14:43
  SPEAKER_01: They were just slightly different than NHSN, enough that it was something that we had to figure out and ensure that we were doing it correctly.
• 14:52
  SPEAKER_01: So it was a fair amount of work, and it was definitely perspiration-inducing for a lot of us.
• 14:59
  SPEAKER_01: But we got it done.
• 15:00
  SPEAKER_01: And thankfully, we could do it.
• 15:02
  SPEAKER_01: Like I said, we had centralized for 25 facilities, we had centralized that reporting.
• 15:08
  SPEAKER_01: And so for our facilities, it was a lot easier because we had that central structure.
• 15:14
  SPEAKER_01: I can't imagine what some of our smaller facilities that are rural that have small populations that they're helping.
• 15:21
  SPEAKER_01: It would be very hard if they all had to do that individually and separately to that level of expertise.
• 15:29
  SPEAKER_01: I don't know that we would have gotten it done without that.
• 15:32
  SPEAKER_01: And so I really have a lot of sympathy for those in smaller facilities in across the country that really had to adapt fairly quickly, knowing that either CARES Act funds or remdesivir allocation might be on the line if they couldn't get it done.
• 15:49
  SPEAKER_01: I think that was a very stressful time for a lot of folks.
• 15:53
  SPEAKER_02: Yeah, I agree.
• 15:54
  SPEAKER_02: I think that added another layer of stress.
• 15:57
  SPEAKER_02: And especially we were all in different places during the pandemic.
• 16:00
  SPEAKER_02: And so there were some areas that were really still challenged with a lot of cases, and then having to make that switch.
• 16:07
  SPEAKER_02: In your experience, what kind of technical support and what kind of guidance was available to you as you were doing that switch?
• 16:16
  SPEAKER_01: You know, I'm not as familiar with the technical guidance.
• 16:19
  SPEAKER_01: We have such good data analysts that they felt that we could create this.
• 16:27
  SPEAKER_01: I think, like I said, there were some new data field and data platform elements that we had to adapt to.
• 16:34
  SPEAKER_01: And I think that's where the technical support came from.
• 16:37
  SPEAKER_01: And teletracking as a company was supportive.
• 16:40
  SPEAKER_01: They did help us, and they are a little bit easier.
• 16:43
  SPEAKER_01: I know I mentioned before that the security aspect of NHSN can be cumbersome.
• 16:49
  SPEAKER_01: This seems to be a bit less cumbersome than the other, yet still provides for security of patient information.
• 16:56
  SPEAKER_01: So it's not a terrible system, but it was the very steep learning curve in that very, very short amount of time, like you say, in a pandemic when we're already pushed to our limits, that was fairly stressful.
• 17:13
  SPEAKER_02: And how are you doing with the switch now?
• 17:15
  SPEAKER_02: So have you adjusted to it?
• 17:16
  SPEAKER_02: Do you have challenges that are continuing to persist?
• 17:21
  SPEAKER_01: We're actually doing reasonably well.
• 17:23
  SPEAKER_01: Again, we're centralized, so it helps.
• 17:25
  SPEAKER_01: I can see where people would still have challenges in terms of if you don't have consistent reporting of the individual elements, such as I know one of the things is your PPE.
• 17:38
  SPEAKER_01: We have consistent data feeds from our folks on the ground.
• 17:43
  SPEAKER_01: How many face shields do we have as a system?
• 17:46
  SPEAKER_01: Do we have enough for a week's worth, a month's worth?
• 17:50
  SPEAKER_01: And we're constantly monitoring that.
• 17:52
  SPEAKER_01: If you're a small facility, you may not have that on-the-ground data.
• 17:57
  SPEAKER_01: That could be a lot more challenging.
• 17:59
  SPEAKER_01: So I think I can see where others would have some significant challenges, especially if they're not as connected and integrative as we are.
• 18:09
  SPEAKER_02: So switching gears a little bit again, CMS recently made COVID-19 data recording on condition of participation in Medicare and Medicaid.
• 18:18
  SPEAKER_02: And do you think that the policy will improve the quality and the integrity of the data that's being submitted to the teletracking system?
• 18:26
  SPEAKER_01: I would expect that's the case.
• 18:28
  SPEAKER_01: We do full house surveillance and we're committed to doing this, especially since it was tied to our REM Desivere allocation.
• 18:35
  SPEAKER_01: And we felt like we wanted to ensure every case was counted to ensure we got as much as we could and that we needed to really support our population effectively.
• 18:46
  SPEAKER_01: If others were not, you know, reporting as extensively, if it's tied to CMS funds, it absolutely should be much more as it was when NHSN was linked to pay for performance.
• 18:59
  SPEAKER_01: So I would expect it to improve.
• 19:02
  SPEAKER_01: I think the question though remains: we don't know anything about the validity of the data going in outside of that.
• 19:10
  SPEAKER_01: We know the processes that CDC and our states go through to validate the data.
• 19:16
  SPEAKER_01: They come by and check us, they come by and make sure that we're doing it properly and that we're collecting fields properly.
• 19:23
  SPEAKER_01: We don't know the process that they're validating data in this, and we also haven't seen reports from teletracking or from HHS yet.
• 19:33
  SPEAKER_01: And so I think we're all a little concerned about the quality of the data and how it's going to be used or how it could be reported.
• 19:43
  SPEAKER_01: And thus far we really haven't seen any useful data, or at least I haven't, that I have acted upon at this phase.
• 19:52
  SPEAKER_02: Yeah, that's a concern given that you know you you talked about how you were acting upon the data before.
• 19:57
  SPEAKER_02: And so that is definitely a worry that you're not right now getting that that feedback and data to be able to act upon that.
• 20:06
  SPEAKER_02: Um, is there anything else that you want to share with our audience about COVID-19 data collection and reporting?
• 20:13
  SPEAKER_01: Yeah, I I think I think my my biggest question is if we're going to give$10 million to teletracking, which again, as I said, is a good company and they're doing an effective job of reporting at this phase, why didn't we want to support CDC funding in a job that they have done effectively and have communicated back all of that data to us so that we could take action so effectively over so many years?
• 20:44
  SPEAKER_01: These are the medical leadership that we've looked to for our guidance, for their data management and support, as well as for what our next step should be.
• 20:55
  SPEAKER_01: And at this time, we feel like we're giving data to both entities to ensure that we're all getting what we need out of it, but we're not seeing anything from teletracking.
• 21:05
  SPEAKER_01: We're not seeing validation, we're not seeing how it would work or what we should be doing with it.
• 21:12
  SPEAKER_01: And so I think we're all a little speculative, as I mentioned, and we'd like to see how it's going to be used and how we should be responding to it.
• 21:22
  SPEAKER_01: In the short term, we're going to do double reporting because we still want to support our health departments.
• 21:28
  SPEAKER_01: We still want to support our CDC and their implementation of interventions as they see fit because we know their guidance is important.
• 21:37
  SPEAKER_01: I think that's where our frustration lies, is not only in our confidence in the HHS system in terms of its validation, but also in terms of its recommendations and what are we going to do next with that.
• 21:53
  SPEAKER_01: And so I'd like to see if we're not going to have any further recommendations, could we possibly have it sent back to CDC so we can use that and have less data management and data entry for us all?
• 22:05
  SPEAKER_01: It's we're, as you mentioned, we're stressed out by this.
• 22:08
  SPEAKER_01: We're at our limits as it is to add additional data administration to our tasks really just adds additional cost and labor to our work.
• 22:19
  SPEAKER_02: Yeah, again, that'll be interesting to see what happens.
• 22:22
  SPEAKER_02: And then really, I think going forward, not that we want to have to think about this, but for future pandemic planning, I think knowing what's going to be in place at that point that is going to allow for data collection and reporting as well.
• 22:38
  SPEAKER_02: Dr.
• 22:38
  SPEAKER_02: Tuscombe, thank you so much for joining us today and for you know educating us on what you've been doing with your data collection and utilization.
• 22:47
  SPEAKER_01: We're grateful that you're willing to listen and we're hopeful that everyone's doing well during the pandemic.
• 22:53
  SPEAKER_02: Thank you.
• 22:55
  SPEAKER_02: Thank you very much to our speaker for sharing your perspectives and experiences.
• 22:59
  SPEAKER_02: And a sincere thank you from Shay to all healthcare personnel for all that you're doing to respond to COVID-19.
• 23:05
  SPEAKER_02: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 23:13
  SPEAKER_02: You'll also find resources such as the recorded webinars, Healthcare Facility Outbreak Preparedness, and the SHAY COVID-19 town hall.
• 23:21
  SPEAKER_02: Additional resources available on Learning CE pertinent to this pandemic include SHA CDC Outbreak Response Training Program, ORTP, and the Prevention Course in HAI Knowledge and Control Prevention Check.
• 23:36
  SPEAKER_02: You can now receive a 75% off SHA membership for the remainder of 2020 using the coupon code podcast during checkout.
• 23:46
  SPEAKER_02: That concludes this episode of the Rapid Response Podcast.
• 23:49
  SPEAKER_02: Thank you for tuning in.