The Honorable Alex Azar, Secretary of the U.S. Department of Health and Human Services & Dr. Robert R. Redfield, Director of the Centers for Disease Control and Prevention - Tillis, Colleagues Call on CDC, HHS to Improve and Modernize COVID-19 Data Collection and Management

While the Administration and states take important steps to reopen communities across the
country as safely as possible, in part by increasing COVID-19 testing capacity, we ask that you
also prioritize the real-time collection and distribution of infectious disease data across federal,
state, and local governments. As demand for COVID-19 testing increases, healthcare workers
and administrators are increasingly burdened with manual, antiquated, and often inaccurate data
entry and management for patient health conditions, patient registration, sample collection, and
testing operations. Thus, we urge that you work more closely with states, health care providers,
and private sector stakeholders to modernize, automate, and streamline COVID-19 and other
infectious disease and symptom data collection and management as quickly as possible.
An analysis in Health Affairs suggests lab reporting networks will have to scale up electronic
reporting at least three-fold to capture the millions of COVID-19 tests per week as recommended
by epidemiologists. To meet this demand, data collection and management platforms must be
simple and efficient to use while minimizing errors. However, as many facilities continue to
resort to hand-written labeling and recordkeeping, manual data entry can lead to serious concerns
such as transcription errors, compliance risks, and delayed turnaround. For example, a 2019
study on point-of-care results found clinically significant errors in 3.7 percent of manual data
entries, of which 14.2 percent included potentially dangerous transcription errors. Manually
entered result flags deviated from the laboratory information management system (LIMS) in 73.9
percent of tested pairs, underlining the importance of automated tools.
Fortunately, software-based systems providing data management for state public health entities
and major testing laboratories already exist, and they are more efficient and accurate while
reducing the burden of excess paperwork. For example, North Carolina and Florida have taken
steps to modernize and improve patients' COVID-19 test results and other infectious disease
symptoms. In Florida, nurses can register patients for COVID-19 testing in the field using tablet
computers that are connected to a HIPAA compliant cloud. By managing the patient and order
requisition information electronically, lab processing time is reduced and transcription errors are
eliminated.
Automating the tedious task of data entry and management improves health care facility
workflow and frees up providers to focus on patients. In addition, new software and technology
systems are helping to improve data collection and patient engagement. Therefore, we urge CDC
to move forward with the deployment of coordinated, interoperable real-time, nationwide public
health surveillance systems. Ideally, these systems would be searchable at a zip code level as
well as by symptoms and co-morbidities.
During an emergency such as the current pandemic, scaling up and using existing systems to the
greatest extent possible can improve data collection and contact tracing efforts. We therefore ask
that you and your colleagues utilize and build on existing data sources, such as EHR and LIMS
systems, claims databases, and other automated systems to provide government leaders, public
health officials, community leaders, and others with actionable, easy-to-interpret data from a
wide-ranging set of sources. Data generated by contact tracing, syndromic surveillance, and
large-scale testing can help inform decisions on how to safely reopen communities and bring
economies back online. Modernizing and automating data collection should augment detection,
testing, and contact tracing plans, while also helping to prevent and improve the management of
new outbreaks. We look forward to discussing strategies to improve COVID-19 data collection
and disease management with you.
Lastly, it is important to work to improve the quality of data collected to include race, age,
gender and location. Higher data quality would allow for improved tracking of disease
progression and better data collection on more vulnerable populations, such as those living in
dense populations, older populations, and gender or other distinct population groups.
Sincerely,
Thomas R. Carper
United States Senator
Bill Cassidy, M.D.
United States Senator
Richard Blumenthal
United States Senator
Susan M. Collins
United States Senator
/s/ Robert P. Casey, Jr.
Robert P. Casey, Jr.
United States Senator
Thom Tillis
United States Senator
/s/ Mark R. Warner
Christopher A. Coons
United States Senator
Mark R. Warner
United States Senator
/s/ Michael F. Bennet
Michael F. Bennet
United States Senator
Tina Smith
United States Senator