Development of a standards based city wide health information exchange for public health in response to COVID 19

Disease surveillance is a critical function of public health, provides essential information about disease burden, clinical and epidemiologic parameters of disease, and is an important element of effective and timely case and contact tracing. The COVID-19 pandemic demonstrates the essential role of disease surveillance in preserving public health. In theory, the standard data formats and exchange methods provided by EHR meaningful use should enable rapid healthcare data exchange in the setting of disruptive healthcare events like a pandemic. In reality, access to data remains challenging, and, even if available, often lacks conformity to regulated standards. As a result of the COVID-19 pandemic, we developed a regional data hub to enhance public health surveillance.We sought to use regulated interoperability standards already in production to generate awareness of regional bed capacity and enhance the capture of epidemiological risk factors and clinical variables among patients tested for SARS-CoV-2. We describe the technical and operational components, governance model, and timelines required to implement the public health order which mandated electronic reporting of data from EHRs among hospitals in the Chicago jurisdiction. We also evaluate the data sources, infrastructure requirements and the completeness of data supplied to the platform and the capacity to link these sources.Following a public health order mandating data submission by all acute care hospitals in Chicago, we developed the technical infrastructure to combine multiple data feeds from those EHR systems. We measured the completeness of each feed and the match rate between feeds.A cloud-based environment was created that received ELR, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project initiation to aid in consensus and principles for data use. Data from 88,906 persons from consolidated clinical data architecture (CCDA) records among 14 facilities, and 408,741 persons from ELR records among 88 facilities, were submitted. Most (90.1%) records could be matched between CCDA and ELR feeds. Data fields absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. Less than 5% of CCDA data fields were empty. Merging CCDA with ELR data improved race, ethnicity, comorbidity, and hospitalization information data availability.We describe the development of a city-wide public health data hub for the surveillance of SARS-CoV-2 infection. We were able to assess the completeness of existing ELR feeds, augment these feeds with CCDA documents, establish secure transfer methods for data exchange, develop cloud-based architecture to enable secure data storage and analytics, and produce dashboards for monitoring of capacity and disease burden. We consider this public health and clinical data registry as an informative example of the power of common standards across EHR and a potential template for future use of standards to improve public health surveillance.