Like most public health agencies in the country, when COVID-19 hit Dallas County, Texas our data management system faced significant challenges. With limited data sharing or interoperability between the Dallas County Health and Human Services (DCHHS) and our partners in the clinical care realm, as the crisis unfolded, we relied on piles of paper reports, faxes and medical students who spent hundreds of hours manually entering testing and morbidity data into our COVID database.
Astonishingly, that meant that the case and morbidity numbers that scrolled across the TV news ticker—along with trillions of dollars’ worth of policy decisions—were all based on a literal paper trail. We immediately recognized this was far too slow, cumbersome, and error prone to be sustainable.
Capitalizing on the urgency of the crisis, DCHHS embarked on a data modernization program aimed to enhance the sharing, accuracy, scale, speed and analysis of local health information. We implemented purpose-built solutions for secure health data sharing and integration and applied creative uses of software typically more at home in B2B and enterprise environments. These efforts resulted in massive improvements in operational efficiency, speed and accuracy of reporting, and the timeliness of our response.
Perhaps most importantly, we have now developed a future-ready system that will allow DCHHS to address other public health needs with the same speed, precision, reliable insights and the ability to measure the impact of our interventions.
Disparate data, isolated teams posed challenges
Between hospitals, pop-up testing facilities, walk-in clinics and the labs that process test kits, the number of disparate sources, systems, and formats of health data made it nearly impossible for our team to track and prevent the spread of COVID-19 with current solutions. The sheer volume of data was overwhelming, and none of it had previously been connected.
Complicating matters, our epidemiologists, front-line clinical providers and IT/data analysts were open to collaborating, but the lack of established systems for integration made coordination more challenging, as there was no structured framework to support it.
That’s mostly due to the historical lack of investment in public health across the country, especially for administrative functions. Funding for initiatives typically peaks in the immediate wake of a crisis, but otherwise most agencies don’t receive the necessary appropriations to keep health data management systems up to date.
In Dallas County, we approached the issue from the perspective that, given our responsibility to the public and obvious connections to the clinical community, our public health data systems needed to be just as modern, with the same best-in-class function, as those in the private sector.
Achieving integration and interoperability with proven solutions
To achieve our goal required a multi-faceted approach. First, we tackled data integration and interoperability to weave together the multitude of data streams.
Because of its best-in-class ability to ingest and aggregate FHIR and HL7 data, we turned to Rhapsody digital health enablement platform as a key element of our system. Given Rhapsody has a history of previous work in public health, including the Michigan DHHS on modernizing their data exchange, we could leverage their proven best practices and schematrons to assess the quality of our electronic case data. The Rhapsody automated system was able to aggregate and integrate siloed data sets and enrich our data quality. As we continue to move forward with our data modernization efforts, we appreciate that out of the box, Rhapsody will allow us to deploy FHIR and TEFCA standards for accuracy and secure sharing for peace of mind and a future-ready solution.
MuleSoft and Informatica provided platform integration and cloud data management to support the ingestion of raw electronic lab reports (ELRs) from the state and Electronic Initial Case Reporting (eICR) from APHL/AIMS.
Next, we used Salesforce for case mapping, contact tracing and notifying residents. Salesforce’s API connected its Customer Relationship Management (CRM) tools to healthcare reporting systems to map cases, validate addresses, track hotspots and reach out to residents in near real time—a process that had taken days previously, hindering our efforts to stop the spread of the disease.
Finally, data visualizations through Microsoft PowerBI allowed us to create internal dashboards, as well as compelling visuals for the public, allowing us to communicate real-time data with clarity, accuracy and confidence.
Greater efficiency, collaboration were key to success
In so many ways, DCHHS’ Health Disease Surveillance and Investigation System created unprecedented improvements in efficiency and accuracy, saved us a tremendous amount of time and improved our ability to communicate clearly, disseminate vital information and earn the public’s trust.
Aside from the data insights to inform our response, one of the biggest takeaways from the project was the vital importance of collaboration between IT, healthcare clinicians and public health epidemiology experts. When we began, DCHHS had zero dedicated health information staff, and epidemiologists served as the product owners. They gained incredible data analytics skills, but the deep blending of technical knowledge with frontline clinical resources and IT expertise has been critical to our success. Disparate departments and siloed IT simply will not work—it must be a collaborative effort.
That collaboration extends to clinical encounters. Again, the historical lack of interface and data sharing was a liability when COVID struck. This project enabled clinicians to understand the limitations of data and the importance of good data gathering practice—the need for accuracy, completion and training to ensure data integrity. By shedding light on the capabilities of our analytics, our team was able to demonstrate to clinicians the value of effective input in delivering relevant, applicable output. At the same time, our epidemiologists gained a new appreciation for the needs and obstacles clinicians face on the front lines of an epidemic.
Our experience also underscores the benefit and need for clinician training in public health. Too often, providers don’t recognize a public health issue until it’s too late, and through tighter collaboration, data sharing and a better understanding of data gathering and reporting, we can work together to get ahead of outbreaks, identify populations most at risk and minimize proliferation.
Beyond COVID, a platform for proactive public health management
There’s no question that tools like Rhapsody to standardize and integrate disparate sources of data—including social determinants of health—will be critical for managing public health going forward.
With access to more complete person profiles, epidemiologists can conduct more thorough investigations, monitoring and contact tracing (when warranted) across a wide range of concerns, including HIV, STIs, Mpox, Ebola, Pertussis, H1N1 and even environmental hazards, opioid contamination or overdoses.
Moreover, the ability to aggregate data from virtually any source allows public health officials to work more closely with community partners such as homeless shelters to identify hotspots, visualize trends and take swift, appropriate action in the event of an outbreak. Further integration with EHR systems may even allow us, for the first time ever, to ingest real-time data on chronic diseases that present heightened co-morbidity risks, like obesity, Type 2 diabetes and cardiovascular disease, and advise individuals on preventative measures.
In addition to giving us the ability to seamlessly and instantly report critical data directly to the state, with the assurance that it meets standards for quality and accuracy before it’s even sent, these systems can also track the outcomes of our interventions in real time, allowing us to better target resources to address urgent needs.
One of the few bright spots to emerge from the COVID crisis has been the fact that public health has finally gained recognition from the public, funding agencies, clinicians and key decision makers for its role in healthcare innovation.
Now is the time for public health agencies across the country to capitalize on this attention and invest in these kinds of comprehensive data modernization programs utilizing best-practice models to prepare for the next crisis before the next public health crisis begins.
Dr. Philip Huang
Dr. Huang has been the Director and Health Authority for the Dallas County Health and Human Services Department since February 2019. Prior to this he served for 11 years as Medical Director and Health Authority for the Austin Public Health Department. He received his undergraduate degree in Civil Engineering from Rice University, his MD from the University of Texas Southwestern Medical School, and his Masters in Public Health from Harvard with a concentration in Health Policy and Management.
Dr. Huang’s tenacity to fostering and protecting public health was proven during the Covid 19 outbreak. He was a spokesperson representing Dallas County educating the public about preventing the spread of COVID-19 and the importance of vaccines. He maneuvered his way against vaccine hesitancy and led the mass vaccination efforts within the county, ensuring that resources reached the underserved and highest need areas of the community. Under his leadership over 600,000 vaccines were administered through DCHHS and County efforts. Previously while working at the Texas Department of State Health Services, Dr. Huang led and supported state-wide efforts to reduce tobacco use, including testimony at over 40 City Council hearings across the state to help with adopting smoke-free ordinances. Dr. Huang has also been leading local Dallas County efforts to address chronic diseases, HIV and modernize our public health data systems. He recently received national recognition by Governing Magazine as one of six “Public Officials of the Year” for 2024.”
