- The Department of Defense (DOD) developed a registry of COVID-19 patient data in the military that was “inaccurate and potentially misleading,” because of a contractor’s sloppy recording, the agency’s internal watchdog found.
- Data from the COVID-19 registry supports research, treatment and information responses to Congress.
- The Defense Health Agency called the patient registry “a critical component to the fight against the COVID pandemic,” in a 2021 social media statement.
A contractor’s sloppy handling of COVID-19 data may have led the Department of Defense’s (DOD) agency overseeing military health programs to base policy and statements to Congress off of “inaccurate and potentially misleading” data, a government watchdog found.
The contractor, who was not directly identified, likely failed to meet the 90% accuracy standard the Defense Health Agency (DHA) required when moving information from individual health records to a searchable database, and cherry-picked samples to verify as accurate, the DOD Inspector General found in a report posted July 11. As a result, Congress may have been misinformed about COVID-19 in the military, while military doctors and policy officials made recommendations and rules with a faulty understanding of the data.
“The DoD cannot rely on the data in the COVID-19 Registry to make public health and clinical care decisions concerning the COVID-19 pandemic because the data were not complete, accurate, or representative of the universe of DoD patients who had a COVID-19 event,” the document said.
DOD defined a “COVID-19 event” as a positive test result, or when a health care provider required a patient to isolate or be hospitalized due to COVID-19 symptoms.
It was intended to give a representative snapshot of all patients enrolled in the military health system who had a COVID-19 event to inform treatment decisions, according to the report. The DOD would use the registry to provide information in response to requests from stakeholders, including members of Congress.
“Any data from the COVID-19 Registry that [Joint Trauma System] officials provided to the DoD and other stakeholders during the COVID-19 pandemic are inaccurate and potentially misleading,” the IG continued. (RELATED: Memo Shows Extensive Taxpayer-Funded Treatments, Surgeries And Exceptions Offered To Transgender Servicemembers)
Authorized users can also access the registry through an online dashboard, allowing them to filter for specific traits such as the “number of patients that received certain treatments,” according to the IG. DOD health care providers could use that information to guide treatment decisions for their patients and track the disease’s progress.
But, DOD also planned to analyze data in the registry for larger purposes, including pandemic response and wartime readiness testing, Undersecretary of Defense for Personnel and Readiness Gil Cisneros, told lawmakers in a December 2021 introduction to a report about the registry.
“Without complete, accurate, and representative data, the DHA may not accomplish this goal,” the IG wrote.
DHA is “addressing any misunderstanding concerning the inclusion criteria for the registry and/or the relationship between the two levels of detail within the registry” a spokesperson said in a statement to the Daily Caller News Foundation.
Because it did not have an automated process for translating the volume of data from one system to another, DHA hired a contractor to abstract information from health records to the registry and manually verify quality compliance.
The IG report did not name the contractor, but provided award identification numbers for the initial contract and a follow up, which the Daily Caller News Foundation matched to awards given to Hawai’i-based Po’Oklela Solutions.
Po’Okela is part of the Alaka’ina Foundation Family of Companies, which describes itself as “comprised of industry-recognized government service firms who are designated as Native Hawaiian Organization (NHO)-Owned and fall into the respective categories of Small Business, 8(a) certified Small Disadvantaged Business (SDB), and [Historically Underutilized Business] Zone.”
DHA mandated a 90% accuracy rate for the abstracted data. However, of the 25 health records the IG reviewed, 24 of them contained errors.”
Rather than randomly selecting records to review, the contractor’s quality compliance nurses picked records based on their opinion, and when they did evaluate the records for accuracy, they did not accurately record the results, the IG found. Out of 10 records the contractor verified, the IG found errors in all of them — for instance, failing to include “high cholesterol” as a preexisting condition in one record.
Po’Okela may be on the hook for $6.2 million in costs for support services that fell short of accuracy standards, according to the IG. DOD awarded Po’Okela a second contract for the same services set to expire in September, records show.
As of May 2021, DHA had entered more than 227,000 cases into the repository, according to Cisneros. DOD planned to continue expanding the registry.
At the onset of the pandemic, EIDS stood-up a COVID-19 registry that pulls COVID-19 patient data – including those related to vaccinations – from #MHSGENESIS and all relevant legacy systems. The data is updated no less than daily and distributed to the @CDCgov every day. pic.twitter.com/RKCLn93XBh
— PEO DHMS (@DoD_EHR) January 13, 2021
At least 7,213 patients with a COVID-19 event were left out of the pipeline to be entered into the registry in the first place, the IG found.
In addition, records selection also did not match the target population, the IG found. If 1% of DOD COVID-19 patients were hospitalized, for example, then the registry should show a similar hospitalization rate. The IG appears to have found a disparity between the two on hospitalization rates, although the public version redacted specific numbers.
“Those who were inpatients or had additional risk factors had additional details collected by manual chart abstraction that were not available through automated data feeds. Those patients who conducted home COVID tests and some who were tested outside of a military hospital or clinic may not have been identified by the registry,” DHA told the DCNF.
The report did not detail to what extent researchers utilized the registry in these studies. However, it noted that the registry was designed to help evaluate the safety and effectiveness of COVID-19 treatments and “support civilian research and medical teams who seek insights to future advancements in vaccines and therapeutics.”
DHA called the patient registry “a critical component to the fight against the COVID pandemic,” in a 2021 social media statement.
“We have full confidence in the registry data and continue to work with the DOD IG to resolve any misunderstandings,” the DHA spokesperson told the DCNF, noting that the agency is working on ways to improve accuracy of the data.
Po’Okela Solutions did not immediately respond to the DCNF’s requests for comment.
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