COLUMBUS -- The Ohio Department of Health's COVID-19 counting of hospitalizations and deaths does not differentiate between those caused by the virus and those with the virus, according to the state auditor's office.
"While ODH counts COVID-19 hospitalizations and deaths in accordance with CDC guidelines, these methods do not differentiate between hospitalizations and deaths caused by COVID-19 and (those) with COVID-19," state Auditor Keith Faber said on Tuesday.
"This guidance conflicts with other federal and global public health organization guidance, which should be studied by ODH," the auditor said as his office released a performance audit of the ODH management of COVID-19 data.
The 92-page audit yielded that and six other recommendations aimed at improving data collection and reporting, as well as certain operational issues.
This effort was launched as part of a multi-state effort to determine the quality of the various approaches to COVID-19 data collection, reporting, and monitoring across the country.
“COVID-19 upended our way of life and forced rapid changes to governing, social interaction, and business practices that understandably fueled uncertainty and speculation from the public at large,” Faber said.
“I can report that although inefficiencies, opportunities to improve transparency, and methods to collect better data certainly exist, the Ohio Department of Health has generally provided the public with correct information and managed Ohio’s response to the pandemic commendably," Faber said.
During the course of the audit, Faber said ODH identified more than 4,000 death certificates that had not been reconciled to the Ohio Disease Reporting System, thereby making the total Ohio COVID-19 deaths statistic inaccurate from approximately October 2020 to February 2021.
Auditors were unable to determine the completeness of the data within ODRS due to ODH's assertion that the Health Insurance Portability and Accountability Act and other undefined constraints required auditors full access to test the data, thus limiting the scope of the review.
When the 4,000 error was detected, Ohio Health Director Stephanie McCloud attributed the mistake to, "we have been building the plane as we fly it."
“And unfortunately, we weren’t given all new parts to build it well. We did not have time to stop the plane to land it, get the new parts that we need, and then take off again," McCloud said at the time.
The seven recommendations made in the audit report stem from four scope areas -- data collection, internal reporting, monitoring, and external reporting (public communication).
Other key findings included:
-- A true count of test results and positivity rate is not available in Ohio because antigen testing and non-laboratory testing data is incomplete. Antigen tests results were only added to Ohio's count as they became more accurate and available, and negative test results were not counted at the beginning of the pandemic, Faber said.
-- ODH should give a more accurate indication of active cases, hospitalizations, and test positivity rates on its dashboard, the auditor recommended. Additionally, terminology used on the dashboard can be viewed as inconsistent or unclear to non-medical professionals.
-- The data system and processes in use at ODH and local health departments, as well as by physicians, hospitals and laboratories, are outdated and could not keep up with volume of cases in the pandemic. This caused backlogs at local health departments and occasional delays in contacting COVID-19 positive residents, Faber said.
-- Current law permits ODH only a coordinating function among the independent local Health Districts in relation to case management, limiting its ability to intervene when necessary.
Faber said certain limitations prevented auditors from completing a full data analysis and assuring the completeness of data within the Ohio Disease Reporting System.
"However, we do not believe these limitations create a significant impact on the conclusions presented to the public," he said.
"For instance, although auditors did not have full access to ODRS due to Health Insurance Portability and Accountability Act (HIPAA) concerns, our office agreed to analyze an anonymized data set that showed errors were present in less than 1 percent of cases recorded in ODRS," the auditor said.
"ODH did report a miscalculation of death data and has undertaken efforts to identify the failure and design a better data gathering and reporting process," Faber said.
"Bottom line: Were the conclusions reported by ODH during this pandemic correct? Generally, yes. Additionally, ODH has already began taking steps to improve some operational issues, while also working proactively to implement recommendations made in this audit report," he said.