In addition to those data and information systems mentioned previously, there are several others employed by the WCHS and throughout NC DPH and NCDHHS that help support access to up-to-date MCH data. Again, the SCHS is a key resource as it provides so many different data reports and analyses based on vital statistics data. In 2018, LHD clinical service data reporting and analysis moved to a secure, direct file upload format called the Local Health Department Health Services Analysis (LHD-HSA) system and located at the SCHS. Data analysis now occurs by SCHS statisticians using SAS. Quarterly and ad hoc custom reports are available on program-specific data and cross-cutting public health issues. Some of these data are used by the WHB in their LHD agreement addenda Outcome Objectives Data Reports and in the Family Planning Annual Report (FPAR).

The SCHS website also hosts the Healthy North Carolina 2030 (HNC 2030) report and 2020 State Health Improvement Plan, which is a companion report to HNC 2030 and the 2019 NC State Health Assessment. The HNC 2030 Scorecard supports the 2020 State Health Improvement Plan as LHD and other partners link their local scorecards to the state scorecard to show the collective impact occurring statewide on 21 population indicators. Results-based accountability drives the HNC 2030 plan (asking how much did we do, how well did we do it, and is anyone better off), and the scorecard shows change over time as well as providing the story behind the data.

The SCHS is committed to restructuring its current website to a modern website that is centered on using data to highlight health equity and disparities. The Center initially decided to use open-source software called Indicator-Based Information System for Public Health (IBIS-PH) but abandoned this approach in May 2021 because the software did not have strong documentation, technical assistance was limited, and NC felt it could build a similar system with existing resources. The NC Community Health and Equity Indicators (NC CHIE) website prototype will be available in December 2021 for focus group testing (pending COVID-19 pandemic delays). Plans are to display the data with attention to low health literacy needs with respectful portrayals of community data. The website will include HNC 2030 Indicators and a Health Equity Dashboard.

Additionally, our MCH Epidemiologist routinely collaborates with statistical staff at the SCHS on a variety of Vital Statistics data quality improvement projects to help ensure the accuracy of NC MCH data. SCHS and WCHS collaborations have included resolving errors in prenatal care information in the birth file, generating facility level birth data quality reports, and verifying the accuracy of pregnancy checkbox information on the death certificate through data linkages and certifier confirmation of pregnancy.

In addition to the NC Composite Linked Birth File described earlier, each month a subset of the birth file is shared with the Early Hearing and Detection Intervention (EHDI) program which is matched with newborn screening data through the WCSWeb Hearing Link data system to ensure proper follow up. The MCH Epidemiologist works closely with EHDI program staff to enhance access to birth data and improve EHDI/birth data linkage rates.

The NC Early Childhood Integrated Data System (ECIDS), a system integrating early childhood education, health, and social services data from state agencies is now in use and continues to be updated. The Early Childhood Action Plan Data Dashboard tracks progress toward the targets and sub-targets of the 2025 goals of the NC Early Childhood Action Plan (ECAP). ECAP County Data Reports are also available. The WCHS also relies heavily on NC Child, a non-profit founded in 2014 to “advance public policies to ensure that every child in North Carolina has the opportunity to thrive – whatever their race, ethnicity, or place of birth” (https://ncchild.org/about-us/ accessed July 26, 2021) in using data from their NC Child Health Report Card, published biannually in partnership with the NC Institute of Medicine, and using KIDS COUNT data which is available through NC Child’s partnership with the Annie E. Casey Foundation.

The NC Violent Death Reporting System (NC-VDRS) is a CDC-funded statewide surveillance system that collects detailed information on deaths resulting from violence (homicide, suicide, unintentional firearm deaths, legal intervention, and deaths for which intent could not be determined) that occur in NC. NC-VDRS began collecting data in January 2004 from a number of data sources such as death certificates, medical examiner reports, and law enforcement reports. In 2021, the IVPB released the NC-VDRS Data Dashboard visualization tool, providing key takeaways on the metrics page and providing more detail including data at a county and demographic level where available on individual pages of the dashboard covering overall violent death, suicide, homicide, and firearm-related deaths.

The IVPB also oversees two other dashboards. The NC Opioid Action Plan Data Dashboard which provides integration and visualization of state, regional, and county-level metrics for stakeholder across the state to track progress toward reaching the goals outlined in the NC Opioid Action Plan. The NC Alcohol Data Dashboard presents data on excessive alcohol use, alcohol outlet density, and alcohol consumption rates as well as related public health strategies, immediate- and long-term impacts of excessive use, and cost to communities.

Immunization data from the NC Immunization Registry (NCIR), a web-based statewide-computerized immunization information system that maintains and consolidates immunization records, is used to assess provider-level vaccination coverage.

As outlined in the MCH Success Story, the NC WCHS is also making great strides with its Maternal Mortality Review Committee and implementing the MHI Program, and data sharing partnerships and quality improvement initiatives mentioned in that section will continue.

During the pandemic, WCHS has also been fortunate to have continuous access to COVID-19 surveillance and vaccine data for women and children in the state. The NC COVID-19 Dashboard was launched in May 2020 as an interactive data dissemination tool that provides an overview of COVID-19 metrics and healthcare capacities that the state is following to inform decisions. The dashboard has grown over time as the COVID-19 pandemic has progressed. As of July 2021, the Dashboard contains the following sections:

• Summaries
• County Alert System
• Vaccinations
• CLI Surveillance
• Cases
• Cases Demographics
• Testing
• Hospitalizations
• Hospitalization Demographics
• Contact Tracing
• Outbreaks and Clusters (including weekly updates of clusters occurring in childcare or school settings)
• Wastewater Monitoring
• Reports on COVID-19 Patients Presumed to be Recovered, Risk Factors for Severe Illness from COVID-19, and COVID-19 Cases in Rural Counties
• Data Behind the Dashboards

The COVID-19 Vaccine Management System (CVMS) is a secure, cloud-based system that enables COVID-19 vaccine management and data sharing across recipients, care providers, hospitals, agencies, and local, state, and federal governments on one common platform, in addition to the NCIR. (https://covid19.ncdhhs.gov/vaccines/info-health-care-providers/covid-19-vaccine-management-system-cvms accessed July 26, 2021). Another tool to help NC reach its goal of vaccinating as many North Carolinians as quickly and fairly as possible is an interactive web-based map application that shows census tracts in North Carolina with the highest rates of social vulnerability and the lowest rates of COVID-19 vaccination. Access to timely vaccination data disaggregated by race, ethnicity, and other social determinants of health has guided North Carolina’s work to reach underserved and historically marginalized populations and deliver equitable access to COVID-19 vaccines.

WCHS is also working with NCDHHS to refine our data use and data sharing agreements throughout the Department. A draft of the NCDHHS Data Sharing Guidebook was shared with the DPH EET in November 2020 with a request to complete data asset inventory forms. According to the draft, the purpose of the Guidebook is to:

• Establish clear pathways for data sharing and integration, for requestors and data owners
• Establish a common legal framework for data sharing and integration across NCDHHS
• Support data use that leads to improved data quality, insights, and improvements
• Clarify processes to reduce burden on staff requesting and granting access to data, increase efficiencies, and ensure privacy and security safeguards

Work to finalize these data sharing processes across NCDHHS and within NC DPH is continuing. DPH’s Office of Regulatory and Legal Affairs continues to review current WCHS data use agreements and discuss revisions with the Title V Director and other staff members to ensure data access and security are maintained.