Public health must be transformed. Health IT can help

° Сovid-19 has hit public health agencies and organizations. Future crises, whether from infectious diseases, extreme weather, or other sources, are likely to do the same unless they change their approach to public health reporting, data management, and information sharing.

Managing public health is not easy, especially in the United States. Not only is this country home to diverse populations that have different genetic predispositions and medically relevant cultural patterns, it is also vast geographically. How epidemics or climate change affect California may be quite different from how they affect Maine. The needs of Pittsburgh residents can vary greatly from the needs of those living 50 miles away in rural Pennsylvania.

These factors make it necessary for most efforts to maintain locally focused — community and state — public health policies and technology infrastructures, and this is the right answer in many cases. A top-down approach implemented at the federal level would miss important nuances and reduce the ability to meet people where they are. But a highly contagious virus or climate change doesn’t recognize municipal, county or state boundaries.


Data management

One problem with a localized approach to public health, however, is the resulting mix of reporting and decision-making, which comes with enormous challenges for public health agencies, healthcare delivery organizations, and developers supporting data collection and sharing. This is true under the best of circumstances, let alone during a crisis.

People do not always seek treatment from the same care provider each time, and may even cross state lines to receive care. Many large healthcare organizations operate in multiple countries and must comply with different privacy laws regarding patient consent to share information. In addition, there are varied approaches to prescription drug monitoring programs, and providers also face multiple public health reporting requirements that, during a public health emergency, can quickly become daunting.


Even within the same state or region, state assemblies and public health organizations often do not coordinate their efforts in making decisions about technological approaches, management decisions about sharing information between localities, or what information should be captured and reported in registries of public health by health care providers. In the early days of the pandemic, a large Altera Digital Health health system client I work for reported Covid-19 data to 18 different city, county and state public health organizations on a daily or weekly basis. Each entity wanted different information, so the health system could not simply share one report with all parties. This multiplied the reporting responsibilities of front-line medical providers, who were tasked with collecting disparate patient information throughout the care process while contending with staff shortages and the influx of Covid-19 patients; also created unnecessary work for the IT department and us as their partner.

Lessons from Israel

This fragmented approach to public health reporting not only creates unnecessary burdens, but the health care organizations providing the information often do not benefit from it. Very few public health systems offer a two-way flow of information back to providers who send data. As a result, hospitals and provider practices rarely receive closed-loop communication about public health data trends to monitor. And even in today’s highly digitized world, when that information is shared with healthcare delivery organizations, it often comes via fax.

Israel’s health IT response to Covid-19 is a great example of a connected, modern public health system in action. Of course, with a population slightly larger than New York City, a land area roughly the size of New Jersey, and a national health care system, it’s not an apples-to-oranges comparison. However, Israel has invested decades in an interoperable national health IT infrastructure and was able to pivot quickly when the pandemic began.

The Ministry of Health and the country’s research community have been proactive in maximizing the de-identified digital information available on Covid-19 patients across the country for research purposes. This allowed epidemiologists and public health authorities to quickly gain insight into the spread of SARS-CoV-2, the virus that causes Covid-19, the comparative effectiveness of vaccines and retroviral treatments, and more.

By comparison, the US had to rely on information and forecasts from other countries because its decentralized, disparate reporting systems made data analysis at the federal level slow, difficult, and imperfect—if not impossible.

To address this challenge, the Public Health Systems Data Task Force, established by the Office of the National Coordinator for Health Information Technology, issued a report in 2021 with 22 recommendations for health IT in the US. This includes guidance for a “new normal” with public health as a strong partner with health care and resources and data shared as appropriate.

Challenges to maximizing public health data can be addressed if states focus on investing in health IT, consistency of reporting, and ongoing digital health technologies.

Many state public health departments—as well as city and county organizations within their jurisdictions—currently use technology that is decades old. Instead, they could use modern health IT that is designed to maximize collaborative, consensus-based standards. Thanks to significant funds appropriated by Congress in 2020 and 2021, including for the Centers for Disease Control and Prevention’s new Data Modernization Initiative, there is a unique opportunity to invest in newer, modernized systems and to eliminate the data legacy between public health and healthcare, with health IT as a conduit.

Electronic health records use standards that provide mechanisms for how data is labeled, categorized, and exchanged. Harmonizing data across public health platforms would make it easier, faster and cheaper to exchange and collect information. And in times of crisis, greater efficiency can make a real difference.

Develop consistency in data reporting

Consensus building on reporting for health care providers can also improve public health. Imagine how much less work hospitals and practices would have to expend if they could report once in a way that many entities—from public health departments at the city, county, state, and federal levels to researchers and others—could. benefit. Researchers and the federal government could compare situations across states and regions to make evidence-based decisions about public health responses with greater access to de-identified data.

Harmonized data plus interstate consensus on reporting would have significant benefits for clinical research and early identification of public health emergencies, including non-infectious diseases.

Many states are now emphasizing addressing social health inequities as part of their larger public health strategies, and the opioid crisis has reached a tipping point during the pandemic. Both are examples of other areas where conflicting data collection and reporting requirements, as well as a variety of state-by-state approaches to technology deployment, are impeding progress in improving patient outcomes and public health monitoring capabilities. However, these and other big issues can increasingly get the attention they (and our communities) deserve by building a better way to share the already massively collected clinical data in the US

The necessary changes will not come without challenges. It is not easy to replace hundreds of established systems or existing policy approaches to data management. And investing in public health infrastructure is not something that local, state and federal agencies routinely engage in. In fact, under-investment is what has put the country in the challenging position it has been in for the past two and a half years.

Take advantage of health IT financing and technology opportunities

As the US emerges from Covid-19, it has a once-in-a-generation opportunity to pour Congressional funding into local, state and federal public health infrastructure. But it’s important to remember that Congressional funds can always be reappropriated, and short-term memory often befalls Congress when the urgency of a situation moves into the past.

If states collaborate on a consistent, standards-based health IT approach to public health reporting and consult with the Office of the National Coordinator for Health Information Technology as subject matter experts, they will be in a much stronger position. when the next public health emergency arises, and even before then, as public health leaders increase expectations for health care providers to report on the social drivers of health and other data.

Lee Burchell is vice president of government affairs at Altera Digital Health and chair of the Electronic Health Records Association’s Public Policy Leadership Task Force.

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