Messy data systems delayed Virginia's COVID response. Kaine's bill could help combat the gap in future crises

This project was produced as part of a larger project for USC Annenberg Center for Health Journalism's 2021 National Fellowship.

Other stories in this project include:

Part 1: Essential and Overlooked: How decades of inaction failed Virginia's Latinos during COVID

Part 2: Essential and Overlooked: Federal relief changed Virginia's COVID response. For some Latinos, help came too late.

At the start of the worst public health crisis in over a century, the Virginia Department of Health was manually tracking the virus through test results sent via fax machines. 

The same team analyzing the flood of data at the state level was tasked with reporting and updating the agency’s website with daily COVID metrics. A year and a half later, some rural health districts were documenting vaccinations by hand, another factor contributing to a three-day data lag that made it difficult to capture the state’s progress in real time.

Legislation proposed Thursday by Sen. Tim Kaine, D-Va., targeted the messy, incomplete and decentralized public health data systems that foiled the COVID-19 response nationwide and left the U.S. unable to adequately comprehend the scale of spread.

If passed, the bill could better equip health departments for future public health emergencies in advance instead of forcing them to build the infrastructure in the middle of a crisis.

A similar bipartisan effort from Kaine in 2019 did not make it to a vote.

“The pandemic has shed light on how outdated and inconsistent public health data systems can hamper efforts to provide life-saving care for people across Virginia and our nation,” Kaine said in a statement. “As a former Mayor, Governor and now U.S. Senator, I know it’s often difficult for local, state, and federal health departments to coordinate when they’re using different systems. We need to better connect our local, state and federal public health systems so we can more quickly aggregate data and tailor our responses to emerging threats.”

Kaine’s push to modernize public health data systems would direct the Centers for Disease Control and Prevention to standardize how health data is collected at the local, state and federal level. The lack of national standards and oversight meant every state and the health departments within it were gathering information differently.

It would also task the U.S. Department of Health and Human Services with streamlining a process that would address the disconnect among data systems used by medical laboratories, hospitals and health departments.

Dr. Danny Avula, who stepped into the role of state vaccine coordinator in January 2021, dedicated his first few months in the role to closing the gap state officials said was driven largely by incompatible data systems.

Lastly, Kaine’s proposed legislation would develop a grant program aimed at funding the “quality and completeness of demographic data collection,” which would include race and ethnicity in addition to disability or housing status.

Before January of last year — when Virginia had not recorded race and ethnicity for the majority of vaccinated residents — there was no statewide requirement for providers to collect race and ethnicity data. That changed in the 2021 General Assembly session, but was an unfunded directive.

While the Centers for Disease Control and Prevention already advises the reporting of demographics, there aren’t consequences for states that don’t. The CDC guidelines health departments reference also do not take into account limited English proficiency, which means the COVID impact on non-English speakers in Virginia is not tracked.

VDH officials emphasized the difference having better data, and more people to analyze it, would have made in supporting the pandemic response in interviews with the Richmond Times-Dispatch.

For years, the agency foreshadowed the consequences of not funding and strengthening its data systems — which can include but are not limited to those dedicated to disease surveillance — through budget requests to the General Assembly.

In 2012, VDH said funding was needed to improve its capacity to monitor emerging health events and that without additional dollars, VDH would be limited in its ability to “recognize and respond to public health threats.”

In 20152017 and 2019, VDH asked the legislature to fund an electronic health records system to manage lab results and demographic information for patients at their clinics.

Officials wrote in each plea that not having an integrated electronic health records system to handle hundreds of thousands of client records meant an inefficient and time-consuming reliance on paper records faxed or mailed to local health districts.

“Without the increased general fund support, VDH will continue to falter behind the standard level of healthcare infrastructure,” the agency said in the 2019 request.

The General Assembly did not fully adopt those requests until August 2021.

This story has been updated to clarify that VDH’s electronic health records system is not used for disease surveillance and was later fully funded by the General Assembly in August 2021. 

[This article was originally published by Richmond Times-Dispatch.]

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