What Will it Take for the U.S. to Modernize its Public Health Systems?

How can countries be better prepared for the next pandemic? How do they need to change their public health infrastructure to ensure they don’t face similar challenges as posed by COVID-19? What can countries learn from each other to get these more modernized systems in place to improve their ability to exchange public health data across the globe?

These questions were at the heart of many discussions during the 2023 Healthcare Information Management System Society (HIMSS) Global Health Conference & Exhibition, which was held from April 17-21 in Chicago. But prior to the conference, PM360 spoke with HIMSS’ Tom Leary, Senior VP, Government Relations; Valerie Rogers, Director, Government Relations; and Jonathan French, Senior Director, Thought Advisory to get their thoughts on the best way forward to improve the public health infrastructure in the U.S. and around the globe.

“Coming through this pandemic, there are a lot of lessons learned about how we should regroup to connect the dots more comprehensively across all factors of health, wellness, and preparedness systems so we are more robustly able to address future health threats,” says Rogers. “We had an awakening that today’s health system has to optimize approaches for care coordination to address health inequities, which also was highlighted during the pandemic. And we are seeing a local to global shift in response to how consumers have new expectations for health systems to offer a greater personalization of care that focuses more on an overall whole person approach to care.”

So, what will it take to get a system like that in place? In May 2022, HIMSS published a report from Rogers and French recommending an approximately $36.7 billion investment over 10 years to help digitize, modernize, and interoperate state, territorial, local, and tribal (STLT) public health data infrastructure. The findings in this “Public Health Information and Technology Infrastructure Modernization Funding Report,” were based on interviews they did with hospital Chief Information Officers (CIOs), local public health agency leaders, market suppliers, and other trusted industry experts to best understand what STLTs require to maintain the software, hardware, workforce, licensing sustainably, and technical support to transmit vital health data electronically to public health agencies.

“One of the things I heard very early in my interview process with health systems is they had to generate a lot of their own intelligence about COVID spread, which they were using to drive decisions about resource allocation at a time when resources were incredibly limited,” French explains. “But their own data could only paint a part of the picture, and that’s because a lot of public health partners had trouble generating actionable insight and sharing it. Now, these health systems—many for the first time—are saying they see the value in exchanging this information and getting that insight back. That wasn’t something we heard often during Meaningful Use discussions. Fortunately, we’re starting to see more federal funding and states making more investment in the space, but we still have a long way to go.”

A Plan to Improve STLT Public Health Reporting

In the report, Rogers and French mention that “even though the U.S. HHS, via the Centers for Disease Control and Prevention (CDC) and the Office of the National Coordinator (ONC), provides strong influence, funding, and technical guidance, these federal agencies are historically limited in how Congress allocates funding to the CDC for public health agencies at the STLT level to use.”

Additionally, while the CDC’s Public Health Data Modernization Initiative (DMI) was established to “transform methods for the collection, use, and sharing of data through modern IT capabilities” it only takes a programmatic approach to support STLT improvements and these systems need to evolve with an enterprise approach to ensure the standardization and interoperability necessary to share data. For example, CDC’s data modernization initiative is primarily driven by the Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), but CSELS is not responsible for immunization information systems (IIS) which results in a gap in modernization efforts.

“I know $36.7 billion seems like a humongous number, but we spend similarly on the Meaningful Use program to incentivize the use of electronic health records (EHRs),” Rogers says. “However, public health was largely left out of that and now that we’ve come through the pandemic, we need to emphasize connected care. In order to do that, it requires a baseline of resources to be provided to those state, territorial, local, and tribal governmental health agencies.”

In the first one to five years in their proposal, they recommend $25,690,975,000 be dedicated to build a foundation of interoperable platforms that includes:

  • Immunization Information Systems and Registry Reporting & Query
  • Syndromic Disease Surveillance Reporting
  • Electronic Case Reporting and Contact Tracing
  • Nationwide Disease Surveillance and Reporting
  • Vital Records Reporting
  • Electronic Reportable Laboratory Results Reporting
  • Local Public Health Informatics Workforce and Systems Compatibility
  • Trusted and secure access to multi-modal health data across virtual, remote, or in-person services

“Some of the core or essential services that will guide us to be more prepared emphasize electronic laboratory and case reporting of notifiable health conditions and enhanced use of disease surveillance such as through the use of mobile and internet-based applications for outbreak management,” Rogers explains. “But we also recognize there’s a need to address other opportunities that bring the greater health system into alignment.”

Some of those other opportunities are addressed in how they propose the other $11,039,800,000 be spent over the course of the 10 years, which is ultimately to maintain the sustainability of the technology and the ability of the workforce to use it.

“One of the quotes that was offered, and I love using it, ‘We don’t want to give public health a Ferrari and put no gas in the tank,’” French offers. “So part of our funding proposal is not only that initial infrastructure investment, it’s the staffing, the resources, getting the systems relicensed with their software on an annual basis, and training the workforce, because the workforce currently doesn’t exist in sufficient numbers to do this.”

Investments will also eventually need to be made to create a national framework or a model law and policy around data standardization and privacy.

“As much as we would like to push forward with many of these advancements, we also have to recognize that there are still some antiquated state, local, and territorial legislation policies that thwart progress, particularly when you start to thinking about privacy, security, and data sharing,” Rogers explains. “We see that as a longer-term battle.”

French adds, “We’re also advocating towards a standard process for how data is collected and exchanged because right now different states have different requirements and that causes a significant number of errors. The exchange of information on a standardized basis would make it easier to share accurate information, which is critically important.”

Addressing the Issues Around Health Data

In the European Union, the sharing of data is a little less of an issue since standardization is in effect there. But Leary believes the U.S. can also look at how other countries treat patient data for ideas on how to further the modernization of public health.

“We will be better served if there is a national strategy for patient identification,” Leary explains. “Some countries across the globe have identifiers for the individual, for the building they live in, for the apartment or the condo they might reside in within that building, so if there’s a fire in the restaurant on the first floor and you know the smoke plume pattern then you can better determine who’s going to be impacted and what’s the public health response that needs to occur. But that all starts with the conversation around whether we can get over the anxiety of having a national strategy on patient identification here in the United States.”

Data privacy is also front of mind for a lot of people in the United States, but while Congress has been expected to move on privacy legislation at various points in 2020 and 2022, it still has yet to be addressed. Leary says if they wait much longer then someone else might decide for them on the best path forward.

“The EU is very seriously moving forward on European health data legislation,” he explains “It’s going to take them a year or so, but as they’ve shown with GDPR from several years ago, they will eventually get to something that works for all the countries and it will have an impact on how healthcare is delivered. Since commerce is delivered across the globe, multinational companies want to build one type of system, they don’t want to build something for each country. So it’s a call to action for the U.S., because individuals are concerned and it’s going to be dictated by somebody else if Congress doesn’t act.”

Part of that concern stems from cyberattacks on healthcare systems, which has been a rising issue since Meaningful Use and the Health Information Technology for Economic and Clinical Health (HITECH) Act have helped to digitize health data. Of course, as countries continue with the modernization of their health data systems, cybersecurity must be factored in every technology they implement.

“What we’ve been talking to other countries about is as you develop systems that are critical to successfully delivering quality access to care for all individuals is you must build cybersecurity into the framework at the same time,” Leary says.

Ultimately, if done right, creating greater harmonization across healthcare systems can lead to benefits for everyone.

“We hope that through these kind of modernization efforts, we would be better able to meet the Quadruple Aim to improve the patient experience, improve population health, reduce costs, and alleviate some of the burden on our healthcare providers,” Rogers says. “We should be able to meet those goals whether we are in a public health emergency or outside of that as we try to improve outcomes for all patients.”

Ads

You May Also Like

Industry Briefs April 2019

Amazon’s Joint Healthcare Venture Focuses on Healthcare for its 1.2 Million Employees The shared ...

Take A Glance Into The Future With The New Apple Watch

On March 9th, Apple announced the Apple Watch and several new products and technologies ...

Realizing the Potential of Precision Medicine for Pharma, Physicians and Patients

Precision medicine is the ability to match the best treatment for a patient, based ...