ALBANY, N.Y. (NEWS10) — A whirlwind of questions still surround how New York State reported COVID nursing home deaths. Why split the number of deaths in facilities from the number of residents who died in hospitals?
New York State law mandates infectious disease cases are reported within 24 hours to the state Health Commerce System and through what’s called nosocomial outbreak reporting applications (NORA). Amy Krause of the WeCare Corporation says it’s been that way her entire 30 years in the business, but with COVID came an all new way to send information.
“The Health Commerce System has been around for a while, but this is the first time that we had created a specific report for the outbreaks,” Krause explains.
WeCare operates The Diamond Nursing and Rehabilitation, formerly Diamond Hill, in Troy and half a dozen other facilities around the state. Krause says the new COVID report system was started in late March and almost immediately, fields were added to quantify deaths.
“There was a field for total deaths, and then it was broken down to deaths by the facility and deaths in the hospitals,” Krause says.
A statement from NYS Department of Health explains the daily reporting is done through a program called HERDS — the Health Electronic Response Data Systems. HERDS was created post-9/11 as an emergency communication system with hospitals. A representative confirms the last time it was utilized was in 2017 during a particularly aggressive flu season.
The request for healthcare institutions — including both hospitals and nursing homes — to submit data to a COVID-specific form within HERDS was further expanded April 16. Representatives do not specify if this was to separate the fields for reporting COVID deaths; however, a written statement from the Department of Health reads:
As part of that correspondence we asked all 613 nursing homes and 544 adult care facilities to provide that same level of information dating back to March 1 to provide a retrospective look, even before our first confirmed case in a nursing home.
The current system features separate fields to input deaths within a long-term care facility and another for resident deaths outside the facility, i.e. in a hospital. So if the state had the information dating back to March 1, why weren’t all numbers added to the NYS online COVID tracker dashboard until after Attorney General Letita James report on COVID-19 response in nursing homes?
The DOH responds the answer to that is in the way HERDS collects information from both nursing homes and hospitals.
A DOH representative responded to NEWS10’s Mikhaela Singleton‘s questions by stating since HERDS data coming in from nursing homes included hospital numbers as well, the DOH chose not to release nursing home totals under the risk of double counting patients also included in a hospital’s total deaths reported to HERDS in the same day.
While DOH reviewed HERDS information coming in, prior to February 2021 only a tally of in-facility deaths were included in the long-term care section of the COVID dashboard, while adding each hospital’s total death numbers together to reach the amounts in that section. The DOH statement does not clarify if the input fields for hospitals in the HERDS survey also separate total deaths from the number of patient transfer deaths.
However, even if HERDS information was still in review, local officials say there were multiple other ways to collect information.
Rensselaer County Public Health Director Mary Fran Wachunas says all death certificates get filled out with the Department of Health’s Electronic Death Registration System.
“We know where people died, but also where they come from. So if someone came from Diamond Hill and they went to Samaritan Hospital, then they died at Samaritan Hospital, my investigators would know that that person came from Diamond Hill,” Wachunas explains.
That’s further supported by a letter the DOH sent to all coroners and medical examiners October 23. It says “to refrain from including a probable or presumed cause of death on a death certificate without corroboration”, emergency amendments were made to New York State code so that it would be mandatory to perform a test within 48 hours of death for any person “suspected of having suffered the effects of either COVID-19 or influenza”. Lab results are also all processed through a state system.
“No matter if it’s COVID or the flu, strep throat or whatever the communicable disease is, it goes through the ECLR system, electronic certificate of labs, which all health departments have access to,” Wachunas says.
The DOH written statement further explains HERDS fatality information is only submitted with a person’s initials and age to protect privacy. A representative also clarifies all that information needs to be cross referenced with what hospitals enter into a completely different program, SPARCS — the Statewide Planning and Research Cooperative System.
That representative further adds the SPARCS data does come with both a person’s name and age, but only initials for the facility they may have lived in if coming to that hospital from a nursing home. The DOH claims this disjunct in the amount of patient information available between the two systems is a contributing factor in why verifying reported numbers took months to complete.
However, that is not enough to satisfy Columbia University School of Nursing Professor Dr. Patricia Stone, a leading voice for nursing home infection control policy. She says back in April, the CDC also mandated all long-term care facilities certified by the Centers for Medicare and Medicaid Services join its National Healthcare Safety Network.
“The model for the nursing homes to join that network had existed for a few years, but out of 15,000 to 16,000 facilities across the U.S., it was voluntary, so only about 600 to 700 were participating before the federal mandate,” Stone explains. “That was a huge thing, going from 600 nursing homes and having a difficult time for them to enroll to going to every nursing home that’s certified by CMS enrolling. That was a huge thing.”
The NHSN network also requires facilities report case numbers in residents, staff, and any resident death whether inside the facility or in a hospital. The data was made accessible to all state health departments.
“I think there wasn’t enough transparency. If there was a problem, [NYS] should’ve just said this data was not clean yet because of the potential — why the state hadn’t gone to the NHSN which should have it because that’s what that federal regulation is and get the numbers there, I don’t know,” Dr. Stone says.
The entirety of the NYS Department of Health’s Statement reads:
“The Department of Health’s Nosocomial Outbreak Reporting Application (NORA) pre-dates COVID-19 and has been augmented by other systems during this pandemic. The Department receives HERDS (Health Electronic Response Data Systems) information daily from more than 1,000 long term care facilities and more than 200 hospitals. In May we also asked long term care facilities to provide that information retrospectively. All HERDS data sets, specific to fatalities, included only initials and age to protect patient privacy. Additionally, the Department received SPARCS (Statewide Planning and Research Cooperative System) data from hospitals, which often comes on a lag and was exacerbated by a healthcare network that was the early epicenter of a global pandemic. While that information does include name and date of birth, it does not specify the name of a long term care facility from which a patient was transferred. Great lengths have been taken to ensure accuracy in data reporting from multiple sources, and that process continues.”
-Hospitals and nursing homes are required to report cases of reportable disease(s) suspected or confirmed to have been acquired within the facility, as well as clusters of any disease occurring above their baseline for that disease, through the Nosocomial Outbreak Reporting Application (NORA). Both the number of cases for any particular outbreak in a NH or hospital, and the number of outbreaks are recorded in NORA. The individual cases, if reportable, go into other reporting systems. Hospitals are also required to report certain surgical site infection rates, central-line associated bloodstream infection rates, Clostridioides difficile infection rates, and carbapenem-resistant Enterobacteriaceae infection rates per the Hospital-Acquired Infection Reporting Program. Annual hospital-specific reports are posted at https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/.
-In order to obtain an accurate clinical picture and assess the needs of each nursing home and adult care facility, the Department launched a daily survey for all facilities beginning March 9th seeking resident information on suspected, positive, and presumed positive COVID-19 cases. That information also required facilities to report fatality data related to COVID-19.
-An updated survey, seeking to further clarify that data was released on April 16. As part of that correspondence we asked all 613 nursing homes and 544 adult care facilities to provide that same level of information dating back to March 1 to provide a retrospective look, even before our first confirmed case in a nursing home.
-The Department spent months reconciling the information received – de-duplicating, correcting data entry errors, etc. – in order to understand and report accurate fatality data.