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How We Transformed Public Health Data for COVID-19 and the Futur

Data is the lifeblood of good public policy, of successful public health efforts, and of any effective emergency response. Especially during an unprecedented emergency like COVID-19, tackling the public health challenges we confront at the Department of Health and Human Services (HHS) requires accurate data, in as close to real time as possible. Over the past year, HHS has completely transformed how it collects, aggregates, and analyzes data for a challenge like COVID-19. These efforts will have a lasting effect on how our country deals with public health data, leaving us better prepared for future outbreaks and other health challenges.
One of the key elements of a response to a health emergency like a pandemic is knowing the burden on healthcare systems—especially the capacity hospitals have for treating patients. But, before the COVID-19 pandemic, the federal government simply did not have a way to know how many patients with a given virus are in hospitals across America.
Moreover, there were many other data points that decision-makers, responders, and analysts across the federal government and state governments would benefit from having access to: levels of crucial supplies, case counts, death rates, demographic information about patients, health expenditure data, and more. These data come from many different sources: federal agencies, state governments, hospitals, other health providers, laboratories, and more. Different federal agencies collect data in different ways, sometimes from sources that conflict.
So, at the end of March, the White House Task Force and leaders at HHS realized that we needed a single data hub: a place where all this data could be securely gathered and accessed by those who needed it. That was the genesis of HHS Protect, an unprecedented system and set of capabilities, powered by various private sector technologies, for sharing, parsing, housing, and accessing COVID-19 data. It was constructed in less than 10 days by dedicated public servants  in the HHS Office of the Chief Information Officer and an integrated, cross-agency COVID-19 federal response team, with partners across the federal government.
Putting all this data in one place was an incredible achievement. But just as important was ensuring we had the data we needed feeding into HHS Protect—like hospital capacity data.
The federal government previously did have some ways to track what’s going on in hospitals. From 2006 to 2016, HHS’s Office of the Assistant Secretary for Preparedness and Response (ASPR) ran a program called HAvBED. HAvBED requested hospitals that were members of ASPR’s Hospital Preparedness Program to provide their bed capacity on an annual basis and, upon ASPR’s request, to provide an update on how many beds were empty and available in the event of a disaster. This was a limited capability, however, only suitable for certain short-term emergencies. ASPR discontinued the program in 2016 because it imposed a burden on top of capacity metrics hospitals were tracking without providing much value to the federal government. In 2019, ASPR put out a standing opportunity for companies to propose new technologies and products that could help with these data challenges. 
The Centers for Disease Control and Prevention (CDC) has a program called the National Healthcare Safety Network (NHSN), through which hospitals report data on healthcare-associated infections, as part of our work to understand and combat antimicrobial resistance. Hospitals are required to report infection data under Medicare regulations, but before the pandemic, NHSN did not capture data on capacity, occupancy, supplies, staffing, or other patient-specific measures.
As COVID-19 spread in the United States in March, it became clear that there was a real risk that hospitals in certain areas could become overwhelmed. We needed data about where COVID-19 patients were filling hospitals in order to understand how to allocate resources like PPE and federal healthcare personnel and to understand the spread of the virus by geography and patient age.
Multiple options were created to start capturing information from hospitals. CDC added the ability for hospitals to report into NHSN how many COVID-19 patients they had. Over the next few months, approximately 3,000 hospitals were eventually reporting this information into NHSN. Second, through the ASPR funding opportunity, we granted a contract to a company called Teletracking, which many hospitals use to report data to states and for other needs, so hospitals could begin reporting their number of COVID-19 patients that way. Hospitals were also using this system to report COVID-19 patient burden in order to demonstrate eligibility for HHS’s $175 billion provider relief fund. Because many states were requiring hospitals to report the same information being requested by the federal response, we also created a third option, to allow states to report on behalf of their hospitals.
Regardless of which of the three methods a hospital used, all of the data was consolidated into a unified hospital data set in HHS Protect. These data streams provided valuable visibility into needs across the country, and the data from them was widely available to federal responders and state decision-makers because of HHS Protect.
But, while many hospitals reported some data, the reporting was inconsistent and incomplete. We also needed data to be reported every day in order to have an actionable picture of stresses on hospitals across the country. When FEMA and HHS were working to efficiently route personal protective equipment to the places it was most needed, we needed granular data. This was a new need: For well-known diseases that have a long history, and especially before technology made near real-time reporting a realistic possibility, it was typical to rely on estimated data. But for a novel pandemic like COVID-19, where we are constantly monitoring new trends, we needed consistent reporting of actual data, not estimates, and the technology to do that existed.
Then, in the summer, another need arose: We had been shipping supplies of the one FDA-authorized treatment for COVID-19, remdesivir, through state health departments to hospitals, based on the data we had on hospital burden, because remdesivir is only for hospitalized patients. But when the science became clear that remdesivir was most effective early on in a hospital admission, we needed more granular data, and we needed to understand the inventory of remdesivir that hospitals had on hand.
Adding that kind of specific data field to CDC’s NHSN was going to take several weeks. Through Teletracking, it could be added in less than three days. Therefore, to get the data we needed most rapidly, CDC recommended that we shift all hospital reporting into Teletracking.
At the time we made that change, on July 15, about two-thirds of hospitals were reporting through Teletracking each week (some directly to us, and some routing the data through their state health departments). Over the course of this year, we’ve worked with hospitals and states and added new incentives to raise that number significantly. By the end of April, 65 percent of hospitals were reporting at least some data, with about 20 percent of hospitals reporting all of the requested fields every day of the week. By the beginning of 2021, 99 percent of hospitals are reporting not only weekly, but seven days a week, and 97 percent are reporting every required field, seven days a week. Having near-real-time updates about the number of COVID-19 patients in every hospital in the country is an incredible result—leaps and bounds beyond where we were at the beginning of the pandemic.
The system we’ve created also offers an even more efficient pathway forward. While the primary goal of Teletracking and HHS Protect has been to increase reporting rates, there are also technology options to reduce the burden of hospitals having to manually report data each day. Around 70 percent of hospitals now have the ability to have patient data electronically submitted directly from their electronic health records or other information systems, and we now have pilot projects to automate the reporting of data on supplies like PPE as well.
All this data can inform not just decisions about allocating key therapeutics, but plenty of other decisions by the federal government and state and local governments. In addition to the hospital data, HHS Protect offers access to more than 200 other data sets, from private-sector sources, federal agencies like the Centers for Medicare & Medicaid Services, CDC, and the Health Resources and Services Administration, and from state partners.
HHS Protect is a solution to a problem that has stymied HHS and government agencies for a long time: how to bring together the huge amounts of data we already have in usable ways to generate useful and actionable insights. To some extent, this was made possible by the emergency we faced. One common barrier to aggregating data from different sources is that agencies can sometimes be protective of their own data and reluctant to go through the work of signing complex data use agreements. The pandemic broke down these barriers and reminded us that we’re all better off when we collaborate and make use, safely and securely, of all the data we have.
Protect makes these diverse data sources available not just across the federal government—to thousands of authorized and vetted users at HHS agencies alone—but for state, territorial, and tribal governments too, including state public health officials and COVID-19 support staff for governors.
Significant amounts of data from Protect is also now available to the public. If you’ve perused, for instance, Covidtracking.com or the New York Times tool for learning how full hospitals are in your area, you’re drawing on HHS Protect-aggregated data.
Executing on this mission required a dedicated data team. HHS and other federal partners created a new, unique interagency team—the Data Strategy and Execution Workgroup—to create and manage the common data and analysis for the federal COVID-19 response, with experts from 13 agencies and components across the federal government. The team has a unified quality assurance process to review and correct errors in data, and it created governance processes to ensure all stakeholders have the data they need. This kind of unified data strategy has been essential to our success and will be a best practice in responses going forward.
Having all this data in one place has boosted our response efforts in diverse ways. Through Teletracking and HHS Protect, hospitals now report regularly on their stocks of PPE. Some hospitals themselves didn’t even keep track of this kind of data before the pandemic, and having it easily at hand for multiple stakeholders can inform decisions to ship PPE by the federal government and the states. Through an effort called Project Greenlight, we specifically monitor PPE data for trouble spots. If, for instance, it looks like a hospital has just a day’s worth of PPE left or has a severe staffing shortage, we can get in touch with the state or the facility to understand whether that’s a data error or a real emergency shortage.
PPE and staffing data are just two elements of a tool created by ASPR, the Healthcare Resiliency Control Tower, which provides states with the data needed to understand the status of their healthcare systems all in one place. Drawing on data that’s been available in HHS Protect for some time, the dashboard offers a full range of data points about how hospitals and long-term-care facilities may be under stress: bed capacity, ICU capacity, drug availability, staffing levels, positive tests, and PPE stocks.
In the event there is a serious shortage of, say, PPE, we are then in a position to work with states and hospitals to ensure they can get what they need from commercial distributors—whose supply chains we also have visibility into through systems built for the next-generation Strategic National Stockpile—or, if necessary, from the revamped and refilled Strategic National Stockpile itself.
HHS Protect isn’t just about hospitals—far from it. For instance, the testing task force working under Admiral Giroir uses it to access all of the data relevant to testing all in one place: daily test results and all of the related information from every state, how many swabs and reagents states have, where private-sector testing supplies are headed, and more. States like Missouri are using HHS Protect as their state data dashboard, and teams working on the placement of Operation Warp Speed’s vaccine clinical trials used HHS Protect Data as well.
Together, all of these data efforts represent what ought to be the future of federal public health data work: where the federal government is not directly collecting data itself, but working as an aggregator of the oceans of data already being generated.
The days of building customized programs and modules to monitor discrete public health threats is coming to an end. In a world where healthcare providers are generating so much data on their own, we need to be streamlining and automating reporting. In a world where Big Data informs so much of what the private sector does, the public sector has to be making maximum use of the incredible data resources at our disposal and working with private-sector technologies to make the data more useful and available. That is exactly what HHS Protect does.
Running such a system requires financial commitments, leadership buy-in, and the dedication of many talented public servants, but it is an incredibly valuable investment. The better data capabilities we’ve developed over this past year have not just enhanced the efficiency of our response but actually saved lives. That is the goal of all public health efforts, and the future of data in supporting that work is now brighter than ever.

Posted in: Emergency Preparedness and Response, Health Data
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Title X Family Planning Program Turns 50

Title X of the Public Health Service Act established the National Family Planning Program at HHS in 1970. For 50 years, Title X clinics have ensured access to a broad range of family planning methods and related health services for millions of women, men, and adolescents with priority given to persons from low-income families. These services are voluntary, confidential, and intended to assist in preventing or achieving pregnancy. Since the program’s inception, Title X clinics have provided more than 190 million client visits1. 
Each decade has brought changes to the program but the dedication of Title X grantees to help clients meet their family planning goals has remained constant. Today, Title X grantees comprise a network of public and private nonprofit entities providing services to their communities in the U.S. and in eight U.S. territories and freely associated states.

The program’s contribution to the prevention of sexually transmitted infections and related adverse health consequences is substantial. Our Family Planning Annual Report (FPAR) data show that from 1999 to 2019, Title X clinics performed 34.1 million chlamydia tests2, 18.3 million HIV tests, and 76.5 million non-HIV STD tests. During this same period, Title X-funded cancer screenings provided 37 million Pap tests and 42 million clinical breast exams.
From 1970 to 2020, Title X grantees have served clients despite a variety of complex challenges. The U.S. Virgin Islands Department of Health Family Planning Program (VIFPP), which has received Title X funding since 1975, is an example of this resiliency. The devastating 2017 hurricanes Irma and Maria destroyed much of VIFPP’s materials and supplies. “We served patients in a flooded building on St. Thomas for weeks, and we had to evacuate our sites on both St. Thomas and St. Croix,” says the program director. “As soon as tents and tarps could be raised, we were seeing clients. We’re pretty tough.” Learn more about how Title X grantees tackle challenges.
The onset of the COVID-19 pandemic in early 2020 created widespread and unprecedented hurdles for Title X grantees across the U.S. Many grantees implemented rapid response plans to provide high-quality healthcare while stay-at-home orders were in effect. Within days of the pandemic’s onset staff began planning for telehealth services. Soon thereafter clinics accessed clinical trainings and began providing services to clients by phone, video, curbside, and other innovative technologies.
Title X grantees are the key component of the program’s success. The grantees’ experience, dedication, resilience, and innovative flexibility are the foundation that will help them tackle future challenges. 
The most recent report from the CDC highlighted the grim reality that sexually transmitted infections reached an all-time high in 2018, marking the fifth consecutive year of increases for chlamydia, gonorrhea, and syphilis3. Young women (ages 15-24) account for 44 percent of reported cases and face the most severe consequences of an undiagnosed infection. Optimal health for our clients requires that we adopt a patient-centered approach that sensitizes providers to identify and support each client’s care, recognizing that some methods very effective in preventing pregnancy, leave clients unprotected against sexually transmitted infections and make their ability to achieve pregnancy in the future more difficult.
Family planning was declared one of the top ten greatest public health achievements in the 20th century.4  Access to these services has continued to assist many Americans achieve desired birth spacing and family size in the early years of this century. As we celebrate 50 years of Title X, we applaud the program’s accomplishments and embrace continued resiliency and innovative change.  We look with confidence and excitement towards a bright future of promoting health across the reproductive lifespan.

1. From 1970 through 2019, an estimated190.3 million individuals visited a Title X-funded clinic for family planning and related preventive health services. This estimated cumulative number of Title X clients is not an unduplicated count; individuals who seek Title X care over many years will be counted as a client in each of the years that they make visit.
2. Data reflects services provided from 2005 through 2019 and assumes 1 chlamydia test per user tested.
3. Sexually Transmitted Disease Surveillance 2018.  Available online at https://www.cdc.gov/std/stats18/default.htm
4. Centers for Disease Control and Prevention, Ten Great Public Health Achievements — United States, 1900-1999, Morbidity and Mortality Weekly Report (April 2, 1999). Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm.

Posted in: Coronavirus, Grants and Contracts, Prevention and Wellness, Telehealth
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We Can Do This: The COVID-19 Public Education Campaign in English, Spanish

You’ve probably seen or heard this phrase a lot recently: “We can do this.” That’s the slogan for the U.S. Department of Health & Human Services‘ “We Can Do This” / “Juntos Sí Podemos” COVID-19 Public Education Campaign. This national initiative aims to increase public confidence in uptake of COVID-19 vaccines and other basic prevention …
The post We Can Do This: The COVID-19 Public Education Campaign in English, Spanish appeared first on Salud America.

The Future of AI in Health and Human Services

As the largest public health department in the world, the U.S. Department of Human Services (HHS) is a standard-bearer for global public health practices. One of the ways HHS leads is by pioneering the use of new technologies in the health and human services spaces to see how they may be applied more broadly across our operating and staff divisions and the programs they administer. One example of this is Artificial Intelligence, or simply “AI”. Far from being the hostile world-ending singularity we have come to know (and fear) thanks to fictional depictions, AI is actually a tool we use and even regulate at HHS to make our jobs more efficient and increase the value of our work.
In fact, HHS has already made many advances in the use of AI. For example, the Food and Drug Administration (FDA) has been developing a regulatory framework for AI/machine learning (ML)-driven software to provide industry with appropriate safety and effectiveness guidelines. The National Institutes of Health (NIH) has collaborated and invested in AI-based projects to discover health solutions across research and medical settings, including using AI to analyze biomedical imaging to diagnose diseases such as COVID-19. Through ReImagine HHS’s Buy Smarter initiative, we utilized AI to modernize the department’s acquisition process to achieve over $1 billion in projected savings and cost avoidance over ten years, including a single contract with over $700 million in savings. We also used AI to analyze HHS regulations, resulting in a first-of-its-kind regulatory “clean-up” initiative across several HHS agencies. And this is just a start.
While the future is uncertain, one thing is clear: AI will be a critical enabler of our mission. To combat 21st century threats to the health and well-being of all Americans, we need a 21st century playbook that supports a sensible use of, and familiarity with, AI. Which is why, today, we are announcing the next step in HHS’s journey to enterprise-wide AI adoption.
HHS is proud to announce its first enterprise Artificial Intelligence Strategy, developed over the last year through engagement with experts and stakeholders throughout the Department. This strategy will be carried forward and refined through a new AI Council and an AI Community of Practice, and is intended, like the field it covers, to evolve and adapt. Our new strategy, governance, and commitment to collaboration will position us to coordinate the great work in AI and machine learning already happening within HHS divisions, and to effectively implement Executive Order 13960 promoting the use of trustworthy AI in the federal government. We will foster, adapt to, and benefit from the extraordinary innovations emerging from the synthesis of health and human services, big data and computer science, and will maintain our role as the civilian agency leader in making wide – and wise – use of these transformative technologies.
Our vision: “Together with its partners in academia, industry and government, HHS will leverage AI to solve previously unsolvable problems by continuing to lead advances in the health and wellbeing of the American people, responding to the use of AI across the health and human services ecosystem, and scaling trustworthy AI adoption across the Department.”
This vision recognizes that the Department has multiple roles in AI – as a developer and early adopter for the use of AI in its own operations, as a regulator of new devices, technologies and techniques, as an investor through its grant-making, and especially as we go forward, as an overall catalyst and accelerator for the fields of health and human services. This will require intentional openness and deliberate engagement with innovators who share our mission to enhance the health and wellbeing of the American people.
Please read our entire strategy and consider how you could contribute to this new era at HHS.

Posted in: Grants and Contracts, Health IT
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Confronting Heightened Cybersecurity Threats Amid COVID-19

Did you know that Americans’ private health data is estimated to be worth up to 20 times the value of financial data on the Dark Web?1 This makes the Health and Public Health (HPH) Sector a primary target for cybercriminals. When an HPH Sector entity is affected by a cyber event, the public may lose its ability to engage with or receive health services, putting lives at risk. The COVID-19 pandemic has raised the stakes, increasing cyber risk in the HPH Sector in proportion the increased pace of activity amid widespread transition to remote work environments.
The HPH Sector has been significantly impacted due to both existing cybersecurity challenges and those brought on by COVID-19. Resource constraints paired with the complex architecture of both Information Technology (IT) and Operational Technology (OT) hindered HPH entities’ response and recovery efforts.

Cybersecurity is essential for effectively securing data needed to treat patients and maintain their access to critical health services. Patient safety and well-being are the top priorities when it comes to securing health infrastructure. Targeted attacks continue to plague the HPH Sector with the distribution of COVID-19 vaccines underway. Increasing cybersecurity awareness among HPH personnel and the general public can help alleviate the frequency and overall impact of incidents.
The Department of Health and Human Services (HHS) and the Cybersecurity and Infrastructure Security Agency (CISA) have been in close coordination since the onset of the pandemic. This coordination has led to key cybersecurity insights, which are reflected in the following infographics we have made accessible to the HPH Sector and general public:

Government and the private sector must work together to confront cyber challenges and secure HPH data and infrastructure. CISA and HHS recommend HPH entities take the following steps:
HPH:

Implement regular network scanning and patching cycles.
Leverage email banners, user training, and other tools to reduce risk of phishing.
Develop and practice incident response plans in a remote environment, including data backup and recovery.
Modernize technologies where feasible—and segment those end-of-life technologies that cannot be modernized. IT modernization through removal of End of Life (EOL) systems and devices will help reduce the risk of introducing permanent vulnerabilities into networks.

Government:

Establish disaster response roles and responsibilities between federal agencies; continue work with private industry and sector partners; and continue meaningful collaboration between the Cybersecurity and Infrastructure Security Agency (CISA) and U.S. Department of Health and Human Services (HHS).
Develop and implement “State of Emergency” standard operating procedures that include leveraging rapid response technical teams.
Implement as appropriate recommendations from the Cyber Solarium Commission (including the addendum during COVID-19).

You can download and share printer-friendly copies of the above Joint-Seal infographics https://www.hhs.govhttps://www.hhs.gov/sites/default/files/cybersecurity-challenges-to-healthcare-sector-infographic.pdf*

https://www.hhs.govhttps://www.hhs.gov/sites/default/files/covid-19-cyber-security-impacts-infographic.jpg

* People using assistive technology may not be able to fully access information in this file. For assistance, contact the HHS Office of the Chief Information Officer 202-690-6162 or by emailing [email protected]

1. Humer, Caroline, and Jim Finkle. “Your-Medical-Record-Is-Worth-More-to-Hackers-than-Your-Credit-Card.” Reuters, 24 Sept. 2014.

Posted in: Coronavirus, Health IT
Tagged: cybersecurity

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