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Cedar Rapids, Iowa 52401
DES MOINES - The process of reporting coronavirus screening results under the $26 million Test Iowa Initiative is illegal and creates opportunities for fraud and errors, the state auditor asserted Tuesday.
Auditor Rob Sand, issuing his staff's findings and speaking with reporters during a virtual news conference, expressed concern that the program's reporting process is unnecessarily time-consuming - putting state health officials fourth in line to learn about positive virus test results and delaying contact tracers for hours from chasing down others who were exposed.
'The fact that we are in a pandemic right now, the cases are rising, and that the importance of getting this information right from a public health aspect is paramount,” Sand said. 'We should not be taking unnecessary risks with data related to the pandemic.”
Sand's assertions were disputed by the Iowa Attorney General's Office and the Iowa Board of Regents, which said requiring state lab officials to enter the data would take even more time.
Nearly 36,000 Iowans have contracted the new coronavirus and 756 Iowans have died of COVID-19, the disease caused by the virus, according to state public health data as of Tuesday afternoon.
In April, Gov. Kim Reynolds announced the state had contracted, without seeking bids, with a Utah-based company to expand Iowa's virus testing capacity.
Sand said the audit found that results from the Test Iowa program are sent from the University of Iowa's State Hygienic Laboratory in Coralville to the Utah-based software companies Qualtrics and Domo, then on to the Iowa chief information officer, and then ultimately to the Iowa Department of Public Health.
The lab and other providers, though, report test results from sources other than Test Iowa directly to state public health officials he said.
'Any number of things because of that long reporting chain can complicate or potentially end the ability of those results to actually get to the Department of Public Health and get to public health officials,” said Sand, who said he conducted the review at the urging of county-level public health officials.
Sand recommended that Test Iowa results be simultaneously reported directly to the state public health department while also being sent to the software companies and state chief information officer.
A state public health department spokeswoman defended the Test Iowa program.
'Test Iowa has been a huge success for Iowans throughout the state, providing widespread access to testing and supporting the state's contact tracing efforts,” department spokeswoman Amy McCoy said in a statement.
Sand, a former assistant attorney general who was elected as state auditor in 2018 as a Democrat, said the reporting process is in violation of Iowa law, which requires health care providers or laboratories to report infectious disease cases 'immediately” to the state public health department. He provided copies of the audit to law enforcement officials.
In a written response to Sand's concerns, the state Attorney General's Office wrote that the Test Iowa results reporting process is automated and takes three to 10 hours. The office said the process nonetheless complies with the public health department's reporting procedures and that the department considers the reporting process to be 'timely.”
Attorney General's Office spokesman Lynn Hicks said that time frame 'is equal to or faster than reporting time frames for tests performed by hospitals and national reference laboratories.”
He also said the use of intermediaries in the electronic reporting process 'is very common in electronic lab reporting in Iowa and other states” and is consistent with guidelines from the U.S. Centers for Disease Control and Prevention.
'Use of these common pathways helps to ensure the reported data is accurate, automated, protected, and timely,” Hicks said in an email. 'Implementing the auditor's recommendations would require the State Hygienic Laboratory to manually re-enter Test Iowa data, leading to increased burdens on the Lab and delays in reporting.”
A spokesman for the board that oversees the state's public universities also said a direct reporting requirement would create 'tremendous inefficiencies” and require additional employees at the state lab.
'Overall, requiring additional, duplicative data entry for the Test Iowa program would lead to fewer Iowans being tested and a general slowdown in statewide COVID-19 testing efforts,” regents spokesman Josh Lehman said in an email.
Sand's office responded to the pushback later Tuesday, saying the Attorney General's Office has a duty to defend state agencies 'regardless of their legality,” and that while data integration engines are common, 'comparing them to wholly separate private entities is like comparing apples to bacon.”
'It is notable that only now, after this examination is completed, is any reason at all provided for the lengthy reporting chain despite our asking twice,” Sand said in the afternoon statement.
'If it is true that changing the Test Iowa reporting system to be legal would require hand entry of data by public lab technicians, then taxpayers probably should not have paid $26 million for that system.”
Asked at a news conference Tuesday in Webster City why Test Iowa results are not delivered directly to the state public health department, Reynolds pointed to the response from the Attorney General's Office.
Sand said he was not able to determine just how the state lab was instructed to give the test results first to the private companies rather than the public.
His report found that 'no documentation was provided” of a state order establishing the process. 'As (the State Hygienic Lab) reports being instructed to report in this manner and (the Iowa Department of Public Health) does not deny that, such instruction must have been verbal,” he said in a news release.
The Gazette also sought answers about the Test Iowa program when local officials and news reports began to raise concerns about the accuracy and effectiveness of the supplied test kits and equipment.
The newspaper, acting under the state's open government records law, in April requested a month's worth of communication between State Hygienic Laboratory Director Michael Pentella and the public health department or governor's office related to COVID-19 testing.
The UI, where the lab is located, asked The Gazette to pay $320 for the eight hours it estimated it would take Pentella to produce the records.
When The Gazette raised concerns about a process that apparently would have Pentella do all the work himself to retrieve the records, UI officials suggested The Gazette narrow its request to just emails - allowing information technology employees to intervene and help.
In May, the university reported receiving similar records requests from other news outlets across the country and suggested the publications split an estimated $300 charge for the records.
The Gazette agreed. But after two months, the UI has not provided the public records.
Vanessa Miller and Rod Boshart of The Gazette contributed.