The Covid-19 pandemic has highlighted many shortcomings within the U.S. health care system, including outdated and ill-equipped technology—and while efforts to upgrade health care technology are already underway in some states, significant challenges remain.

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'The next great challenge': Outdated health care technology

Health technology issues have become increasingly difficult to ignore during the pandemic. When lockdowns first began, hundreds of thousands of people were forced to wait months for unemployment assistance as states struggled to integrate newly created benefits into their existing software, NPR's "Shots" reports. In addition, local and state vaccine registration sites were riddled with issues that created a barrier to access for many people.

Is it time to cancel the fax machine? Not if I have anything to say about it.

Currently, technology challenges are widespread across the government, from local public health agencies to state-run benefits programs, Kaiser Health News reports. In fact, Matt Salo, executive director for the National Association of State Medicaid Directors, said the need to upgrade technology is "the next great challenge that government has to solve."

Outdated information systems can have negative effects throughout the public benefits system, according to Jessica Kahn, who previously led data and systems for Medicaid at CMS. For example, when online benefits applications are difficult to navigate, more applicants may call phone help lines, further straining understaffed call centers.

In Missouri, a 2019 McKinsey & Company assessment of the state's Medicaid program found that the system consisted of roughly 70 different components partially developed within a mainframe from 1979. According to the assessment, the state's program was "not positioned to meet both current and future needs."

Notably, in a 2020 report for the state of Missouri, Department of Social Services (DSS) staffers called the state's benefits enrollment process "siloed" and "built on workarounds," and participants said it was "dehumanizing."

Some states are trying to update their systems

In response to these long-standing technology issues, some states are exploring technology upgrades. Pandemic relief funding and higher-than-expected tax revenues have resulted in "once-in-a-generation pools of money" that are helping fund these technology upgrades, according to NPR's "Shots."

In December, President Joe Biden issued an executive order calling for the benefits enrollment process to be more streamlined. As a result, state lawmakers are advocating for the use of unspent Covid-19 relief funds to address existing tech issues.

For instance, Wisconsin Gov. Tony Evers (D) has allocated up to $80 million to replace the state's outdated unemployment infrastructure.

In addition, Kansas is among the first states to work with the U.S. Department of Labor's new Office of Unemployment Insurance Modernization—an organization that will manage $2 billion in funds from the American Rescue Plan Act.

And last year, a bipartisan state Senate committee in Missouri recommended allocating unused Covid-19 relief funds for DSS to update its benefit computer systems. The department also proposed allocating federal pandemic money to fund artificial intelligence that would process around 50,000 documents each week—work that is currently being done manually at an average rate of two minutes per document.

Why upgrading health care technology may be easier said than done

For decades, public health and safety-net programs have been underfunded, Kaiser Health News reports. As a result, many public health officials have been hesitant to allocate the necessary funds to update computer systems and technology because these types of projects can cost tens of millions of dollars—and even when funding is available, recent evidence suggests these upgrades may be easier said than done.

For example, over 10 years ago, the Obama administration invested $36 billion to help develop and mandate the use of EHRs for all U.S. patients. However, despite the administration's sizeable investment, the conversion to digital patient records has been riddled with problems, KHN reports.

The Affordable Care Act (ACA) also provided an opportunity for states to upgrade their technology infrastructure. Between 2011 and 2018, the federal government offered to cover up to 90% of the funds required to replace or update old Medicaid IT systems—many of which were programmed with a programming language from 1959.

However, the ACA stipulated that the updated Medicaid computer systems had to communicate directly with the health care exchanges created by the law, according to Salo. As a result, many states ran into issues and never completely upgraded their benefit systems.

Even now, many patients who want to be reimbursed under the Biden administration requirement that insurers reimburse individuals for rapid Covid-19 tests must fax or mail in their claims and receipts, a Kaiser Family Foundation poll shows. (Sable-Smith, Kaiser Health News, 2/1; Sable-Smith, "Shots," NPR, 2/1)