Improving Texas’ Health Data Infrastructure

The following testimony was provided to the Senate Committee on Health & Human Services on March 31, 2021

Texas 2036 submits these written comments in support of SB 969.  Texas 2036 is a non-partisan public policy organization designed to bring together the sensible center on data-driven policies.  SB 969 focuses on public health data reporting during public health disasters. This bill would establish an office of chief state epidemiologist, create a standardized process for health data reporting and health data quality protocols, require data compliance reports from hospitals and labs, and establish a civil penalty for failure to report health data.

The COVID-19 pandemic has highlighted the uneven and unstandardized data infrastructure that has historically characterized the Texas health care system. In the early days of the pandemic, county public health departments were receiving health and lab reports via fax[1], with little standardization of data fields or format.

These problems created discrepancies between state figures and local figures.  For example, the state reported hundreds more Harris County deaths than Harris County itself did.[2]  However, later the state appeared to undercount the number of deaths in Hidalgo County compared to local figures there.[3]  In addition, early delays in the vaccine reporting system Immtrac2 may have hampered the effective distribution of vaccines to providers.[4] Currently, Texas does not know the race or ethnicity for 97% of COVID-19 cases and 18% of vaccinated persons.[5]

These discrepancies risked undermining public trust in the ability of government to understand the problems facing Texas, as well as in government’s ability to effectively develop and implement solutions and plans.  In order to improve the public’s trust in government’s ability to accurately inform and protect Texans, we need to focus on improving our health data infrastructure, with the goal of improving the collection, sharing, and use of health care data.

(1) Collect

  • We need to improve the process of collecting data to ensure that the data coming in is standardized and accurate.
  • Without clean data at the outset, the rest of the process breaks down. As the saying goes, “Garbage in, garbage out.”
  • Existing legislation requires this process of standardization (HB 2641 from 2015), but implementation has been slow to date.

(2) Share

  • In order for state and local policymakers to be as informed as possible, our public agencies that are collecting data must share it efficiently with each other.
  • Data sharing needs to be improved within state agencies, among state agencies, and between state and local entities.
  • In some cases, agencies are unsure of their legal authority to share certain data. These legal ambiguities should be clarified in a way that enables rapid data-sharing while protecting personally identifying information.
  • In other cases, funding to upgrade systems and interoperability is a problem. Grant programs could be established to improve interoperability between state and local jurisdictions.

(3) Use

  • Raw data needs to quickly be turned into actionable information for state and local policy-makers to make informed decisions.
  • Data experts are needed to develop systems that automatically interpret and translate raw figures into compelling visualizations and stories that accurately inform policy-makers and the public.
  • Data should be made public quickly and transparently to enable the public to participate in the deliberative and interpretive process.

SB 969 lays out a framework to improve how the state handles all three stages of the data cycle so that we can better manage public health in the future.  Accordingly we support passage of SB 969.

[1]Texas Coronavirus Testing Delays as Lab Uses Fax Machines to Send Results,”, accessed 3/30/2021.

[2] Health Official Explains Steep Discrepancy in Number of COVID-19 Fatalities Reported by State and County.”, accessed 3/30/201.

[3] “‘Major disconnect’ between state, counties on COVID-19 deaths”, accessed 3/30/21

[4]Texas has a problem with its COVID-19 vaccination data, and the stakes are high. Now the state is scrambling to solve it.”, accessed 3/30/2021.

[5] Kaiser Family Foundation, COVID-19 Vaccinations and Cases by Race/Ethnicity, accessed 3/30/2021.