‘We must allow for the opportunity lớn disaggregate data khổng lồ identify more precisely where health advantages & health disparities may exist.’ The inability to examine potential disparities within subpopulations is a concern. Our data collection should allow for racial & ethnic granularity lớn really underst& and address disparities. We need to reconsider how we are collecting data and recognize that there is significant heterogeneity even within subgroups of race và ethnithành phố. We also cannot continue to put people into lớn these standard buckets without also offering the ability to lớn look at intersections of race và ethniđô thị with other variables, such as socioeconomic status, income, and education. ### How does insurance data play a role in assessing telehealth services? In 2020, the Centers for Medicare and Medicaid Services (CMS) và the Department of Health & Human Services (HHS) provided temporary insurance measures and waivers linked lớn the federal public health emergency declaration. This significantly expanded the use of telemedicine. It allowed for additional providers lớn participate in telehealth — e.g. physical therapists and mental health professionals — and for providers to lớn use different platforms. It also allowed telemedicine visits to lớn be reimbursed at the same rate as in-person visits. Without the public health emergency declaration và these CMS và HHS measures, we wouldn"t have sầu seen this expansion of telemedicine. Insurance claims provide robust data in terms of who"s getting healthcare and how they are getting healthcare, which allows us to lớn look at trends over time. The COVID-19 pandemic disrupted care when in-person visits drastically fell at first, but several weeks later — due to the CMS and HHS accommodations — there was then a stark uptichồng in telemedicine visits. Insurance data allows us to look at who"s deferring care, as well as state-cấp độ variations. Because insurance claims allow you khổng lồ study a wide geographical area, you can more easily identify trends in outpatient visits. ### What vị data indicate should be the future role for telehealth? There has been excess mortality during the pandemic — deaths from causes apart from COVID-19 infection. I wrote an
(https://www.acpjournals.org/doi/full/10.7326/M21-3841) commenting on a paper that defined excess mortality during the COVID-19 pandemic, comparing observed deaths lớn expected deaths during this period. We now know that more people died due khổng lồ causes other than COVID-19, many of them cardiovascular disease & chronic conditions, because they delayed getting healthcare. There was a lot of energy spent on curbing the spread of the vi khuẩn and reducing mortality, but we did not focus on averting other causes of death. We need khổng lồ keep an eye on many different types of data in the midst of a crisis to lớn ensure that as we are responding lớn the crisis, people are not dying from other diseases or delays in healthcare. > ‘Many people have lost access lớn or stopped seeking healthcare throughout the pandemic, và we need to get them bachồng. Telemedicine is an opportunity to vị so.’ Telemedicine has the opportunity to cthua trận the access gap exacerbated by the pandemic. Now is the time lớn re-engage people that we"ve sầu lost. Patients being able lớn see other members of a healthcare team online can reduce wait times và the burden on primary care providers. Additionally, patients won’t need lớn cancel meetings with their doctors regarding maintenance of their chronic conditions because they can’t find childcare or transportation if appointments are virtual. However, the data show that the playing field is not màn chơi, and not everyone has equal access to reliable Internet, which we need khổng lồ address if we intover khổng lồ actually cđại bại healthcare access gaps with telemedicine after this pandemic." order="0" attachments="https://nhlhockeyshopuk.com/hoc-corona/imager_1_89718_700.jpg" verticals="pandemic-data-initiative" data-tracking-id="article-card" href="/pandemic-data-initiative/news/q-and-a-data-concerns-magnified-in-virtual-telemedicine-environment">


Expert Insight | April 13, 2022

Q&A: Data Concerns Magnified in Virtual Telemedicine Environment

By Joshua E. Porterfield, PhD

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1 and fewer people pursuing testing due lớn how mild the Omicron variant has been compared to lớn Delta.2 Even when COVID-19 transitions lớn an endemic disease, recording cases và collecting test samples remains critical. These data help researchers to assess vaccine efficacy & kiến thiết new treatments, hospitals to lớn prepare for surges, epidemiologists khổng lồ understand disease transmission, & molecular biologists lớn search for new variants và diseases. Abandoning testing when the pandemic ends would remove an essential component of surveillance. When testing và case data fail, we then have lớn rely on hospital admissions data to lớn reflect the current state of disease spread. Thankfully, hospitalization data is some of the highest unique data available, for now. The Centers for Medicare and Medicaid Services (CMS) mandated standardized, robust data collection and reporting from all hospitals as a condition of funding back in Fall 2020.3 The mandate was tied to lớn the declaration of a Public Health Emergency pursuant to lớn the Public Health Service Act by then Secretary of Health và Human Services Alex Azar. The state of emergency has been renewed every 90 days since then, with many major healthcare organizations pleading for current Secretary Xavier Becerra lớn extkết thúc it once again this month.4 While the state of emergency is in effect, the CMS reporting mandates will also likely continue, but what happens once the state of emergency is lifted? Public accessibility & real-time reporting of hospitalization data are still very important for endemic diseases. As we discussed with (https://coronavi khuẩn.nhlhockeyshopuk.com.edu/pandemic-data-initiative/expert-insight/q-and-a-executing-on-hospital-operations-data), public availability of hospitalization data enables hospitals to lớn triage more rapidly when overwhelmed and supports informed decision-making about resource và staffing allocations. The CMS data mandates may have sầu been difficult for hospitals to lớn initially enact,5 but now that they are in place, this data reporting should continue regardless of the state of emergency và penalties for non-compliance. However, hospitalization data is not enough. !() In the flow of COVID-19 data (above), testing & case data are upstream of hospitalization data, encompass all confirmed cases of COVID-19 regardless of severity, và are available much earlier. There is significant value in maintaining testing and case data as part of an early warning system for COVID-19 outbreaks or surges. However, with the continued decrease in testing use by non-hospitalized individuals,2 obtaining reliable testing and case data for surveillance will require designing dedicated systems. Random sampling of the population is a promising option for continued disease surveillance.6 Testing of a random set of individuals across the country should give sầu a clear understanding of the current state of COVID-19. One option could be testing samples from random patients who happen to be in clinics or hospitals for other reasons. There would be some privacy concerns, but no more than with current testing, & individuals would have to consent lớn participate. We could also rely on concerned citizens who want khổng lồ contribute to public health efforts và donate samples or offer them for a small monetary reward as many retìm kiếm studies are currently performed. That, however, could produce significant sampling bias as the people most likely lớn help with continued prevention of COVID-19 would be those who are particularly cautious about disease transmission. Whatever the kiến thiết, we vày need an ongoing system of COVID-19 testing surveillance, which will also feed sequencing datasets that monitor for new variants. A system of random sampling would vastly improve sầu our current sequencing infrastructure, which does not reflect the majority of the country. Instead, most samples come from Thành Phố New York City & Los Angeles.7 This process will also require significant, continued funds, when Congress already appears hesitant to continue funding COVID-19 efforts.8 We don’t want lớn be surprised again, whether it’s a COVID-19 surge, a new variant, or even a new virus. We built suitable data infrastructure for disease surveillance during this pandemic, but we have sầu khổng lồ maintain it, adapt it khổng lồ this new purpose, & provide adequate samples to represent the full geographic & demographic diversity of the United States. No one wants to face something lượt thích this again as unprepared as we were. But by not instituting a disease surveillance data system complete with testing data, we are starting back at zero. If history inevitably repeats itself, we should at least be prepared next time. --- References 1. A. Patil, U.S. colleges that once championed surveillance virus testing are backing away, The Thủ đô New York Times, 04 April 2022. 2. M. Maddipatla, M. Roy, Lower testing rates likely reason for falling COVID-19 case reports - WHO, Reuters, 16 February 2022. 3. CMS releases guidance on COVID-19 data reporting as a condition of hospitals’ Medicare participation, American Hospital Association, 6 October 20đôi mươi. 4. Association of American Medical Colleges, AAMC, Hospital Groups Urge HHS Secretary to lớn Renew Public Health Emergency, 01 April 2022. (https://www.aamc.org/advocacy-policy/washington-highlights/aamc-hospital-groups-urge-hhs-secretary-renew-public-health-emergency). (Accessed 05 April 2022). 5. R. Pollaông chồng, RE: Interpretive sầu Guidance For CMS-3401-IFC, American Hospital Association, 04 September 2020. 6. A. Foddẻo, J. Lubroth, J. Ellis-Iversen, Base protocol for real time active sầu random surveillance of coronavirut disease (COVID-19) - Adapting veterinary methodology lớn public health, One Health 9 (2020) 100129. 7. Council on Foreign Relations, Data"s Role in Preventing the Next Pandemic, YouTube, 16 February 2022. 8. E. Cochrane, A.E. Petri, A.J. Khan, Covid News: Senators Announce Smaller Aid Proposal Without Global Vaccine Funds, The Thủ đô New York Times, 04 April 2022." order="0" attachments="/images/assets/Surveillance_Title_b6b82cf3a9.jpg" verticals="pandemic-data-initiative" data-tracking-id="article-card" href="/pandemic-data-initiative/news/endemic-disease-surveillance-requires-quality-testing-and-hospitalization-data">