In July, the Trump administration released a new directive telling hospitals to send COVID-19 patient data directly to the U.S. Department of Health and Human Services, bypassing the Centers for Disease Control and Prevention.

Since then, some state hospital associations say they've adjusted to the new system. Others, however, still report headaches.

An initial scramble

Despite claims from the CDC and HHS that the move had been a joint decision – which would later be thrown into doubt by CDC Director Robert Redfield – the shift sparked concern among public health experts and legislators about the possibility that vital information would become politicized. 

HHS Chief Information Officer Jose Arrieta abruptly resigned this past Friday after 16 months, citing the desire to spend more time with his family. Two senior CDC officials also recently resigned to start a new venture.

Other advocates and elected officials voiced skepticism about TeleTracking, the Pittsburgh-based data firm tasked with managing the new system.

Sen. Patty Murray, D-Wash., wrote an open letter in early July claiming that TeleTracking had been issued a noncompetitive contract. HHS denied these claims, but reporting by NPR pointed to irregularities in the awarding process. The firm this past week declined to answer senators' questions about the contract, citing its nondisclosure agreement with the Trump administration.

Meanwhile, hospital associations told Healthcare IT News that the change had thrown their member systems into "chaos." Many said they'd had two days' notice that the directive was going into effect. They described a scramble to meet the arduous new reporting requirements. Many feared a failure to do so would put their access to remdesivir, the COVID-19-treatment drug, in jeopardy. Some pointed to apparent errors in the public-facing data.

Analysts at the COVID Tracking Project also flagged discrepancies between the data being reported by the states and HHS. 

As of today, HHS' tracking portal had last been updated a week ago.

Eventual adjustment

Some hospital associations that had initially reported problems with the new system say they've gotten the complications mostly straightened out.

One issue had been the need for hospitals to submit data both to HHS and their respective states. 

"Since the implementation of the new COVID-19 data requirements to HHS, the state of Michigan successfully integrated their data system with the HHS TeleTracking portal, allowing our members to submit data to the state and having that data submitted to the federal HHS on their behalf," said Jim Lee, vice president of data policy and analytics with the Michigan Health and Hospital Association. 

"Taking effect August 4, this change removes the burden of a dual entry reporting process for our members," Lee continued.

"As with any transition, we did experience some delays as our members worked through changes in the system. However, all reporting requirements continue to be met by our membership," said Lee.

In Nebraska, the state department of health and human services "reported that they expected the state to be able to report on our behalf by next week," said Margaret Woeppel, Nebraska Hospital Association Vice President of Quality and Data. "It has taken longer than expected but is progressing."

The Florida Hospital Association referred to its previous statement, which said the state Agency for Health Care Administration had updated its online reporting system to incorporate the new data fields as early as July 17.

Other state hospital associations pointed to the relaxed requirements at HHS as key to helping them adjust. Initially, the agency had reportedly asked for updates every day, including weekends – a burdensome request for some hospitals, especially smaller ones.

Now, the agency only requires updates for some information three times a week, which makes things more manageable, say associations. 

A spokesperson for the Montana Hospital Association says the relaxed requirements for supply reporting and the ability to back-date data have contributed to an easier adjustment. The association also notes that it had signed a contract with Juvare to expand its EMResource platform and simplify reporting.

"We’re glad HHS listened to the hospital field and agreed to ease reporting on supply inventories, by both reducing the number of days of reporting needed and moving to ranges rather than specific amounts," said Maryland Hospital Association CEO Bob Atlas, who noted that 100% of hospitals in Maryland are entering daily data in the new HHS platform, according to the federal agency. 

"This is a significant achievement for our hospitals," Atlas continued.

"So far, so good here in Vermont," said Jeff Tieman, president and CEO of the Vermont Association of Hospitals and Health Systems. "Hospitals in Vermont are not sharing any problems or concerns, at least with the hospital association, about the new data reporting system. I know HHS is trying to accommodate small, rural hospitals around the country that may be challenged to submit data on weekends."

Still other associations say existing infrastructure allowed them to pivot relatively quickly.

"Missouri is out of the woods at this point," said Dave Dillon, vice president of media and public relations at the Missouri Hospital Association. "We have full reporting into the system and have worked through most if not all of the definitional changes that created difficulties at the beginning of the conversion process." 

"We were in the dark for two weeks, but we have now had our dashboards back up on a daily and weekly basis for three weeks," Dillon continued. "We have a fairly robust preparedness staff and our data company, the Hospital Industry Data Institute, working on this, which probably puts us at a strategic advantage in responding to reshuffles.

"Healthcare happens where people live," said Dillon. "The federal data are important, but we need to be on a single system (and we are now) so that we don’t have hiccups like we saw on July 15."

"HHS and TeleTracking are doing a good job of addressing our concerns," he said. "We’ve been very engaged with HHS’ regional office when we needed assistance."

Continued struggles

Other associations say they're still working to smooth out the process. 

In Maine, Becky Schnur, director of communications for the Maine Hospital Association, said not much has changed. 

Last month, Schnur told Healthcare IT News, "The fact that our hospitals are having to report separately to both the state and federal governments is an administrative burden."

"We’re hoping that the state of Maine will assume responsibility to the U.S. Department of Health and Human Services," Schnur said in that same interview.

Healthcare Association of New York State director of public affairs and media relations Janae Quackenbush said, "Reporting continues to be challenging, but our hospitals understand the importance of these data collection efforts. Our hospitals are making the necessary adjustments as HHS’ survey continues to evolve."

"Unfortunately, not much has changed since we last spoke about this issue," said Cara Welch, director of communications at the Colorado Hospital Association. 

"Colorado hospitals and health systems are still entering data in two platforms – a state program (EMResource) and the federal program (TeleTracking). Unfortunately, the definitions and fields in those two platforms are not the same, so it has been difficult to try to align and simplify that data entry process," Welch continued.

"Our hospitals have been frustrated by the lack of coordination between the federal and state agencies, as well as the fact that the definitions and fields in TeleTracking have been changing frequently since the rollout last month. While our Association has requested that the state align the data definitions in our EMResource tool with those in the TeleTracking platform, that change has not occurred yet," she said.

Overall, this has added an additional barrier to existing hospital needs, said Welch: "The hospitals are doing their best to comply with the federal and state reporting requirements, but it has certainly added an administrative and financial burden at the worst possible time for our hospitals."

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.