Infectious diseases can move fast, spreading from person to person within days or sometimes mere hours. To effectively identify and reduce the spread of communicable diseases and other health threats, public health departments need timely, standardized, and complete data from doctors, hospitals, and other health care providers. But this critical information is often incorrect, delayed, or simply unavailable, and a new report from The Pew Charitable Trusts helps shed some light on why.
In this first-of-its-kind, nationwide assessment, which includes data from all 50 states and the District of Columbia, Pew looked at policies and practices for reporting four main types of public health data (see callout box). Among the key findings:
Case and lab reports provide state and local health departments with information about individual conditions such as communicable diseases and environmental illnesses.
Syndromic surveillance is an early-warning system of symptoms and syndromes captured primarily from emergency departments; this data does not include the patients’ identities.
Immunization information systems collect data on individual vaccinations.
From banking to retail to transportation, digital technologies and the use of automated electronic data sharing have transformed most sectors of the economy, saving users incalculable amounts of time and money—and generating troves of data that companies use to further improve service. Unsurprisingly, numerous studies show that automation can benefit public health data reporting as well, improving accuracy and efficiency so that threats can be found and fought more quickly.
Yet, Pew’s analysis revealed that only a small number of jurisdictions specify automated electronic reporting as an option in their statutes and regulations, and even fewer require it.
Table 1
| Case | Lab | Syndromic | Immunization | |
|---|---|---|---|---|
| Where is reporting required in statute or regulation? | 51 jurisdictions | 51 jurisdictions | 13 jurisdictions* | 34 jurisdictions for all ages; 11 jurisdictions for only childhood immunizations† |
| Where is automated electronic reporting required in statute or regulation? | 0 | 3 | 4 | 0 |
| Where is electronic reporting required in statute or regulation? | 3 | 7 | 4 | 5 |
| What methods are specified as optional in statute or regulation? | Phone, 46 Electronic, 34 Fax, 25 Mail, 19 Email, 3 Web portals, 3 Automated electronic, 2 |
Phone, 38 Electronic, 27 Fax, 20 Mail, 16 Automated electronic, 7 Web portals, 6 Email, 2 |
Automated electronic, 2 Electronic, 1 File transfer protocol, 1 Batch messages, 1 |
Electronic, 14 Automated electronic, 7 Web portals, 7 Fax, 1 Mail, 1 Phone, 1 |
| Who is required to report data? | Health care providers, 51 Hospitals, 45 Schools and school officials, 37 Child or day care centers, 30 Labs, 21 Correctional facilities, 14 Pharmacists, 13 Veterinarians, 10 |
Labs (including in hospitals), 51 Health care providers, 2 |
Emergency departments, 10 Urgent care centers, 3 Health care providers, 2 Inpatient facilities, 2 |
Pharmacists, 37 Health care providers, 32 Hospitals, 15 Schools and school officials, 11 Child or day care centers, 8 Insurers or health plans, 7 |
|
* This excludes states that collect syndromic surveillance data under authorities established through broader statutes or regulation. † States that require reporting for children’s immunizations alone vary in how they define ages of children. |
While that may seem surprising, Pew’s interviews with hundreds of public health officials across the country (conducted between October 2022 and April 2023) tell a different story. We found that in practice, states are using automated electronic reporting quite prolifically for lab results, syndromic surveillance, and immunizations even though it’s rarely mentioned in policy. For example, almost all interviewees estimated that 50% to 90% of vaccinations that are required to be reported were provided by automated electronic means even though none of the jurisdictions require automated reporting of immunizations. And, while just three jurisdictions require it, officials in two-thirds of states estimated that at least 90% of their lab reports were transmitted via automatic electronic reporting.
These high levels of automated electronic reporting are good news for public health, but the distinct disconnect between policy and practice speaks to an opportunity for developing public health data policies that can keep pace with fast-moving technology and also be flexible and visionary enough to drive and incentivize progress.
There is one type of data reporting, however, for which practice is not leading policy. Patient case reports lag when it comes to automation and are still commonly shared via phone, fax, and even postal mail in some cases. Because these methods require manual input, they take time to prepare, are inherently more susceptible to human errors that cost time and money, and, as a result, slow public health agencies’ response to emerging threats.
While there was a major uptick in the use of automated electronic case reporting (eCR) to report COVID-19 cases during the pandemic, Pew’s interviews with public health officials revealed that few jurisdictions were using it for other conditions or diseases despite the potential benefit of widespread adoption given enough time and investment. Additionally, in about half of the jurisdictions, officials said that although their state health department does receive some eCR, they often are not able to incorporate that data into their surveillance systems due to technical, resource, or other limitations. The strides made in case reporting during the COVID-19 pandemic demonstrate that eCR is a valuable tool that can be as widely adopted as electronic lab reporting. Expanded use of this technology should continue to be a focus for policymakers and public health officials moving forward.
The U.S. has come a long way since physicians first started systemically reporting diseases in 1874 —via postcards—and we hope that this report will be a resource for ongoing efforts to improve data reporting, and ultimately health outcomes. In particular, we encourage public health leaders to:
While there is no one-size-fits-all approach to modernizing public health data reporting in the U.S., there is unquestionably more we can be doing to build on the progress that has been made to better protect people from disease and save lives. And we must.
Margaret Arnesen is a senior officer with The Pew Charitable Trusts’ public health data improvement project and Kathy Talkington is a director with Pew’s public health programs.