Hospitals and states are scrambling to adopt a new national Covid-19 data reporting system hastily implemented by the Trump administration last week that has left some, mostly rural, states in the dark about the severity of their own coronavirus outbreaks.
The Department of Health and Human Services abruptly instructed all hospitals last week to stop reporting their coronavirus data to the Centers for Disease Control and Prevention's long-standing National Healthcare Safety Network. Instead, hospitals were instructed to report the data to HHS through a new portal that went live on Monday. HHS gave hospitals two days to comply and tied their cooperation to the distribution of remdesivir, a vital drug used to treat Covid-19.
HHS officials said they made the move to ensure the federal government had more comprehensive and real-time data used to make important decisions, such as remdesivir distribution. But it's left some states without key information on their own Covid-19 outbreaks: coronavirus hospitalizations, available hospital beds and available ICU beds.
Some states don't collect the data themselves and rely on the CDC to assemble and share that information, which public officials use to decide how to allocate key resources. The abrupt change left many hospitals, especially smaller and rural ones, as well as local policymakers in the lurch as health systems transition to the new system, officials in Missouri, Idaho and Montana told CNBC.
In Missouri, hospitals went "all in" on building out computer systems to quickly report data to the CDC, Missouri Hospital Association spokesman Dave Dillon told CNBC. About 99% of hospitals across the state were successfully reporting their Covid-19 data to the CDC before the change, he said. Over the past four days, just 82% of Missouri's hospitals submitted data to the new system, according to HHS data.
"It is taking time to pivot," Dillon said. HHS has requested new, "poorly defined" data they weren't collecting for the CDC before, he said. What's more, the state used the CDC's data to build its own Covid-19 dashboard for the public and now it's unable to access the same information on the new HHS platform, he said.
The hospitalization data presented on Missouri's dashboard has not been updated since July 12 as a result. The Missouri Department of Health and Senior Services' website now reads: "Please note, due to an abrupt change in data measures and the reporting platform issued by the White House... Missouri Hospital Association (MHA) and the State of Missouri will be unable to access critical hospitalization data during the transition."
"This is the worst possible time for a data blackout," Dillon said. "It is quite possible that during the downtime, Missouri exceeded the all-time high for hospitalizations."
Hospitals in the state are working "nonstop" to comply with the new guidance, Dillon said, and the state is working to get access to the full data from HHS so it can update its dashboard. He said the state hopes it can update basic information such as available "beds, vents and admissions" as soon as this week.
"Until MHA can see everyone's data, we won't be able to report. More critically, we won't be able to understand where resources are needed," he said. "It's hard to manage this crisis when the goalposts keep moving."
Even though HHS is getting hospital data from every state, that information remains incomplete. But the agency says it's collecting more information than the CDC was ever able to get.
Across the country, nine states currently have fewer than 50% of their hospitals reporting data through the new HHS system, according to the agency's site. Roughly 25% of the hospitals in North Dakota and 28% in Louisiana were reporting their Covid-19 hospitalization data through the new system as of Wednesday, HHS data show.
To be sure, many states and hospitals were able to transition to the HHS portal without any problems. And some states were already collecting their hospital data themselves and didn't lose much, if any data, when the CDC's system was shut down.
John Haupert, CEO of Grady Health System in Atlanta, Georgia, for example, said the new reporting system hasn't placed much of a burden on them.
"There is slightly more information being requested, but in our minds it's essential information for [HHS] to be able to make decisions," he said on a conference call organized by the American Hospital Association. "As far as the effort to submit the data and collect the data, that has not been significant."
The Covid Tracking Project, which monitors Covid-19 hospitalizations and other coronavirus statistics across the country, said most of their data has remained uninterrupted.
"However, some smaller states like Idaho, South Carolina, and Missouri were using the CDC system that HHS replaced to provide data to the public," the Covid Tracking Project said in a statement to CNBC. "Now, those states are scrambling to create new pipelines that can provide that data."
Idaho can finally access the HHS data, but its own Covid-19 dashboard was outdated for several days during the transition. The information, however, is still incomplete. "Not all hospitals are reporting, so that does present some challenges," said Kelly Petroff, spokeswoman for the Idaho Department of Health and Welfare.
Until that data is restored, some researchers, states and others are missing critical information in tracking and responding to the outbreak, according to the Covid Tracking Project, which is a volunteer organization launched by journalists at The Atlantic.
"This is important because current hospitalization data had become the most reliable indicator of the severity of outbreaks in different states," the group said. "Unfortunately, now we're not sure if some of the erratic changes in hospitalizations that we're seeing are due to reporting problems or real changes on the ground."
HHS Chief Information Officer Jose Arrieta told reporters on a conference call Monday that the new system collects data from roughly 4,500 hospitals on most days, compared with 3,000 hospitals under the CDC's old reporting system.
"From our perspective, when we look at the total number of hospitals reporting since the transition has occurred, the number has actually increased pretty significantly," he said. "We realize this is a change and anytime there is a change, it obviously creates a little bit of tension, maybe a little bit of pain to transition."
An HHS spokeswoman told CNBC the agency has "held a number of calls" with hospitals and industry representatives to "share details of the program changes and respond to questions." HHS also set up a service desk to help hospitals submit their data, she said. The new TeleTracking system provides more frequent and detailed data, which will help the U.S. response, she said.
"This methodology also highlights recent case increases in states/territories and allows us to allocate more amounts of commercially available remdesivir to areas of the country with the most need," she added.
The transition is a tough one for smaller, more rural hospitals that don't have as many resources, Charles Kahn, CEO of the Federation of American Hospitals, told CNBC.
"On the other hand, the data is needed for the distribution of remdesivir and other materials ... so I can see their reasoning for collecting much of the data that they're now asking for," he said in an interview.
Brian Whitlock, CEO and president of the Idaho Hospital Association, said the burden of the policy change is weighing heavily on some hospitals in his state. Hospitals had roughly 36 hours to transition to the new system, and the federal government threatened to cut off allocation of resources such as remdesivir if they failed to do so, he said.
Part of the problem, he said, is that the state's contractor wasn't initially cleared to access the HHS data. So Idaho hospitals now have to report the data to both the federal government and the state instead of one centralized database as they adjust to the new system, he said.
"When you're talking about a rural, critical-access hospital that may have somebody who is wearing half a dozen other hats in the hospital, being tasked with Covid-19 reporting is an additional hat," Whitlock said. "We're finding that that person who already is wearing half a dozen hats, they now have to go back and do duplicative reporting to the state system until we can figure out how to crosswalk the data between those two systems."
Before the policy change, he said Idaho was successfully collecting data from "nearly every hospital" in the state. HHS says it's now collecting data from about 65% of the hospitals. Whitlock, however, said he's confident that over the next few weeks more hospitals will adapt to the new system. But that extra strain comes as Idaho is grappling with a major spike in cases and cash-strapped hospitals are struggling to care for patients and with less staff. Many hospitals had to lay off workers after several states imposed mandatory shutdowns that prohibited elective surgeries earlier this year.
Rich Rasmussen, president and CEO of the Montana Hospital Association, echoed the experiences described in Idaho and Missouri. He said cash-strapped hospitals across the state worked hard to ramp up their reporting infrastructure as the virus hit the U.S. in March.
"We just got the system working with NHSN. We were reporting it. We were moving right along," he said in an interview with CNBC. "And then we have to switch and now we have to learn a new portal, new training, more questions."
Rasmussen added that some hospitals in Montana, especially in "frontier communities," "have less net patient revenues than the average Home Depot has in revenues." He said staffing resources are particularly tight, making this transition to the new reporting system a "heavy lift."
"It's kind of a catch-22 to take limited resources that you have in your hospitals and add additional responsibilities and reporting requirements to those stretched-thin resources," said Whitlock, of Idaho. "More time to make these changes and some resources to pay for these changes would have been nice."
— CNBC's Bertha Coombs contributed to this report.