Sharing Tribal Health Data Improves Data Quality in Alaska

Public health problem

Nearly 20% of Alaska residents are Alaska Native or American Indian. Many live in rural areas that are accessible only by boat, plane, snow machine, or off-road vehicles. Often the only local health care options are Tribal hospitals or community health clinics, which treat all residents, regardless of race.

Because of this unique situation, Tribal facility patient data are essential for a complete picture of health statewide. Alaska Native and American Indian people have been underrepresented in syndromic surveillance data, in part due to the size and scope of the Tribal health system. Although AK facilities receive federal funding from Indian Health Service, they are locally managed by Tribal health organizations.

This complexity means that only a portion of the AK facilities that provide emergency care to Alaska's Tribal communities had been onboarded into the NSSP BioSense Platform. This cloud-based syndromic surveillance system collects emergency department and clinic visit data from participating facilities. Public health officials can monitor this information to detect health threats in near real-time.

The COVID-19 pandemic highlighted the need to onboard more AK Tribal facilities into the BioSense Platform. This would benefit both the state's public health system and the Tribal health organizations that manage the hospitals and clinics. Additional onboarding would enable state and Tribal epidemiologists to serve Tribal communities as well as pinpoint issues disproportionately affecting rural and frontier areas. The platform's advanced capabilities would also make data sharing and analysis easier.

Actions taken

The Alaska Department of Health and the Alaska Native Epidemiology Center (located within the Alaska Native Tribal Health Consortium), a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska, already had a strong partnership. During the pandemic, they worked together more closely to acquire Tribal health organization consents, which led to open-ended formal data use agreements.

As a result of these efforts, three more Tribal hospitals were onboarded to share data through the BioSense Platform. An additional Tribal hospital was re-onboarded after adopting a new electronic health record. In all, seven of the state's eight Tribal hospitals have been added to the platform. Some of those facilities have patient populations as high as 90% Alaska Native and American Indian.

In one region, Tribal health clinics and community health clinics have also completed BioSense Platform onboarding. This is especially impactful because clinics tend to cover large geographic areas.

These changes have improved the syndromic surveillance geographic coverage across the state, especially in the southeastern region. Four Alaska boroughs, which equate to counties, have also been added, providing visibility into populations that were not represented before.

The analytic tools that are part of the BioSense Platform, including ESSENCE, make it easy to share dashboards and data down to the facility level. Tribal health organizations have given permission for analysts at the Alaska Native Epidemiology Center to see their facility data in ESSENCE. Analysts at both the state and the Alaska Native Epidemiology Center have created reports at the request of health care providers to monitor for health conditions like tuberculosis, fentanyl overdoses and behavioral health issues. The information serves as an early warning system and helps identify trends.

Tribal facilities can receive data support from the state or from the Alaska Native Epidemiology Center.

Outcome

Using newly available data, the Alaska Department of Health closely monitors syndromic information to identify issues in near real-time. Concerns can be tracked more effectively thanks to increasingly comprehensive syndromic surveillance data in Alaska, including:

• Large storm systems such as Typhoon Merbok. Data helped public health experts assess the impact of this event in 2022.
• Wildfire seasons, which have localized impacts. Better coverage increases analysts' ability to detect emerging issues, informing communication and action to support affected communities.

This work is crucial to detecting potential problems—but in many cases, it also provides assurances. In February 2024, for example, the town of Kotzebue declared a public health emergency following an issue with the water supply. The Alaska Department of Health monitored syndromic data and found there were no apparent health issues following the incident.

"We were able to relay that there wasn't an increase in people going to the emergency department due to gastrointestinal complaints in the Kotzebue area during this time," said Anna Frick, the syndromic surveillance epidemiologist at the Alaska Department of Health. "This information provided reassurance to the community."

In another case, a sick baby in a rural area resulted in concerns about the potential for further spread of this illness because it had been diagnosed late. Frick was able to determine that infection rates did not appear to be increasing according to syndromic surveillance data, which allayed community concerns about an outbreak.

The Alaska Department of Health and the Alaska Native Epidemiology Center continue to onboard more Tribal health facilities into the NSSP BioSense Platform, with a special focus on clinics. Currently, one Tribal health organization sends clinic data, but others are interested in doing the same. Maniilaq Health Center Medical Director Robert Onders, MD, JD, MPA, estimates that 50-70% of all Tribal emergency care takes place at the clinic level.

"Having the reporting gives us an idea if there are changes in baseline levels," he said. Maniilaq plans to onboard their clinics to the BioSense Platform in fall 2024.

Resources

Anna Frick, Epidemiology Specialist II
Alaska Department of Health
anna.frick@alaska.gov

Lowrie Ward, MPH, CPH, PMP, Senior Epidemiologist
Alaska Native Epidemiology Center
Alaska Native Tribal Health Consortium
laward@anthc.org

Centers for Disease Control and Prevention
Office of Public Health Data, Surveillance, and Technology
Detect and Monitor Division
www.cdc.gov/nssp

The findings and outcomes described in this syndromic success story are those of the authors and do not necessarily represent the official position of the National Syndromic Surveillance Program or the Centers for Disease Control and Prevention.