Columbus – Auditor of State Keith Faber’s office yesterday released a performance audit of the Ohio Department of Health’s (ODH) management of COVID-19 data, yielding seven 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.

Faber said:

 “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. 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.”

Overall, analysis of test and death data provided by ODH uncovered minimal errors and the information presented to Ohioans was found to be generally correct. The seven recommendations made in the audit report stem from four scope areas – data collection, internal reporting, monitoring, and external reporting (public communication).

Key findings include:

  • 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.
  • ODH should give a more accurate indication of active cases, hospitalizations, and test positivity rates on its dashboard. Additionally, the terminology used on the dashboard can be viewed as inconsistent or unclear to non-medical professionals.
  • 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 with COVID-19. This guidance conflicts with other federal and global public health organization guidance, which should be studied by ODH.
  • 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and processes in use at ODH and local health departments, as well as by physicians, hospitals and laboratories, are outdated and could not keep up with volume of cases in the pandemic.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.
  • 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.

It is worth noting that certain limitations prevented auditors from completing a full data analysis and assuring the completeness of data within the Ohio Disease Reporting System (ODRS). However, we do not believe these limitations create a significant impact on the conclusions presented to the public. 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. 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.   

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.

“I would like to thank ODH staff, as well as the medical professionals and front-line workers across the Buckeye State who have worked tirelessly to keep us safe over the last year.” Auditor Faber said. “The light at the end of the tunnel is near.”

A full copy of this report is available online.

Reading the report: The full report is broken down into three exceedingly more detailed sections: Performance audit digest – for those who want a brief overview; Executive summary – for those wanting additional detail and information on scope, this is a good starting point before reading the entire report; and finally the full recommendations including background and methodology.

Letter from the Auditor

Audit Summary

Appendix A – Purpose, Methodology, Scope, and Objectives of the Audit

Appendix B – Example Death Certificate Imagery

Appendix C – Local Dashboard Examples

Appendix D – Other State Dashboard Examples

Appendix E – Full ODH Data Downloads for Death Certificate Lag Analysis

Questions and Answers

Return to Ohio Performance Team Homepage