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.

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    The Department of Justice has published proposed regulations that provide a clear and comprehensive statement of sex offenders’ registration requirements under the federal Sex Offender Registration and Notification Act (SORNA).  SORNA requires convicted sex offenders to register in the states in which they live, work, or attend school, and it directs the Attorney General to issue regulations and guidelines to implement SORNA. 
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  • Secretary Antony J. Blinken Before Virtual Meeting with Kenyan President Uhuru Kenyatta
    In Crime Control and Security News
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  • Justice Department Reaches Proposed Consent Decree to Resolve Hampton Roads Regional Jail Investigation
    In Crime News
    Today, the Department of Justice’s Civil Rights Division and the U.S. Attorney’s Office for the Eastern District of Virginia filed a complaint and a proposed consent decree with the Hampton Roads Regional Jail Authority.
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  • Science & Tech Spotlight: Agile Software Development
    In U.S GAO News
    Why This Matters Agile software development has the potential to save the federal government billions of dollars and significant time, allowing agencies to deliver software more efficiently and effectively for American taxpayers. However, the transition to Agile requires an investment in new tools and processes, which can be costly and time consuming. The Methodology What is it? Agile is an approach to software development that encourages collaboration across an organization and allows requirements to evolve as a program progresses. Agile software development emphasizes iterative delivery; that is, the development of software in short, incremental stages. Customers continuously provide feedback on the software's functionality and quality. By engaging customers early and iterating often, agencies that adopt Agile can also reduce the risks of funding failing programs or outdated technology. Figure 1. Cycle of Agile software development How does it work? Agile software development is well suited for programs where the end goal is known, but specific details about their implementation may be refined along the way. Agile is implemented in different ways. For example, Scrum is a framework focused on teams, Scaled Agile Framework focuses on scaling Agile to larger groups, and DevOps extends the Agile principle of collaboration and unites the development and operation teams. Scrum, one of the most common Agile frameworks, organizes teams using defined roles, such as the product owner, who represents the customer, prioritizes work, and accepts completed software. In Scrum, development is broken down into timed iterations called sprints, where teams commit to complete specific requirements within a defined time frame. During a sprint, teams meet for daily stand-up meetings. At the end of a sprint, teams present the completed work to the product owner for acceptance. At a retrospective meeting following each sprint, team members discuss lessons learned and any changes needed to improve the process. Sprints allow for distinct, consistent, and measurable progress of prioritized software features. How mature is it? Organizations have used versions of incremental software development since the 1950s, with various groups creating Agile frameworks in the 1990s, including Scrum in 1995. In 2001, a group of software developers created the Agile Manifesto, which documents the guiding principles of Agile. Following this, Agile practitioners introduced new frameworks, such as Kanban, which optimizes work output by visualizing its flow. The Federal Information Technology Acquisition Reform Act (FITARA), enacted in 2014, includes a provision for the Office of Management and Budget to require the Chief Information Officers of covered agencies to certify that IT investments are adequately implementing incremental development. This development approach delivers capabilities more rapidly by dividing an investment into smaller parts. As a result, more agencies are now adopting an incremental, Agile, approach to software development. For example, in 2016, the Department of Homeland Security announced five Agile pilot programs. In 2020, at least 22 Department of Defense major defense acquisition programs reported using Agile development methods.  As the federal government continues to adopt Agile, effective oversight of these programs will be increasingly crucial. Our GAO Agile Assessment Guide, released in 2020, takes a closer look at the following categories of best practices: Agile adoption. This area focuses on team dynamics, program operations, and organization environments. One best practice for teams is to have repeatable processes in place such as continuous integration, which automates parts of development and testing. At the program operations level, staff should be appropriately trained in Agile methods. And at an organizational level, a best practice is to create a culture that supports Agile methods. Requirements development and management. Requirements—sometimes called user stories—are important in making sure the final product will function as intended. Best practices in this area include eliciting and prioritizing requirements and ensuring work meets those requirements. Acquisition strategy. Contractors may have a role in an Agile program in government. However, long timelines to award contracts and costly changes are major hurdles to executing Agile programs. One way to clear these hurdles is for organizations to create an integrated team with personnel from contracting, the program office, and software development. Clearly identifying team roles will alleviate bottlenecks in the development process. Figure 2. Different roles come together to make an Agile software development team. Program monitoring and control. Many Agile documents may be used to generate reliable cost and schedule estimates throughout a program’s life-cycle. Metrics. It is critical that metrics align with and prioritize organization-wide goals and objectives while simultaneously meeting customer needs. Such metrics in Agile include the number of features delivered to customers, the number of defects, and overall customer satisfaction.  Opportunities Flexibility. An Agile approach provides flexibility when customers’ needs change and as technology rapidly evolves. Risk reduction. Measuring progress during frequent iterations can reduce technical and programmatic risk. For example, routine retrospectives allow the team to reflect upon and improve the development process for the next iteration. Quicker deliveries. Through incremental releases, agencies can rapidly determine if newly produced software is meeting their needs. With Agile, these deliveries are typically within months, instead of alternative development methods, which can take years. Challenges GAO has previously reported on challenges the federal government faces in applying Agile methods; for the full report see GAO-12-681. Lack of organizational commitment. For example, organizations need to create a dedicated Agile team, which is a challenge when there is an insufficient number of staff, or when staff have several simultaneous duties. Resources needed to transition to Agile. An organization transitioning to Agile may need to invest in new tools, practices, and processes, which can be expensive and time consuming. Mistrust in iterative solutions. Customers who typically see a solution as a whole may be disappointed by the delivery of a small piece of functionality. Misaligned agency practices. Some agency practices, such as procurement, compliance reviews, federal reporting, and status tracking are not designed to support Agile software development. Policy and Context Questions In what ways can Agile help the federal government improve the management of IT acquisitions and operations, an area GAO has identified as high risk for the federal government? How can policymakers implement clear guidance about the use of Agile software development, such as reporting metrics, to better support Agile methods? How might resources need to shift to accommodate the adoption of Agile in federal agencies? What risks could those shifts pose? What updates to agency practices are worth pursuing to support Agile software development? For more information, contact Tim Persons at (202) 512-6888 or personst@gao.gov.
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  • FY 2020 Request for Concept Notes for NGO Programs Benefiting Refugees, Displaced Iraqis, and Other Vulnerable Populations in Iraq, Jordan, Lebanon, and Turkey
    In Human Health, Resources and Services
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  • Medicaid: Information on the Use of Electronic Asset Verification to Determine Eligibility for Selected Beneficiaries
    In U.S GAO News
    What GAO Found Individuals who receive assistance from the federal Supplemental Security Income (SSI) program may also become eligible for Medicaid. SSI provides cash assistance to eligible individuals who are over age 65, blind, or disabled; and who have limited resources (i.e., assets) and income. Medicaid programs in 42 states and the District of Columbia use the SSI asset limit of $2,000 for an individual or $3,000 for a married couple. Medicaid programs in the remaining eight states may set an asset limit that differs from the current SSI asset limit. The Social Security Administration (SSA), which administers the SSI program, and state Medicaid programs electronically verify the assets of these individuals when determining financial eligibility: In the 42 states and the District of Columbia that use the SSI asset limit, SSA is the entity that verifies applicants' assets. SSA has two data sources to detect assets among SSI beneficiaries. The first data source is the Access to Financial Institutions initiative. This initiative verifies reported bank accounts and can detect potential undisclosed accounts from financial institutions within geographic proximity of an SSI recipient's residence. The second data source is Non-home Real Property, which uses a commercial data source to help investigate potential ownership of real property other than a primary residence. In the eight states that may set their own asset limits, the state's Medicaid program must verify Medicaid eligibility for SSI recipients using an electronic asset verification system (AVS). An AVS provides a portal between state eligibility systems and banks or other third-party systems with electronic access to financial information. Once a state has an AVS in place, state eligibility workers can submit a request through the portal to perform an asset check for a Medicaid applicant. The request is sent to different financial institutions. A vendor gathers the information from the financial institutions and returns it to the state, and eligibility workers use the information to make an eligibility determination. Some states also use their AVS to check on applicants' property information, which may come from commercial data sources. Why GAO Did This Study GAO was asked to review the use of electronic asset verification to determine eligibility for selected Medicaid beneficiaries. This report provides an overview of what is known about how state Medicaid programs verify assets of applicants who are eligible because they receive SSI, and how SSA verifies assets of SSI applicants, among other issues. To describe what is known about how state Medicaid programs and SSA verify applicants' assets, GAO reviewed its prior work, as well as related research by other organizations. GAO also obtained input from officials from the Centers for Medicare & Medicaid Services and SSA; and reviewed relevant federal laws, regulations, and guidance. The Department of Health and Human Services and SSA reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate. For more information, contact Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov.
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  • The United States Designates Al Qa’ida Financial Facilitator
    In Crime Control and Security News
    Michael R. Pompeo, [Read More…]
  • Company President and Employee Arrested in Alleged Scheme to Violate the Export Control Reform Act
    In Crime News
    Assistant Attorney General for National Security John C. Demers, Audrey Strauss, the Acting U.S. Attorney for the Southern District of New York, and Jonathan Carson, Special Agent in Charge of the New York Field Office of the U.S. Department of Commerce, Office of Export Enforcement (OEE), announced the arrests today of Chong Sik Yu, a/k/a “Chris Yu,” and Yunseo Lee.  Yu and Lee are charged with conspiring to unlawfully export dual-use electronics components, in violation of the Export Control Reform Act, and to commit wire fraud, bank fraud, and money laundering.  Yu and Lee were arrested this morning and are expected to be presented later today before U.S. Magistrate Judge Kevin Nathaniel Fox in Manhattan federal court.
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  • Man Pleads Guilty to COVID-19 Relief Fraud Scheme
    In Crime News
    A Washington man pleaded guilty today to perpetrating a scheme to fraudulently obtain COVID-19 relief guaranteed by the Small Business Administration (SBA) through the Economic Injury Disaster Loan (EIDL) and the Paycheck Protection Program (PPP) under the Coronavirus Aid, Relief and Economic Security (CARES) Act.
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  • United States Reaches Agreement to Protect New Orleans Waterways and Lake Pontchartrain
    In Crime News
    Today, the U.S. Environmental Protection Agency (EPA) and the Department of Justice announced a settlement with the Churchill Downs Louisiana Horseracing Company LLC, d/b/a Fair Grounds Corporation (Fair Grounds) that will resolve years of Clean Water Act (CWA) violations at its New Orleans racetrack. Under the settlement, Fair Grounds will eliminate unauthorized discharges of manure, urine and process wastewater through operational changes and construction projects at an estimated cost of $5,600,000. The company also will pay a civil penalty of $2,790,000, the largest ever paid by a concentrated animal feeding operation in a CWA matter.
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  • Owner and Operator of India-Based Call Centers Sentenced to Prison for Scamming U.S. Victims out of Millions of Dollars
    In Crime News
    An Indian national was sentenced today to 20 years in prison followed by three years of supervised release in the Southern District of Texas for his role in operating and funding India-based call centers that defrauded U.S. victims out of millions of dollars between 2013 and 2016.
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  • Two California Men Indicted in Hate Crimes Case Alleging They Attacked Family-Owned Restaurant and Threatened to Kill the Victims Inside
    In Crime News
    A federal grand jury in Los Angeles has indicted two Los Angeles-area men on conspiracy and hate crime offenses for allegedly attacking five victims at a family-owned Turkish restaurant while shouting anti-Turkish slurs, hurling chairs at the victims and threatening to kill them.
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  • MS-13’s Highest-Ranking Leaders Charged with Terrorism Offenses in the United States
    In Crime News
    Earlier today, an indictment was unsealed in Central Islip, New York charging 14 of the world’s highest-ranking MS-13 leaders who are known today as the Ranfla Nacional, which operated as the Organization’s Board of Directors, and directed MS-13’s violence and criminal activity around the world for almost two decades.
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  • International Trio Indicted in Austin for Illegal Exports to Russia
    In Crime News
    A four–count federal grand jury indictment returned in Austin and unsealed today charges three foreign nationals – a Russian citizen and two Bulgarian citizens – with violating the International Emergency Economic Powers Act (IEEPA), Export Control Reform Act (ECRA), and a money laundering statute in a scheme to procure sensitive radiation-hardened circuits from the U.S. and ship those components to Russia through Bulgaria without required licenses.
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  • Ongoing Investigation into Violent White Supremacist Gang Results in Rico Indictment and Additional Charges against Members and Associates
    In Crime News
    The Justice Department announced today that additional charges have been brought in a superseding indictment against members and associates of a white supremacist gang known as the 1488s. The 1488s have been charged as a criminal organization that was involved in narcotics distribution, arson, obstruction of justice, and acts of violence including murder, assault, and kidnapping.
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  • Texan sentenced in CARES Act unemployment fraud scheme
    In Justice News
    A 29-year-old Corpus [Read More…]
  • Justice Department Sues Town of Wolcott, Connecticut, for Discrimination Against Persons with Disabilities
    In Crime News
    The Justice Department today filed a lawsuit alleging that the Town of Wolcott, Connecticut, has discriminated against persons with disabilities in violation of the Fair Housing Act.
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