2021-02-25 CDC+NACHC C19 Meeting notes

Fred Rachman, AllianceChicago, CEO, Pediatrician

HCCNs groups of CHCs to support economies of scale, is positioned to act as a de facto system during this pandemic. Both HCCNs are national and cross state boundaries.  CHCs are de facto primary health care providers.  Mission/challenge to use individual data to look at the population health level.  HCCNs bridge the role between the locally responsive CHCs and the larger infrastructure that helps them work at public health level.  Rapid response - networks are able to help put CDC recommendations within EMRs, given that they have the infrastructure - the flow from CDC to the HCCNs to the CHCs - the infrastructure that HCCNs already have allowed innovations for response to COVID to ramp up rapidly from the breaking findings at CDC through to the patient care level at the CHCs.

Assist CHCs:

1. Shift to telehealth on a broad scale, including access to technology from the patient side.
2. Surveillance and testing for COVID
   1. Challenges: 
      1. Coordinating with local public health authorities, state and city. eCR NOW can be part of this.
      2. Case reporting via eCr, validating standard eCIR-NOW for case reporting.  Help PH authority to receive the eCR.  CHCs called upon to do contact tracing - example of environment changing over the time of the pandemic.
3. Using data to inform CHCs about activities via dashboards, prediction of spikes; impact of visits on core quality measures (both tele- and in-person health).
4. COVID Vaccine support - developing workflows in EHR to track rollout of vaccine, to share data with states and IIS, help track and understand who has received the vaccine with a focus on equity across populations served.  Tracking of vaccinations for staff - who has received, who has both doses.

Areas of interest:

1. CHCs, HCCNs are well known
2. Populations Served
3. Burden of disparities - for testing, for vaccine, for high-risk populations - be able to look at the data collected through this project, share the important role of CHCs in this enterprise.  Use the data and lessons learned to inform national strategy.
   1. Florida SEAL program, funded by NIH - what are perceptions among underserved communities around COVID, vaccination. HCN is a partner, along with universities and Moffatt cancer center.  Identify appropriate interventions based on the information collected.
4. Leverage existing and newly-built capacity and infrastructure toward future needs.

Planning to provide similar maps for vaccinations, example overlay communities hardest hit by the disease.  Vaccines in CHCs vs other outlets for vaccinations - are CHCs providing the vaccines to the underserved populations vs other systems. Example below of this kind of heat map, data for other cities Houston, Miami are similar.

Challenge: Getting data into the IIS, the CHCs in Hawaii are facing the biggest challenge as the immunization registry was offline until just last month making data exchange a manual effort.

Disparities - the role of staff, not only acceptance of vaccine of 

Survey administered by AllianceChicago and HCN staff at CHCs 462 respondents from HCN. Staff attitudes; responses, will be fielding the survey again after their webinar on this.

52% of black or AA staff were vaccine hesitant, compared to 30% of Latinx vs 20% white (see slides for numbers)

Dr. Chung - The Community Health Workers from the CHCs are getting together to share, some of them are also vaccine hesitant.  The connections between communities has been key to focusing on the interactions with the patients.  

Initially, about 30% of staff were vaccine confident, but it has risen to the 80s - would be a good case study to look at how this changed.

Interesting to look at the relationship between staff vaccine confidence and patient vaccine acceptance and uptake.

Challenge: We are inundated with quantitative requirements from different entities - city report, slightly different version to the state, slightly different version to HRSA because the reporting requirements are not aligned.  If we could align city, state, federal reporting needs, it would free up time to do some more qualitative reporting and ameliorating reporting response in general.  That would help the local CHCs continue to focus on the local needs.  At all levels, we are spending energy trying to normalize the data.

These data that we have so far could help us figure out where to point future qualitative inquiries to help us understand where to focus our efforts, 

• RE: ONC work on USCDI - would be helpful to align using that since that infrastructure is being built.
• Gravity project via HL7 to create data standards for SDOH. Andrew Hamilton (Unlicensed) and Julia Skapik (Deactivated) are on advisory committee.
• Data Modernization Act activities could be informed by these issues of lack of standardization.

Future meetings/Suggestions

• Dashboards, data visualizations are helpful.
• What do we do with this data to show what CHCs are doing, and the impacts on the populations served by CHCs.
• How NACHC is pulling together the data and information from the networks
• Harvest where the short term recommendations vs long term. What are the things we could address when we have a break that would help us in terms of infrastructure?