This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Since COVID-19 began making headlines in March, Michiganders have relied on maps and graphs of COVID-19 cases and deaths to inform their daily activities. Behind those color-coded counties and line graphs, data sharing among Michigan's many health providers has helped the public, health care organizations, and public health professionals better understand the pandemic.

Dr. Sarah Lyon-Callo.

"A lot of different data systems are used in public health. Healthcare providers, physicians, and facilities are reporting information to public health on cases, including information during the height of the first wave," says Dr. Sarah Lyon-Callo, director and state epidemiologist for the Michigan Department of Health and Human Services' Bureau of Epidemiology and Population Health. "We're always grateful to health care providers for taking time out to share that information."

One of many systems that has proven essential, the Michigan Syndromic Surveillance System, facilitates rapid detection and response to unusual outbreaks of illness. While a global pandemic like COVID-19 had not been considered during its design, the system's real-time collection of patient data has helped map numbers of people seeking care for COVID-19 symptoms and helped direct response, such as personal protective equipment (PPE) distribution, tracking hospital beds, and creating additional care facilities.

"It tracks how many emergency room visits [and] what sorts of symptoms people communicate as chief complaints – for example, respiratory conditions," Lyon-Callo explains. "We were able to make use of this data feed timely by looking at influenza- and COVID-19-like complaints."

Another vital player in Michigan health data sharing is the Michigan Health and Hospital Association (MHA), which represents all community hospitals in Michigan. Its data services help hospitals create comparative reports on patient demographics, outcomes, and utilization, as well as track their impacts on health and wellbeing in their communities. Since the implementation of MDHHS COVID-19 data reporting requirements, MHA has helped its members connect with the U.S. Department of Health and Human Services' TeleTracking portal, which submits data to both state and federal health and human services agencies.

"Michigan's data sharing is actually pretty good and has in many ways benefited pandemic response," says Jim Lee, vice president of data policy and analytics at MHA. "We work very closely with [Lyon-Callo] and the MDHHS around helping provide as much data as possible to help them from a public health perspective."

Tim Pletcher, executive director of the Michigan Health Information Network.

Tim Pletcher, executive director of the Michigan Health Information Network (MiHIN), believes sharing data has been essential to getting the word out about the pandemic's progress and determining what to do about it. Launched in 2010 by the Office of the National Coordinator for Health Information Technology, MiHIN is a public and private nonprofit collaboration that supports the statewide exchange of health information, connecting Michigan healthcare providers via electronic health care records. It also works to provide both a legal framework and policy infrastructure to safeguard and standardize health data transfer.

"We've been able to deliver healthcare providers data that's accurate from day one [of the pandemic]," Pletcher says. "It's been a whole lot easier because we had this pre-existing infrastructure. The relationships and trust and recognition of the impact of public health agenda wasn't something a bunch of IT people had to learn."

Beyond testing numbers

Michigan health care providers have shared a variety of pandemic data beyond the commonly discussed COVID-19 testing numbers. Hospital admission, discharge, and transfer records are another crucial data source. An MiHIN program, MIDIGATE, shares these records to help keep all providers involved in a person's care aware of the patient's care status. Among its many functions, MIDIGATE also updates patient rosters and sends information to Michigan Medicaid about health outcomes, patient safety, care coordination, and adherence to clinical guidelines as a way of assessing quality of care.

"It's really [about] understanding how the pandemic has impacted the community and the health care providers in that community," says Lee. "For example, in southeast Michigan, the hospitals had a large amount of COVID-19 patients showing up. Having data allowed the health departments and others to plan for additional equipment, ventilators, or needs around PPE, and even building care sites to handle the overflow that could not be taken care of in traditional hospitals."

This shared data does not include individual patients' personal information, but it does provide aggregated counts of COVID-19-related issues such as how many people are in hospitals, how many of those are in intensive care, or the ages, races, and ethnicities of individuals testing positive. This information is uploaded to both federal and state systems.

"Our hospitals are very supportive about providing data in trying to understand what exactly is going on in regard to the pandemic," Lee says.

The data not only directs decisions made by health care systems and health departments, but assures that individual patients receive consistent, informed care from all of their providers. For example, MiHIN's Active Care Relationship Service provides a common infrastructure that allows a patient's providers to access relevant information. Public health staff with authorization are also allowed access when investigating a COVID-19 case. In addition, partnering laboratories handling COVID-19 testing share results with MDHHS directly so that potential cases can be investigated more quickly.

"We can inform [patients] of lab results, link them with resources, help them to understand how to self-isolate, learn who they may have exposed, reach out to those folks, and break the chain of transmission," Lyon-Callo says.

Lyon-Callo notes that when an individual tests positive for COVID-19, shared lab results allow MDHHS to support contact tracing, reducing pressure on Michigan's local health departments. When contact tracing occurs, no names are provided. People who are contacted are simply told that they came in contact with someone who tested positive for COVID-19, but are not given that person's name or identifying information. Lyon-Callo says she's grateful that those health departments had worked out arrangements to share case data before the pandemic.

"This pandemic has been something that no one has had to address in the U.S. in my lifetime," she says. "We've been able to work out protocols and new systems where we take on their contact tracing and monitoring."

Data sharing between the state's communicable disease program and vital records area has also helped to more promptly provide COVID-19 mortality numbers. Callo says the state has implemented electronic death certificate reporting, improving its collection of death certificates from across the state.

Jim Lee, vice president of data policy and analytics at the Michigan Health and Hospital Association.

"We are able to more accurately determine how many have died who had COVID-19, ... which is important in understanding the impact of the epidemic," Callo says.

Areas for improvement

While data sharing in Michigan was ahead of many states when the pandemic hit, none of the systems in place had been designed to deal with a pandemic of COVID-19's proportions.

"Many of the systems are predicated around regional issues, not a global pandemic," Lee says. "Certainly, no one thought about the need to collect data from a state or U.S. perspective with the entire country overrun with a pandemic."

"In the first three months of the epidemic we processed more test information than we had the entire year before," Callo adds. "We're very proud of the system but would like to revamp it to something a little bit easier to use."

Pletcher sees data sharing as an infrastructure as important as roads. And like roads, it needs funding to ensure maintenance and continued improvement. While data sharing between hospitals, providers, and public health has been hugely successful, the pandemic has focused attention on how people's health depends on social determinants ranging from housing to education to employment. Including schools, nonprofits, and community agencies in data sharing could help ensure even better health for all Michiganders.

"This is where we really need to put our energy going forward," Lee says. "Sharing information around social determinants of health ... really advances that space in an equitable way so we understand where some of the disparities are and we are in a better position to leverage that information to mitigate those disparities."

When a COVID-19 vaccine becomes available, yet another data system will guide Michigan's next steps. The Michigan Care Improvement Registry, created in 1998 to collect reliable immunization information for children, will help target, monitor, transfer, and track expiration dates for vaccine doses across the state.

"Michigan has been very fortunate that health care and public health came together in response to COVID-19," Lyon-Callo says. "Since the pandemic has started, the Michigan health information networks have very much stepped up to the plate and offered assistance, know-how, and creativity in COVID-19 response."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Jim Lee and Tim Pletcher photos by Roxanne Frith. Sarah Lyon-Callo photo courtesy of MDHHS.