After receiving a request by Vice President Mike Pence to submit daily reports on COVID-19 testing within their facilities, hospitals with in-house labs are struggling to figure out exactly how to do it.
"That came as a surprise," said Dr. Karen Kaul, chair of the Department of Pathology and laboratory medicine at suburban Chicago-based, NorthShore University HealthSystem. Especially since most hospitals were already reporting their testing to state health departments, which in turn report results to the Centers for Disease Control and Prevention, a federal agency.
Not all states require hospitals to provide the same types of testing data. Recent reports indicate some states provide only positive COVID-19 test results from private labs. Other states post positive tests and deaths but not the number of tests that turn out to be negative results. All that leads to incomplete view of how the virus is spreading—something that epidemiologists say has put the U.S at a disadvantage.
On Sunday, Pence sent a letter to hospitals with in-house labs asking that test results be sent to HHS every day by 5 p.m. ET. In his letter, Pence stated the "data was needed at the federal level" to support state efforts in addressing the outbreak. Hospitals have already been sharing capacity and patient impact information with federal health officials, providing updates on bed counts, number of available ventilators, and the number of suspected COVID-19 patients presenting in their emergency departments.
"The data will help us better understand disease patterns and develop policies for prevention and control of health problems related to COVID-19," Pence wrote.
The request has revealed a breakdown in public health coordination between state and federal governments—something that to date has prevented many hot spots throughout the country from receiving the supplies necessary to combat the pandemic and from receiving the testing tools to contain the spread of the virus.
On March 17, NorthShore was the first provider in the Chicago area to start conducting in-house coronavirus testing. Since then, more hospitals and health systems have begun conducting their own COVID-19 testing, frustrating by the delay in getting test kits. Private labs such as Quest and Labcorps have also now experienced delays. Many in-house hospital labs can get results back in just a few hours instead of days.
According to the CMS, there are more than 9,000 facilities designated as "hospital labs" in the U.S., though only a few can test for COVID-19, according to the American Association for Clinical Chemistry, a leading trade organization representing clinical laboratory professionals.
While Kaul didn't foresee reporting to HHS as a huge administrative burden, she says there is a better approach.
"I think what our questions are: is this redundant and is there a way to do one-stop reporting," Kaul said. "It would be nice to consolidate these efforts."
Dr. Brian Rubin, chairman of the Robert J. Tomsich Pathology & Laboratory Medicine Institute at Cleveland Clinic, said the health system plans on complying with HHS' request. But he said the process will require the health system to extract data manually since HHS is asking for more information than what is usually sent to the state health department.
"We only report positives to the state," Rubin said. "They want a lot more data looking at many different aspects related to testing including, daily negatives and positives, cumulative negatives and positives, cases that failed, etc."
Dr. Dwayne Briening, executive director of Northwell Health Labs, said he didn't see the extra reporting as a challenge because he felt confident the health system had the infrastructure it needed to set up "things like this pretty readily".
"For many smaller institutions with less support it will be more of a challenge," Briening said.