Multiple updates to the rules and avenues for reporting critical pandemic-related capacity information left hospitals confused, overwhelmed and unable to comply.
The COVID-19 pandemic has been a major learning curve for the Health and Human Services Department, which made iterative changes to the methods and types of data hospitals reported to the agency throughout the pandemic. But the pace of those changes and lack of input from health care practitioners caused major problems, according to the Government Accountability Office.
Hospital capacity—or lack thereof—has been one of the main difficulties of the pandemic, as staff and resources are overwhelmed with COVID patients. Understanding hospital capacities at individual and regional levels is key to managing through a pandemic. HHS, as the central public health authority, plays a critical role in that respect.
“As we have noted in our work throughout the COVID-19 pandemic, the virus’ rapid spread and magnitude have underscored the importance of having quality data to help the federal government understand the health care system’s capacity—including the capacity of hospitals to admit and treat patients—to provide needed care and to inform timely and responsive decisions,” GAO said in its latest report.
The department launched the HHS Protect program in April 2020—early in the pandemic—as a way to collect and disseminate capacity data, including “national- and state-level data on inpatient and intensive care beds in use, supplies of personal protective equipment and COVID-19 treatments,” the report states.
But as the pandemic went on, HHS officials found the ways in which data were being reported was not effective.
“Subsequently, HHS changed the methods through which data could be reported to HHS Protect and also changed reporting requirements,” the report states. “According to HHS officials, this was done to capture more complete data and to capture more information, such as data on influenza-related hospitalizations and COVID-19 vaccines administered.”
But the “frequent and significant changes” were done without full consultation of stakeholders, including the local hospitals most in need of the data.
Originally, HHS established five avenues for hospitals to report staffing and resources data, including:
- States or state hospital associations could report on behalf of hospitals in that state directly to HHS Protect.
- Hospitals could report through TeleTracking, a method developed specifically for reporting to HHS Protect.
- Hospitals could report their data to the National Healthcare Safety Network, or NHSN.
- Hospitals could authorize their information technology vendor to share information directly with HHS.
- Hospitals could publish their data in a standardized format on their websites.
But three months later, HHS removed NHSN as a reporting option.
“According to HHS officials, the department opted to remove NHSN as an option in part because its hospital capacity data were incomplete,” the report states. “Additionally, HHS officials told us that during this time, the department had asked CDC to add new data fields in NHSN to capture information on the distribution of remdesivir—a therapeutic treatment for COVID-19—but that change would have taken too long to implement.”
At the same time, HHS increased the types of data that were being collected, including remdesivir inventories, influenza cases, COVID-specific therapeutics and the number of hospital employees and patients that had been vaccinated.
“Reporting entities said they experienced multiple challenges implementing the changes, including a lack of clarity on the requirements and logistical challenges such as having to adapt their systems to provide the data,” auditors said.
Hospital associations that spoke with GAO cited staffing resources—not enough people to dedicate to data reporting—and the quality and maturity of local data systems as the biggest challenges, along with the lack of clarity from HHS.
The confusion over federal-level data reporting led local public health officials to rely on state and local data, such officials told GAO.
“For example, epidemiological association officials said their members relied on state and local data for case investigation because they contained more detailed information and did not use HHS Protect data on hospital capacity,” the report states.
Health care workers and advocates told GAO that more communication with HHS could have mitigated some of these issues.
“Officials GAO interviewed from stakeholder organizations and selected states noted that increased collaboration and communication—as well as more time to implement changes—would have facilitated the implementation of the changes to the data collection process,” the report states.
HHS officials told GAO the agency has learned important lessons for the next public health emergency, including more dialog with stakeholders outside the agency and “external validation to ensure data quality and accuracy.”
GAO reiterated a similar recommendation made in early 2021 to ensure stakeholders are considered when making changes to major data collection programs. While HHS officials agreed with the recommendation at the time, the new report notes “the department has not implemented it.”
HHS officials read a draft of GAO’s latest report and did not offer comments.