GROUP 01

● Ancheta, Fatima Kaye

● Angobung, Kyla Geniveve
● Banaga, Princess Krenzelle
● Bauzon, Emil Felix

I. TITLE

Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals’
Challenges with Data Exchange

II. EXECUTIVE SUMMARY

The novel coronavirus 2019 (COVID-19) pandemic has revealed significant barriers to critical
information exchange between hospitals and local public health agencies. As a result, it is critical to
clarify the specific issues that hospitals may encounter when reporting to public health agencies in order
to inform targeted approaches to improve information exchange for both the current pandemic and
ongoing public health activities and population health management. The 2017 American Hospital
Association Annual Survey and Information Technology supplement provided cross-sectional data from
acute-care, nonfederal hospitals for this study. Using content analysis and the
technology-organization-environment framework, coded responses to a question about the challenges
hospitals face when submitting data to public health agencies. The researchers used multivariable
logistic and multinomial regression to identify hospital characteristics linked to the types of challenges.

According to the findings, 1,696 (61%) of the 2,794 hospitals examined reported at least one
difficulty in reporting health data to a public health agency. Organizational issues were the most
commonly reported type of challenge by 1,455 hospitals, and public health agency general resources
were the most commonly reported specific issue by 1,117 hospitals. Participation in a health information
exchange and an advanced EHR system both increased the likelihood of reporting an organizational
challenge while decreasing the likelihood of not reporting a challenge. The findings have been used to
make policy recommendations such as improving data standards, increasing funding for public health
agencies to improve their technological capabilities, offering workforce training programs, and clarifying
policy specifications and reporting. These methods can help hospitals and public health agencies share
information more effectively.

However, the study has a limited ability to detect changes in technological adoption rates over
time. There are no public health organizations represented in the perspectives on challenges. The AHA
IT supplement contains some confusing open-text responses. To assess the route of public health
agency informatics needs, more recent data is needed. In terms of state-level differences, the scope of
the study is limited. State and local health departments have inconsistencies in their governance and
reporting structures. According to the authors, delays in responding to pandemics are caused by a lack
of data sharing between hospitals and public health agencies. The lack of contact tracing is one of the
critical components of a successful response to the current pandemic. To enable collaboration, public
health agencies must modernize their surveillance systems.
 Understanding how the public health reporting system is governed will aid in the development of
targeted, state-specific policies to improve reporting capabilities. Despite the fact that most hospitals
have the technological capability to exchange data with public health agencies, the majority continue to
face challenges. The majority of challenges are due to the general resources of public health agencies,
though workforce limitations, technology issues such as a lack of data standards, and policy uncertainty
regarding reporting requirements remain significant issues. Ongoing funding to support technology
adoption and strengthen the development of the health informatics workforce, combined with revising the
promotion of the interoperability scoring approach, will most likely help improve the exchange of
electronic data between hospitals and public health agencies.

III. STATEMENT OF THE PROBLEM

Hospitals, in connection with public health agencies can strengthen and modernize our public health
system. Both of these contribute to the advancement of public health activities, as well as health
management in general. It is great that these are observed by numerous hospitals, however, majority still
experience challenges. It is of a well-timed thing that the COVID-19 also happened, as it can't be denied
that barriers were evident to the exchanging of information between hospitals and public health agencies.
These significant barriers are to be clarified in order to recognize what are needed to be improved,
especially for a successful response to the current pandemic. Interoperability, in this case, is a critical
matter. For us future health professionals, we see lack of progress in interoperability as a hindrance in
the sense that, it limits the information exchange to occur and also the opportunities that can be used in
order to respond accordingly to health circumstances, not to mention the current pandemic we are in.

Thus, challenges observed in this scenario can hinder the needed progress in data exchange and
reporting. On the other hand, despite the reported performance of hospitals engaging with advancements
in health reporting, public health agencies, conversely, struggle for financial incentives and policy
attention for informatics infrastructure. That unlike hospitals, public health agencies experience delays
with regard to their informatics capacity and electronic handling. These then contribute to the weakness
of data exchanging. If we look into the case, challenges like these can affect how responses can be
made, as well as miss opportunities, which can then interfere to our satisfactory health management.

Generally, most challenges encountered are specifically due to public health agencies' general
resources. With that being said, this article is relevant as it covers specially the opportunities and
challenges experienced by both hospitals and public health agencies. Thus, being able to learn and
understand what are those that slow down progress in strengthening public health informatics
infrastructure will definitely reveal what are needed to improve, and strategies and policies to develop, in
order to support necessary changes. Therefore, support to both public health agencies and hospitals is
needed to be able to vision the improvement we are aiming for a better health management to all of us.

IV. DATA AND ANALYSIS

Our findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least
one challenge in reporting health data to a public health agency. Organizational issues were the most
frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue,
reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR
system and participation in a health information exchange both decreased the likelihood of not reporting
experiencing a challenge and increased the likelihood of reporting an organizational challenge.
Figure 1 presents for each state the estimated predicted probabilities for hospitals experiencing any
challenge from the multivariable logit model, including hospital characteristics. Hospitals in Washing- ton
DC (25%), Arkansas (28%), New Mexico (32%), Missouri (33%), and New Jersey (42%) had the lowest
predicted probability of reporting a challenge, whereas hospitals in New Hampshire (87%), North Car-
olina (86%), Utah (85%), Minnesota (85%), South Dakota (82%), and Wyoming (82%) had the highest
predicted probability of reporting a challenge.
Table 3 gives the findings from the multinomial model examining the association of hospital
characteristics with each type of challenge. Hospitals with either a basic or comprehensive EHR, or that
participate in an HIE, were 9% and 14%, respectively, less likely to report not expe- riencing a challenge
than were those with no EHR or not participating in an HIE. Only census divisions significantly affected
the likelihood of reporting a technology challenge, with hospitals in the Middle Atlantic, East North
Central, East South Central, and Pacific more likely to report a technology challenge than were hospitals
in New England. For orga- nizational challenges, teaching hospitals had a 10% lower likelihood of
reporting a challenge than nonteaching hospitals did. Conversely, hos- pitals with a comprehensive EHR
and those participating in an HIE had a 15% and a 12% greater likelihood, respectively, of reporting an
organizational challenge, than did those with no EHR or not participating in an HIE. In contrast to the
census division’s findings for technology challenges, hospitals in the Middle Atlantic and East North
Central had a significantly lower likelihood of reporting an organizational challenge than did those in New
England. No hospital or geographic factors were
found to be associated with environmental challenges.

Our study used a mixed-methods, cross-sectional design with data from the 2017 American Hospital
Association (AHA) Annual Survey, a voluntary survey of hospitals’ organizational characteristics. We
combined these data with the AHA Information Technology (IT) supplemental survey data. Both the AHA
Annual Survey and IT supplements are sent, digitally, to hospitals’ leadership (e.g., chief executive
officer, pres- ident, executive director) of both AHA members and nonmembers and requested that they
be completed by the individual with the great- est familiarity with the hospital’s characteristics. A paper
version was available, and each hospital received multiple phone calls and email reminders. Earlier work
has demonstrated that the survey reports are both a reliable and valid measure of hospitals’ HIT
characteristics.45 More than 90% of all US hospitals complete the annual survey, and 3,542 (56%) of the
responding hospitals in 2017 also responded to the AHA IT survey, which reports data on the HIT
capabilities for each hospi- tal. Our analytic sample included the hospitals that responded to both surveys
and were acute care, defined by CMS as “a hospital that pro- vides inpatient medical care and other
related services for surgery, acute medical conditions or injuries,”46 nonfederally owned and operated
hospitals that treat non specialty populations (e.g., pediatric, cancer, long- term care, psychiatric care).

V. RECOMMENDATIONS
The research supports policy suggestions that include better data standards, more financing for
public health organizations to upgrade their technology infrastructure, staff development initiatives, and
clearer policy requirements and reporting. These methods can enhance communication between
hospitals and public health organizations.

Data management, usage, representation, format, definition, transmission, structure, and tagging
are all governed by preset criteria known as data standards. They relate to technical requirements or
written agreements that specify how data should be kept or transmitted across various systems in order
to remove a number of issues and obstacles. Organizations may profit from data standards in a variety of
ways, and they can also improve the data's quality to enable smarter and more informed
decision-making. Additionally, they enable the reuse of data components, lowering costs and boosting
dependability while simultaneously decreasing redundancy.
 Health funding is a basic function of health systems that can enable progress towards universal
health care by enhancing effective service provision and financial protection. Millions of individuals
nowadays avoid using services because they are too expensive. Even when they pay out of pocket,
many others still receive subpar treatment. These problems may be addressed with the aid of well
crafted and executed health funding strategies.

Patient care is enhanced as a result of professional growth. No matter what our positions, we can
all improve patient outcomes by learning more. Through continuing education, those who provide
bedside care can learn about best practices and the most recent research. This is crucial because
employee empowerment results from knowledge. Giving staff members the opportunity to use what they
learn in their profession and improve their ability to care for patients empowers them. Knowing that what
they do on a daily basis makes a difference gives the majority of professionals who offer direct patient
care a high sense of achievement.

Reporting is a quality method that focuses on the dissemination of data on efficacy, safety, and
responsiveness of care, as determined by indicators of structure, process, or result. Quality issues in
many care settings, such as primary prevention, acute care, chronic care, or palliative care, may be
addressed by reporting. Only hospital care and physician practices—most of which are solo or group
practices depending on the healthcare system under consideration. Meanwhile, organizations are held
together by their policies and processes. A healthcare organization can function effectively thanks to its
standardization and streamlining of everyday operational tasks. Each organization's policies and
processes are distinctive and adapted to match certain objectives and results. Healthcare policies also
assist personnel in understanding their obligations and functions. In the field of healthcare, legislation
should lay the groundwork for the provision of high-standard, safe treatment at reasonable costs.

VI. REFERENCES AND ACKNOWLEDGEMENT

● Geraedts, M., Cacace, M., & Berger, E. (n.d.). Improving healthcare quality in Europe:
Characteristics, effectiveness and implementation of different strategies [Internet]. NCBI.
https://www.ncbi.nlm.nih.gov/books/NBK549281/

● Satori Cyber. (2022, April 27). What are Data Standards and Why Do You Need Them? Satori.
https://satoricyber.com/data-management/what-are-data-standards-and-why-do-you-need-them/

● Schickel, T. (n.d.). Benefits of Professional Development for Healthcare Employees. Study.Com.

https://study.com/academy/lesson/benefits-of-professional-development-for-healthcare-employee
s.html

● World Health Organization. (2019, July 10). Health financing. WHO.

https://www.who.int/health-topics/health-financing#tab=tab_1