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CSTE National ELR Workgroup

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Becky Lampkins, Manager, Surveillance/Informatics Program at CSTEMegan Toe, CSTEScott Troppy, Surveillance Epidemiologist at MA DPHMeredith Lichtenstein, CSTEAmy Drake, NMJohn RobertsNancy Barrett, Epi 4/PH Informatics SpecialistErin Holt, TDHRita Altamore, EpidemiologistDavid DiCesareJason HallWalter Kemper, ELR Coordinator, NC DHHS Div of Public HealthJulie LuepkeCarmen Pugh, Labcorp Manager State Reporting at LabCorpTom Safranek +399 others
Posted by Rachelle Boulton ·

VA reporting

We've been having increasing challenges with getting COVID data from our VA. Today they told us that "a determination was made by the VA's National Infectious Disease Service (NIDS) to 'NOT REPORT negative COVID-19 test results at this time even when legal authority might exist for a particular State.'" 

They have also told us they "will consider" sending us clinical records for confirmed cases. We've typically had a great relationship and partnership with our VA, so this is all really out of left field for us. 

Is anyone else running into similar issues?

Comments & Events

Amy Bittrich Amy Bittrich
Yep, WI has the same problem, and we are trying to work through it. In the meantime, if there is a federal entity who can talk to the VA national org, we’d greatly appreciate it!
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Sita Smith Sita Smith
I got this from a VA privacy officer on 5/15

At this point we will not be able to release the negative results. A ruling just came down from the VHA Privacy Office. See below. This just came down within the last hour.  
 
VHA facility Privacy Officers,
Well another week is coming to a close and you all continue to excel in providing privacy support to your facilities during these unpreceded times.  Thank all of you for your hard work and dedication.  The main questions we have recently received have been around COVID-19 reporting to State/Local Public Health Departments. We reached out to various VHA Program Offices for input regarding our privacy guidance on this topic. So here you go:
 
Many State Public Health Departments are requesting reporting of both positive and negative COVID-19 test results for public health purposes. VHA Directive 1605.01, Privacy and Release of Information (para 27 and 28) stipulates that VHA may disclose individually-identifiable health information, excluding 38 U.S.C. 7332-protected information, to any public health agency (e.g., Federal, State, local or tribal) or state registry upon written request when required by law and the request meets the requirements of 38 U.S.C. 5701(f).  
38 U.S.C. 5701(f) stipulates that Veterans’ names and/or addresses may not be released without signed, individual consent unless a qualified representative of an agency or instrumentality charged under law with the public health has made a written request that such name or address be provided for a purpose authorized by law. The State law must require or mandate reporting in order for the written request to be valid. 
 
While positive COVID-19 cases may be reported to a State/Local Public Health Departments under existing standing written request letters from these Public Health Authorities due to the declared National Emergency by the President and State Emergencies by Governors, there is no such ability to report individuals with negative COVID-19 test results.  Even if the States submit a letter to a VHA facility indicating the COVID-19 negative test reporting is necessary during the pandemic for emergency public safety purposes, citing their State authority as an agency charged with the public health, the requirements of 38 USC 5701(f), and corresponding Privacy Act routine use disclosure statements, for the reporting to be for a purpose authorized by law would not be met.  General communicable disease reporting laws would not cover a request to report individuals with negative COVID-19 test results as these individuals do not have a communicable or infectious disease.
  
Therefore, VHA does not have legal authority to make these disclosures pursuant to a State request.  VHA facilities shall not report individuals with negative COVID-19 test results to State/Local Public Health Departments unless signed, written authorizations are obtained from the individuals.
 
VHA reports current COVID-19 aggregate test results by VA health care system at https://www.accesstocare.va.gov/Healthcare/COVID19NationalSummary.   VA categorizes case data by active, convalescent, and known deaths.  This is information is available to the public and is downloadable for additional analysis.  
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Sita Smith Sita Smith
That said, VA reached out to me again on Monday 5/25 to ask for copy of our letter signed by our state epidemiologist. 
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Jason Hall Jason Hall
Trying to push it


Jason
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Kristy Lunquest, Maryland Department of Health Kristy Lunquest
I just heard this from the DC VAMC as well.
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Nancy Barrett, Epi 4/PH Informatics Specialist Nancy Barrett, Epi 4/PH Informatics Specialist
Only one problem with this -- now we will have a huge backlog of files to work through. We were able to get VA results piggybacking off work done with HIV that we now get in csv. We have some SAS coding to work through these, but it still takes 2 people to review and organize due to the huge amount of deduplication and cleaning required. Not to mention they have been doing repeated testing from the start. The VA people are nice, but their data and tech options are limited. If we got files, it may not be something we could tackle immediately. We haven't even approached them about case reports. And we only have one VA - can't imagine what this would be like for states that have more than one.
Right now it's all about the nursing homes. We'd need some serious federal level assistance to get them caught up and squared away. Too bad we couldn't get VA reporting fully resolved before when we were working on the position paper. I know you'll do your best Jason! If CSTE needs to hear from our state epis -- of course they can reach out. 
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Joseph Bareta Joseph Bareta
New Mexico has had a similar response about not reporting negatives from Albuquerque VA.
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