By Lambert Strether
Let me begin by listing the headlines, in order of increasing hysteria:
- Coronavirus data is funneled away from CDC, sparking worries AP
- Transparency questions after hospitals directed to report COVID data to HHS, not CDC ABC
- Trump Administration Orders Hospitals To Bypass CDC, Send COVID-19 Data To Washington NPR
- Trump administration takes control of COVID-19 data in US Al Jazeera
- Coronavirus hospital data will now be sent to Trump administration instead of CDC CNN
Headlines 3, 4, and 5 are wrong, in that they imply that the CDC is not part of the Trump Adminstration. In fact, the Centers for Disease Control and Prevention (CDC), as a glance at its About Page shows, is part of the Department of Health and Human Services (HHS), and hence part of the Trump administration. The CDC is no sense an independent agency like the SEC or the FAA, and hence is politicized, or not, as any other portion of the executive branch; such independence as its “scientific experts” and other personnel may have is due solely to the Norms Fairy, and is in no way the result of statutes or regulations. (That may be a bad thing, but it is so.)
In institutional terms, for collecting and aggregating COVID data, the administration has phased out the CDC system (National Healthcare Safety Network, or NHSN) in favor of the HHS Protect[1] system (produced by TeleTracking Technologies Inc. of Pittburgh, PA). In this post I will first compare and contrast the two systems; despite the hysteria, I think there’s a prima facie case for the administration doing what it did, because TeleTracking[2] has better tech. I have priors from past lives where I worked in and with companies like TeleTracking, especially on the data side — which is not at all easy — so I feel I know where I am; that said, it’s hard to dope out the contractual relation between HHS and TeleTracking from the news reports, so at times I will have to speculate.) In an Appendix, just for fun, I’ll look at the CDC under Obama. It will be evident that the CDC has had problems — not necessarily of its own making — for some time, long before its COVID testing debacle in 2020.
So now let me run through the differences between centering COVID-19 data collection and aggregation via the CDC’s NHSN, and the HHS Protect. (I’ll leave aside that the Administration is replacing a government program with a public-private partnership, not because I thinik that’s a good idea, but because it’s sadly ubiquitous.)
First, from the perspective of somebody in the trenches trying to move data, descriptions of the CDC’s dataflow raise red flags. For example, under HHS Protect:
HHS said it will also no longer ask for one-time requests for data to aid in the distribution of remdesivir or any other treatments or supplies.
“One time requests” for data under NHSN, especially in a highly stressed environment like that of a hospital during a pandemic, are a recipe for error, evershifting priorities, and a stressed staff. Further, NHSN coverage is incomplete. In addition, it’s slow:
Michael Caputo, an HHS spokesman, said the CDC has been seeing a lag of a week or more in data coming from hospitals and that only 85% of hospitals have been participating. The change is meant to result in faster and more complete reporting, he said. A CDC official, who is familiar with the agency’s system, disputed Caputo’s figures, saying only about 60% of the nation’s hospitals have been reporting to the CDC system, but most data is collected and reported out within two days.
Since a pandemic is multiplicative, neither a week nor two days are acceptible. Both these red flags provide good reasons for change.
Second, the TeleTracking System is better than NHSN at handling data. From Prepared Remarks from HHS Media Call with CDC Director Redfield and CIO Arrieta on COVID-19 Data Collection:
TeleTracking also provides rapid ways to update the type of data we are collecting—such as adding, for instance, input fields on what kind of treatments are being used. In order to meet this need for flexible data gathering, CDC agreed that we needed to remove NHSN from the collection process, in order to streamline reporting.
From what I can tell, the NHSN provides fields for ICU bed occupancy, Healthcare worker staffing, and Personal protective equipment (PPE) supply status and availability. That’s not very much, particularly if we expect new drugs or vaccines to come online soon. Even better, the TeleTracking System provides a standard schema to structure and validate the fields. HHS, in “COVID-19 Guidance for Hospital Reporting and FAQs For Hospitals, Hospital Laboratory, and Acute Care Facility Data Reporting” provides a number of ways for hospitals to provide data, including:
Publish to the hospital or facility’s website in a standardized format, such as schema.org. Use one of the above alternate methods until your ASPR Regional Administrator or HHS Protect notifies you that this implementation is being received.
(The schema referenced is by Dan Brickley (!)). He writes, in “COVID-19 schema for CDC hospital reporting“:
The COVID-19 pandemic requires various medical and government authorities to aggregate data about available resources from a wide range of medical facilities. Clearly standard schemas for this structured data can be very useful.
The Centers for Disease Control (CDC) in the U.S. defined a set of data fields to facilitate exchange of this data. We are introducing a Schema.org representation of these data fields.
The purpose of this schema definition is to provide a standards-based representation that can be used to encode and exchange records that correspond to the CDC format, with usage within the U.S. primarily in mind. While the existence of this schema may provide additional implementation options for those working with US hospital reporting data about COVID-19, please refer to the CDC and other appropriate bodies for authoritative guidance on the latest reporting workflows and data formats.
I’m shocked that CDC had not already adopted a schema. If you want to interchange COVID-19 data electronically between many organizations running different systems, a formal and machine-readable definition of the data fields is the way to go (as opposed to human-readable documentation). Further, since Brickley’s schema already expands on CDC’s definitions, I would speculate that TeleTracking’s use of schemas is the source of the “rapid ways to update the type of data we are collecting” referred to by Redfield.
So that is the approach to data. Let me now speculate why TeleTracking was selected, and how they might be useful to HHS in the future.
TeleTracking is in the business of “patient flow.” From “Statement of TeleTracking Technologies, Inc. at the House Ways and Means Subcommittee on Health (PDF):
TeleTracking’s mission is to optimize health system operations by enhancing patient flow with solutions and services that enable the highest quality of care delivery and coordination. What does it mean to enhance patient flow? It means helping hospitals care for more patients without building more physical space or purchasing more beds. It means making sure that patients don’t languish in emergency rooms – or leave the hospital without receiving care – because of long waits for beds. It means harnessing technology to make the most of the resources already within the health care system to improve quality of care, minimize waste, and decrease health system costs. And, it means unburdening care providers so that they can focus their attention on the patients who need them…
This is not just about costs or financial performance. “Forty-six minutes was just enough time to save the life of a new mother” began a recent news story about how the process efficiencies gained at Baptist Memorial Health System are having lifesaving effects. After an emergency cesarean section, a new mother suffered cardiac arrest and needed to be transferred from one facility’s emergency department (ED) to an intensive care unit at Baptist’s flagship hospital. If Baptist had performed like an average US hospital, this young mother would never have had the chance to meet her new baby. Baptist’s streamlined patient flow processes, service standards and technologies supported caregivers in their efforts to save this young mother’s life, and undoubtedly the lives of countless others.
To this end, the Agency for Healthcare Research and Quality (AHRQ) targeted patient flow as a viable improvement strategy in 2011. And, the Institute of Medicine (IOM) identified billions dollars of waste in the health system diverting resources away from patient care…. It is apparent that an operational focus is needed to drive down costs, improve efficiency, and assure all patients receive timely access to care and sufficient time with caregivers.
Needless to say, I have other views on how best to drive down costs, but clearly an operational focus would be needed even under a single payer system. The focus on patient flow motivates the data structures on the one hand, but also motivates the creation of “dashboards” so that executives can make decisions about resources. From Becker’s Hospital Review:
1. Recently, New Cross Hospital in the UK reported that it reached one million hand hygiene observations using TeleTracking’s sensor technology. In that same period of time, only 600 visual observations were made.
2. TeleTracking’s system allows real-time monitoring of patients and availability so rooms can be cleaned and turned over immediately.
3. TeleTracking’s technology tracks the hours of care given to each patient along with the number of staff members that come in contact with each case. The data can be used to reduce waste and plan future staffing and costs.
If I were an HHS administrator, and I was faced with the immediate problem of distributing remdesivir (of which the United States bought the world’s stock) or, later — touch wood — faced the problem of distributing vaccines, the tech that TeleTracking has exactly what I would want. I would want very granular data, I would want to understand capacity, and I would want to dashboard to display all that to my crazy boss. Now, I don’t know if TeleTracking has a contract for that. But I can see that some clever person has put them in a position to secure one, should that become necessary. By contrast, CDC is merely aggregating data. Not very interesting!
Conclusion
My guess is that a Biden administration would retain the HHS Protect system, much as Obama rationalized and consolidated Bush’s programs for warrentless surveillance and assassination.[3]
NOTES
[1] HHS Protect seems to have a lot of other functions than collecting COVID-19 data, but those functions are beyond the scope of this post. Palantir is involved with those functions, and yes, I know the business of data can be quite seamy. I don’t think TeleTracking is the prime on HHS Protect, which sounds like a topic for another post.
[2] TeleTracking looks as legitimate as any other health IT company; the field is littered with smallish firms, many smaller than TeleTracking. Employee reviews are good; it’s not a body shop. They have a good customer list, including the Mayo Clinic, and good reviews. They’ve been in business since 1991, so they’re not a fly-by-night shell company. A search of OpenSecrets shows no campaign contributions either by TeleTracking or by its CEO (adding, although Zamagias is a Republican donor).
[3] The current moral panic is that the Administration will use HHS Protect to jigger the data, as Florida seems to have done. For one thing, the use of a schema means more transparency, not less. For another, there are too many eyes on the dataflow. For a third, both Big Pharma and the hospitals would be very unhappy were revenue to be taken away from them via undercounts, and they would be very willing to share their unhappiness with others. And for a forth, CDC is a branch of HHS, hence part of the executive branch. If Trump wants to damage the dataflow, he doesn’t have to set up a new system to do it; he can use the one he already controls.
APPENDIX: The Obama Administration, Pandemics, and the CDC
PPE shortages. Fortune, 2014:
This week, registered nurses will gather in cities across the country—from Bangor, Maine, to St. Louis to Sacramento—to call on the Obama administration and Congress to institute standards for protecting front-line healthcare workers from Ebola.
The rallies, which have been organized by National Nurses United, the nation’s largest union for registered nurses, are the latest in a series of actions the group has taken to protect nurses from the virus since—as NNU co-president Deborah Burger puts it—”our worst fears were realized.”
Budget Cuts. Mike the Mad Biologist, 2010:
the Obama Administration has decided to massively cut the funding for the CDC’s antimicrobial resistance and vaccination efforts. I thought this was the kind of anti-science bullshit that the Bush Administration did. Even the Bush Administration wasn’t this bad. I am not feeling hopey or changey.
Weak Authority. Reuters, 2009:
Jeff Levi of the Trust for America’s Health, an advocacy and study group often critical of U.S. health policy… argued that the agency’s director is often a passive diplomat with fewer powers of direct persuasion than a state or city health officer and that the organization must wait to be invited by state authorities or governments to intervene.
And the CDC itself agrees, in its deservedly famous post on the zombie apocalypse, in 2011:
If zombies did start roaming the streets, CDC would conduct an investigation much like any other disease outbreak. CDC would provide technical assistance to cities, states, or international partners dealing with a zombie infestation. This assistance might include consultation, lab testing and analysis, patient management and care, tracking of contacts, and infection control (including isolation and quarantine). It’s likely that an investigation of this scenario would seek to accomplish several goals: determine the cause of the illness, the source of the infection/virus/toxin, learn how it is transmitted and how readily it is spread, how to break the cycle of transmission and thus prevent further cases, and how patients can best be treated. Not only would scientists be working to identify the cause and cure of the zombie outbreak, but CDC and other federal agencies would send medical teams and first responders to help those in affected areas.
Note that the CDC failed at “lab testing and analysis.”
General Failed State Fecklessness. From Health Affairs, in 2014:
There is no question that public- and private-sector leaders involved in the Ebola response, including Frieden, made serious mistakes. Frieden, Texas authorities, the President himself and others were overconfident – at times cocky – that the U.S. health system could handle infection control, contact tracing, isolation, and containment responsibilities if faced with an Ebola case. That proved drastically wrong for Texas Health Presbyterian Hospital, a 900 bed, highly respected institution that fumbled badly at several turns. Frieden and others in the administration were slow to reverse course and admit they had underestimated the need for intensive training of hospital staff, better protocols, faster dispatch of CDC ‘swat teams,’ and far more stringent oversight of those who had been exposed and possibly infected.
Politically, Frieden and other officials failed to appreciate just how swiftly a small number of Ebola cases in Dallas could ignite fear across the nation, raise the risk of panic, and begin to erode public trust. Sadly, that fear built upon Americans’ surprisingly high skepticism that their public health institutions are in fact capable of competently protecting them.
Sound familiar? Adding: The Obama adminstration didn’t understand either a multiplying process or the Precautionary Principle. Not a recipe for success, as we have seen.
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You can always count on the Americans to do the right thing after they have tried everything else…
Pity about the body count.
So, let me get this straight: The Trump administration does something. And, occasionally, the “somethings” it does make sense. Even so, the hysteria is mandatory.
Not that I’m a fan of Trump. Far from it. But I am getting tired of the mandatory hysteria.
That’s why I said, tongue in cheek the other day, that if Trump really wanted schools to open, instead of threatening and withholding funds to school districts that won’t open, he would say “We must close all schools. Preferably for the whole year blah blah blah’. Would then the TDS crowd be pushing to re-open schools across the country? Given our current madness, you could definitely see it happening that way
Here’s what I was told by a person who’s familiar with the system that aggregates the data.
The flow is Hospital EMR -> system created by a certain organization -> export to Excel -> CDC
The new flow is to TeleTracking. Nobody ever heard of them before and based on the website, their execs appear to be real estate guys. As far as anyone can tell they’re nobodies who handle local healthcare network resource status updates. The data set they’re asking for is more comprehensive than the CDC, but it’s a huge mess. The developers and their users only learned about this the night before the story broke. There are several different templates for the data they expect. None of templates match the written specifications.
Anyhow, they’ve got a bit less than a week to implement the new import/export functionality. Most of the software modules don’t have much flexibility. There’s almost no way they’ll meet the deadline.
Personally, to me, it sounds like a formerly public function (govt agency collecting data) outsourced to somebody’s college roommate with pretty suspicious timing, an unrealistic deadline in a situation that absolutely requires data accuracy for good decision-making, and typically shoddy implementation. As expected of our ruling class.
That was my thoughts as well. From Lambert’s description the intent of the upgrade is not bad, and I have worked with government agencies enough to be shocked, shocked! to hear that they are using an inefficient system. And I can certainly see an argument for improving the process, even or especially in a time of pandemic.
But why the arbitrarily short deadline, and why the no-bid contract? The downside risk of a bad choice with no warning is far higher than the inefficient but workable.
In some sense it reminds me of the earlier scandal way back at the start of the Trump administration when they were working to privatize the VA. According to one VA head who opposed it “move fast and break things is fine when it isn’t someones life.” This feels like another “warp speed” effort that may ultimately be good, but that doesn’t mean it is being done well.
> why the arbitrarily short deadline
Because a pandemic is a multiplicative process.
I would be interested to know if Obama’s genius-level pandemic plan had anything about dataflow in it. I’m guessing no; it would have been a checklist of what to do with current institutional arrangements.
> warp speed
It makes sense, even if it is an enormous windfall for Big Pharma, to set up redundant production lines to develop and even manufacture vaccines in parallel, before they have been tested. Taleb would approve, since the alternative to warp speed is ruin.
> Nobody ever heard of them before and based on the website, their execs appear to be real estate guys.
That’s absolutely not true.* Did you read the post? See note [2]. I’d like to believe that you know the data flow, but based on your second paragraph, your comment is not in good faith. As also shown by your link-free third paragraph. I mean, I’m perfectly willing to believe in corruption, but I some shred of evidence. Please go enforce somewhere else. The door to Kos is that way.
NOTE * It is — follow me closely here — possible for a CEO to own properties (particularly if they’re not Silicon Valley weasels with stock options).
Would be interesting to know how much advance warning hospitals were given. At least one post I’ve seen from a nurse responsible for doing the reporting says it was a “as of tomorrow, use this new process” thing – but not clear if someone higher in the chain was notified earlier.
I’d also note that having a defined schema is a good thing, but again, if hospitals weren’t given time to prepare their systems to use the schema, it is a recipe for incorrect schema use (and misreporting).
> I’d also note that having a defined schema is a good thing, but again, if hospitals weren’t given time to prepare their systems to use the schema, it is a recipe for incorrect schema use (and misreporting).
True. Then again, if we’re supposed to be on a wartime footing…. take some bright technical person off entering billing codes for a week and have them figure it out. The fields will be recognizable, since they are based on existing CDC documentation, so it’s not like they’re dealing with a blank slate.
This can’t be cool. Teletracking Technologies is an acquisition of majority owner and CEO Michael Zamagias, a somewhat dead-beat-adjacent real estate developer with demerits for defaulting on PA state loans, stalled projects, and a portfolio of dilapidated commercial property in Pittsburgh. This memory hole is about reelection, control, and getting the evidence of negligence* inside the black box of someone desperate enough to burn themselves getting near the First Family for being shown the proper gratuity via a Ben Carson Federal Grants propping-up ghost condos built on the foundations of de-industrialized America.
*If a private citizen in charge of others’ well-being ignored the COVID figures as Trump does, that person would face criminal negligence penalties in the same category as toxic substances, collapsed mines, and self-destructing automobiles. I am surprised the benefits of so many doubts are being granted in this case. The context in which decisions are made is everything.
Links needed. Did I mention hysteria? If you want to the case, make it. The NC Comment section is not the place to test out your new memes. The door to Kos is that way.
Dagnabbit Lambert, do you have to spoil my righteous indignation? With facts and everything? I thought I was going to be able to settle into a nice, comfortable seethe on this one.
Grudging thanks for your efforts.
There can be plenty of reasons to seethe. I don’t think this is one.
Doesn’t the article above cite some of Teletracking work? It seems they have actually done something in the past in regard to health care.
> It seems they have actually done something in the past in regard to health care.
Does anybody read what I write? See note 2. They’ve been in business since 1991, they have a good client list, their employees like them, etc.
This post appears to make sense to me ( to the limited extent I can even understand it) on the dispassionate face of it.
But since this is the Trump Administration doing it, we should consider the possibility that Trump’s reason for doing this is to prevent effective data-collection, erase data and otherwise destroy enough evidence that
Trump’s Conservative Correctness Commissars at the new data receiver group will massage whatever they allow to remain in existence of what they collect to support the Trump Campaign’s ongoing needs and desires from moment to moment. In time we will see.
Just because a President Biden will probably keep the new arrangement will not in hindsight make it a good thing to have done.
> Just because a President Biden will probably keep the new arrangement will not in hindsight make it a good thing to have done.
No, and it wasn’t a good thing that Obama “looked forward and not back” on torture, either. But the mandatory hysteria obscures this fact. A cynic would claim it is designed to do so.
This change was made in the context of Trump’s continuous fact-free screeching about the whole thing being a conspiracy to destroy the economy, and that more testing (much less tracing) is a bad idea, and the deliberate efforts to turn mask-wearing into a political statement against Trump.The idea that this is being done for any other purpose but to make the stats look better and therefore Trump look better is incredibly naive, or a product of a justifiable negative reaction to Trump Derangement Syndrome, or a combination. As bad as the stats in Florida are, they are really worse, because of the deliberate, shameless efforts of De Santis. I don’t give a hoot about the hysteria over Russia, including the reported efforts to ‘spy’on anglophone multinationals for info on Covid-19 research. They should all be working together and trying to get something effective done on a worldwide basis anyway. The Russian bounties story was a deep state hoax. Okay. But if the stats going forward do not reflect clearly absurd deep drops in the reported cases and hospitalizations and deaths, it was because this transparent scheme did not work, not because it was intended to actually improve reporting.
I agree with Andrew Goodman here. Just because hysteria is not called for does not mean that bitter opposition and rejection is not called for.
This changing-of-the-target for sending the hospital data to is strictly and only a Trump Conspiracy initiative to destroy data and hide whatever data can not be destroyed in order to put out Fake News about Doing Better Corona-wise.
I’m not familiar with this technology but from the description the VA seems to have already set up something similar. The VA National Surveillance Tool, “a new reporting tool allows VHA leadership to monitor its national COVID-19 case load, hospital staffing, bed and supply availability in real-time….. the tool brings together information from dozens of different publicly available internal and external databases to provide an unprecedented view of the battlefield in the war against COVID-19.
The tool’s databases can display the number of positive cases in a community or in a region, and with customizable view options, VA staff can see all the elements necessary to run their health care systems from a strategic, operational, or tactical perspective.”
It is currently up and running.
I think the secret sauce, as it were, is the capacity management + dashboard, needed to allocate remdesivir (and certainly, if it comes to that, a vaccine). Nothing the CDC or VA has competes with that. And it makes sense to integrate the data collection with patient flow and capacity management, which is what the TeleTracking software does.
Thank you Lambert for this timely post. Just this evening I received an e-mail from a friend who has severe TDS screaming that Trump is now going to bypass the CDC and collect the data all for himself so he can manipulate the numbers. (headline No. 3) I didn’t realize that the CDC was part of HHS After reading your post I now understand all the scare mongering hysteria is just another stupid headline. I forwarded your post so another TDS sufferer might better understand — not that I’m any fan of Trump, but one has to weed out the hysteria from the truly depressing. Just hope TeleTracking doesn’t get screwed up.
It’s amusing to see liberal Democrats yammering about politicizing the CDC while at the same time doing everything they can to politicize (and after, see the Appendix, treating the CDC very badly during the Obama years).
I am not saying that there are not concerns with how the Administration is handling COVID-19 data. What I am saying is that the hysteria about this project is not warranted by the evidence; STAT News (elsewhere on this thread) agrees. It’s just “any stick to beat a dog” stuff.
I have many years of upgrading and migrating IT business systems. After everything is tested at the functional level, it then is imperative to run a full parallel of both systems and reconcile all differences. This is done before officially switching over. Seems like this step has been bypassed. Look out below.
That’s a good point. On the other hand, a pandemic is a multiplying process. So the linear testing process also carries enormous risks. (Also, one can bet on the company’s track record. One notes that the CDC’s track record in this pandemic is abominable. So here we are!)
Well then there is this: The White House Is Still Cutting Off the Public From COVID-19 Hospitalization Data
If true this would invalidate the move, even if the reporting is an improvement, the downside loss of public data would be a severe blow to open governance.
First, I looked at the article. The difficulty is that there’s nothing cited to back up the claims. To a careless reader, the link here — “…the American public will have to access coronavirus hospitalization data from private sources…” — would imply that the policy is being linked to, so that the reporter is backing up his claim. It is not; it’s to the Johns Hopkins site, an example of a “private source” (which, incidentally, everybody uses quite happily).
Second, the CDC is a branch of HHS. It is part of the executive branch. It’s independence is purely nominal, Norms Fairy-level. The administration doesn’t need to rejigger the data flow to manipulate or suppress the data. It could do that right at the CDC if it wanted to!
Third, the data is ultimately HHS data. It is not privatized. STAT writes:
And:
And:
Lambert, with respect to your first point yes, that is why I said “if true”. With respect to your second and third points I agree that it is ultimately their data but if they are going to cease making it public as they move then it is a loss. in Redford’s statement, for example, he noted that he was confident CDC will still have the data, but that is not the same as public release. Having worked with government data I have a strong bias towards public release. As I noted in a prior comment improved quality of reporting is good. But, I have a problem with any attempt to suppress data.
As Canadians we are deeply concerned about this development, since it will allow the Whitehouse to greatly under report the number of active pandemic cases and deaths in the USA, while there is a huge spike in unknown and unreported hospitalizations and deaths due to respiratory and other “mysterious” conditions.
And with this fake reductions of cases in the USA, there will be incredible pressure to open up the Canada-USA border to unrestricted travel, even though we managed with great sacrifice to legitimately flatten our curve along with most other developed democracies.
Perhaps the mascot of the Republican party needs to change from an elephant to an ostrich with its head buried in the ground.
> As Canadians we are deeply concerned
Thank you for sharing your concern. Oh please. If the Administration wanted, for example, to shut down or manipulate the Johns Hopkins site, they could to it today by shutting off the dataflow at CDC. They don’t need to set up a whole new system to do what they can already do!
Please go hone this idiotic talking point somewhere other than the NC comments section. The exit to Kos is to the right.
Am I to understand that a politically compromised CDC is being outsourced to an app which increases long lines of information through an unvetted process in a compressed timeline and no parallel backup in a national emergency ….
I’m sorry but this puts the ACA to shame in its roll out, scooter, stone, pandering to the self healer evangelists and a life with a trail of destruction a mile wide is not indicative of TDS … its acknowledgement of fact.
No, you are not. The CDC, being part of the executive branch, has always been “politically compromised” (see the Appendix). It’s not an app. Pandemics, being multiplicative, demand compressed timelines. See note [2] for the vetting. I don’t see a parallel reporting system today. If one is wanted, the schema CDC in its infinite wisdom decided not to develop will enable that.
I don’t know if you know this, but the health care system accounts for 24% of government spending, and employs 11% of American workers. HHS has a trillion dollar budget and 80,000 workers. In short, the scale is enormous. Statistically, then, it is actually possible for good things to be done within it, simply out of institutional inertia, business responding to policies and regulations, etc. For example, I loathe Andy Slavitt with every fibre of my being, because his US of Care is set up to oppose #MedicareForAll (here; here). There is also no question that Slavitt has done a very good job on the Twitter presenting “the science” and highlighting good studies and people to follow. Sure, he’s going to leverage his new-found credibility to kill more of us by opposing #MedicareForAll, but this one thing is good. If I can bring myself to say good things about Slavitt, others can bring themselves to look at the systems instead of bringing their kneejerk reactions.
Adding, you write:
Yes, the ACA rollout was brilliantly managed. After Obama’s signature program, meant to provide “access” to health care for millions, collapsed on launch under the weight of a few users, Obama personally and his administration’s mad PR skillz allowed them to completely evade any responsibility for the rollout. I know; I covered it in detail at the time. You’re seriously arguing that a rollout whose results we have not yet seen is worse than that? Really?
I’m aware of everything your wrote on ACA in excruciating vivid detail, especially the O’faithful denying its Heritage roots.
The demands of Science cannot be compressed to fit a desired political outcome, especially since this is an election year and considering the Dear Leaders track record … I concur with his relatives informed views.
This is not an attack on your post or its views IMO, its an account of the endemic failures of this kinda of approach acerbated by decades of neoliberal white anting both public and private sectors abilities to respond to a known risk because of short term profit incentives.
BTW parallel is the only way to facilitate migration whilst providing a fail safe for whatever malfunction might occur E.g. human or system error and the compiling of data for future reference to be reconciled.
Personally I find it antiquarian Homeric that a virus has exposed the inherent inabilities of neoliberalism to deal with anything it can’t price and thus absorb into its construct.
There is going to be a huge fallout over this after it all washes.
Looks like the original NYT article on this was scooped by this almost two months ago:
https://www.fedscoop.com/hhs-system-white-house-coronavirus-response-jose-arrieta/
which came from problems with this initiative:
https://www.fedscoop.com/white-house-hospital-coronavirus-testing-data/
From the above it looks like it was the Trump Administration that started the CDC to collect the data that all the complaining is about?
My guess is that this change is intended to consolidate the political control/profiteering of the future distribution of remdesivir.
There may well be some confusion at HHS.
The other day in water cooler, someone linked to an article that included a quote from the HHS secretary saying they were hoping to have 100MM/month test capacity by the fall, which I found surprising.
More recently (here [Reuters]) he seems to be saying 20MM/month, (specifically for point-of-care-tests, and I am interpreting this as the max production capacity of the consumable items specifically, due to come online, rushed etc). Anyway I think 20MM is more like what there might be if all goes well. The other thing the article says is we’re back to rationing tests again.
One can hope you’re correct and this change is actually driven by a desire to improve a process in need of revisions. I have to say though, in my 25 years of service in the Federal government, that these sorts of public-private data collection “cooperations” end up being a method by which control of the evaluation of data ends up in the hands of political appointees in DC as opposed to the scientists in the agency involved. Yeah, yeah, I know, they ALWAYS have gotten to manipulate the final word but cutting out that pesky expert layer is so nice for Beltway types. I’ll also say that crappy data collection systems in the Federal Government (DOI in my experience) are a feature – as opposed to an accident – resulting from repeated, and usually conflicting, demands placed on developers by political appointees. Failure or a clunky mess is designed-in. Hence my inherent skepticism of the motivations of this serially corrupt administration.
While a bit late to reply to this post I would like to thank Lambert for an insightful posting on the situation behind the change in managing this data. That said I think the entire situation has been handled poorly from a public perspective as has everything around covid-19 from both Trump and his administration. I don’t think I need to waste space here providing reference notes as that is easily googled.
I previously worked for a decade at a testing laboratory, on the IT side primarily systems support and data movement so I think I have some background to critic the situation as it appears to an outsider. And I fully admit I’m an outsider not having sat on any of the teams that would have been involved in this migration. Yet I have some problems with this posting,
First, if as Lambert stated there was no standardized data format (schema) for all institutions to use in reporting it must have been a mess behind the scenes collating information at the CDC. However to think that one can just grab a standard schema and use it is short sighted and wrong. I’ve worked around teams that spent years trying to coordinate industry players to standardize on an accepted XML data exchange format. Just agreeing on an accepted timestamp format can be incredibly time consuming (ISO standard format? In UTC? etc). There are always difficulties in getting widespread agreement on what the data structure should look like. I can imagine its even worse in government than in private industry due to competing interests.
Second I take issue with the quoted information supporting TeleTracking from the ““Statement of TeleTracking Technologies”. Those statements are PR bullshit presented to congress. Marketing material is what I see. Now they very well maybe a good company but to use their carefully prepared words to support that conclusion is ludicrous. Again the track record of the current administration in awarding contracts is poor at best.
Third I completely agree with those that already stated things should be running in parallel while migrating data. I’ve never worked on any project that this wasn’t done to some degree. We should be able to compare CDC numbers to the new dashboard whatever that is. This is a burden but it primarily falls on the source (Healthcare Providers) IT staff and not on patient care personnel. Again I’ll note to not being in the trenches so what is happening behind the scenes is not available to me.
Lastly I’m not the least bit sure why the appendix referencing past failures in the O administration was included other than to score a political point or defend an indefensible administration. Exit to the door on the right to Breitbart?
Let me respond beginning at the end. You write:
Clearly, I was correct to make hysteria the first word in the headline and the twelve word of the first paragraph; a cursory glance at my oeuvre, by one not too lazy to take it, would show I have nothing in common ideologically with Breitbart. I don’t read them, and I have never linked to them (since they falsify content).
You write:
In a past life I too have worked in exactly this field. As you surely must know, it’s possible to create a data interchange system based on documentation alone (i.e., without a machine-readable schema). Many firms do this, and because such systems are at best hard to maintain, an XML consultant (at least back in the day) would have been called in. That is the business reality behind your attempted reductio ad absurdum “mess behind the scenes.” Further, a careful reading of the post would have disclosed that the schema designer, Dan Brickley, would hardly have “just grab[bed]” anything, being world-class (hence the “(!)”). Nor did Brickley “grab” a “standard schema”; I document the changes he made by adding fields (an HHS requirement).
It is true, as you point out, that it’s possible for schema development to “take years”; certainly very profitable for the sort of consultant that takes the attitude of a mercenary to their work. However, since a pandemic is a multiplying process, Brickley is surely to be commended for his efficiency.
You write:
First, I used TeleTracking Congressional testimony so that they could describe their business model, and that’s it. (PR bullshit or not, Congressional testimony is given under oath.) However, to say that I used that material to support the conclusion that “they are a good company” is a crude straw man. I showed TeleTracking had a good client list (not from their site), good employee reviews (also not from their site), and a good industry ranking (also not from their site). This is all in footnote [2]; my advice is never to skip the footnotes. Finally, from strawmanning we descend to question-begging: It’s up to you to show that this contract is bad, not simply handwave by referring to the administration’s track record.
Finally, I don’t understand your objection to the Appendix (especially since by silence you agree with all the material therein). I wrote:
First, I get to have fun. Second, the thesis of the Biden campaign seems to be that if only the Obama Alumni Association were put back in charge — or had the Clinton team been in charge — than all would have been well; in short, we aren’t looking at systemic problems, but “leadership” problems. The Appendix is there to question that thesis (“There is no question that public- and private-sector leaders involved in the Ebola response, including Frieden, made serious mistakes. Frieden, Texas authorities, the President himself and others were overconfident – at times cocky – that the U.S. health system could handle infection control, contact tracing, isolation, and containment responsibilities if faced with an Ebola case”). I had thought that the overwhelming volume of political coverage in all media would have made that context obvious, but it seems that I was wrong. So I hope this helps.
Adding to your appendix on CDC’s questionable track record, CDC stonewalled a USA TODAY FOIA for two years related to lab incident reports regarding anthrax and other pathogens. This is good reporting. I’d like to see more deep dives on CDC. My summary view is that top management focus is less on public health and more on bioweapon compatible research…it’s a weapons silo. https://www.usatoday.com/story/news/2017/01/04/cdc-secret-lab-incidents-select-agents/95972126/