The Centers for Disease Control and Prevention plans to take back its role as the main agency collecting hospital data on infectious disease threats, after being stripped of the job mid-pandemic because of its slow response.
The move is rekindling a debate about the Atlanta-based agency’s handling of the virus and its ability to adjust quickly to a fast-moving pathogen. Supporters say the new proposed regulation would make needed changes to how the CDC’s National Healthcare Safety Network operates, easing its ability to get data into its system.
But more than a half-dozen current and former U.S. health officials involved in the pandemic response told Bloomberg News that they were concerned about the NHSN’s ability to scale up and process that data in real time.
Under the proposal, hospitals participating in the United States' Medicare and Medicaid programs would be required to funnel hospital data to NHSN, the CDC’s infection-tracking service. The change is outlined in the draft of a regulation from the Centers for Medicare & Medicaid Services, or CMS, a copy of which was obtained by Bloomberg.
As the latest wave of COVID-19 infections recedes, the U.S. government is reviewing its programs that monitor and respond to health threats. Emergency data-collection programs set up during the pandemic could help detect new viruses and determine how the government allocates medical supplies, but critics of NHSN say the CDC hasn’t proven it can handle that type of rapid-response surveillance.
“If CDC’s NHSN system is responsible for collecting pandemic data in the future, it will inevitably fail and put the nation at risk,” said Jose Arrieta, the chief information and data officer at the Department of Health and Human Services in 2020. Arrieta helped build HHS Protect, an umbrella platform that coordinates and consolidates much of the U.S.’s pandemic data, including hospital reports collected by an outside firm named TeleTracking Technologies Inc.
“While they're trying to turn a Model T into a Tesla, the nation will be suffering. NHSN is not flexible enough technically to collect the data,” he said.
The CMS didn’t return multiple requests for comment. Some aspects of the draft regulation were reported earlier by Reuters.
Arrieta and other former and current federal health officials expressed concern about CDC’s willingness to share data rapidly and transparently. Several spoke on condition of anonymity because the details aren’t yet public.
A 2005 system
The CDC’s National Healthcare Safety Network was built in 2005 to track infections that happen in health-care settings, as well as antibiotic-resistant infections. In the early months of the pandemic, the program struggled to add new data fields that were needed to track Covid-19 hospital data, frustrating U.S. health leaders including then-White House Coronavirus Task Force Coordinator Deborah Birx, according to 10 current and former health officials.
Birx pressed HHS officials to shift work away from NHSN, according to several of the people. (Birx didn’t return requests for comment). On July 13, 2020, then-CDC Chief Operating Officer Sherri Berger wrote an email to a handful of U.S. health officials, including Birx, stating that, “While NHSN does receive daily data, there are challenges with making rapid changes or additions to the system’s data elements.”
In a copy of the email obtained by Bloomberg, Berger said that, “In order to allow you the flexibility you need, CDC’s recommendation is to move forward with a system other than NHSN at this time.” The switch to the outside TeleTracking system was made that month, and NHSN was directed to focus instead on collecting data from 15,400 nursing homes.
Then-CDC Chief of Staff Kyle McGowan, who was responsible for sharing hospital data with top U.S. officials, said Birx and others were “rightfully frustrated” by the slow pace of the agency’s data collection. McGowan casts blame on what he describes as an antiquated and bureaucratic federal law, known as the Paperwork Reduction Act, that required the CDC to seek time-consuming approvals before making data-collection changes. The agency also didn’t have the legal power to force hospitals to report the data through the NHSN, McGowan said.
“People are throwing the CDC under the bus for not having this information daily, but it wasn’t given the enforcement mechanisms to be able to,” McGowan said. “The CDC has never been given the tools to do its job. The CMS rule is needed and will help them do that job.”
Berger said that she has confidence in the CDC to lead hospital and disease data collection and reporting, and that the agency has made data modernization a priority. NHSN has been a focus of that work, she said, and should be given greater authority to ensure that it can respond quickly and flexibly in the future.
Future of data collection
The new proposal is being reviewed by the White House Office of Management and Budget and HHS. It’s expected to be made public at the start of April, according to people familiar with the matter.
Titled, “Reporting of Data Related to Viral and Bacterial Pathogens and Infectious Diseases of Pandemic or Epidemic Potential,” it would require 6,200 Medicare- and Medicaid-certified hospitals and rural “Critical Access Hospitals” to electronically report information to NHSN on respiratory illness including Covid-19, seasonal influenza, and other viral or bacterial pathogens. The facilities would also have to share demographic data about their patients as well as vaccination status, race, ethnicity, gender, age and health conditions.
It would also require the hospitals to report on supplies of protective equipment, ventilators, dialysis machines and intensive care unit beds, as well as data on staff shortages.
NHSN has started to get more funding. Last year, the CDC invested $11 million from its Data Modernization Initiative into the NHSN; and through the Biden administration’s American Rescue Plan Act, CDC is investing $150 million in the unit through fiscal year 2026.
HHS Protect was moved under CDC oversight in October, while TeleTracking was shifted into the Office of the Assistant Secretary of Preparedness and Response. Two federal health officials said the CDC plans to continue to operate HHS Protect, and NHSN will continue to feed its data through to the platform.
