Transforming Public Health Data Systems Post-Pandemic

Public health emergencies such as the COVID-19 pandemic put the spotlight on long-standing data challenges faced by the nation’s public health system. At the start of the COVID-19 pandemic, most data exchange between healthcare and public health, and across public health, was manual, relying on faxes, labor-intensive data entry, and other outdated technology. 
Recognizing the urgent need to develop a comprehensive strategy to modernize the data exchange between healthcare organizations and state, tribal, local, territorial, and federal public health authorities, the Centers for Disease Control and Prevention (CDC) released its first Public Health Data Strategy in 2023. 
The strategy establishes annual milestones to make sharing health data simpler and more standardized, bring modern data tools to more places, share health insights quickly, make vital disease trends readily apparent, and advance data system interoperability to improve how different health data systems communicate. 
The work we, along with our healthcare partners and public health jurisdictions across the country, are doing to meet these milestones is showing tangible results.
In Utah, Andrew T. Pavia, MD, professor of pediatrics and medicine, University of Utah Health in Salt Lake City, has seen many ways in which simplified, more standardized sharing of data between healthcare and public health has improved patient care and informed decision-making.
“Having access to RSV [respiratory syncytial virus] data has helped us make decisions about visitor restrictions and surge staffing in our children’s hospital. Influenza data has been useful for physicians deciding to initiate empiric antiviral treatment and deciding how much testing to do. Opiate overdose data fed back to ED [emergency department] docs and first responders could help us see if there is a ‘hot’ batch of opiates circulating.”
Access to public health data from across the country has been particularly helpful with the upsurge their clinicians are seeing in patients with congenital syphilis and of syphilis-exposed babies. 
“Now we can see if the mother was appropriately diagnosed and treated for syphilis in Utah or elsewhere across the country, without having to make multiple telephone calls or hitting dead ends. None of this could happen without healthcare feeding data to our public health colleagues, and then healthcare having access to the aggregated data,” Pavia said. 
In Alaska, Robert Onders, MD, JD, MPA, medical director at Maniilaq Health Center in Kotzebue, 15 miles north of the Arctic Circle, is working with the 11 tribal clinics surrounding his hospital to share syndromic surveillance data with CDC to help monitor issues including gastrointestinal outbreaks, respiratory diseases, suicide rates, and substance abuse disorder. 
Onders estimates that 50%-70% of all tribal emergency care takes place at the clinic level, in communities primarily accessible by plane, boat or snowmobile — yet relatively few of those clinics share syndromic surveillance information with CDC. 
“There is a large amount of data that’s missing,” Onders said. “Having the reporting gives us an idea if there are changes in baseline levels.”
Tamara Sheffield, MD, MPA, MPH, medical director of immunization programs at Intermountain Health, Salt Lake City, remembers a time before they created an immunization registry. 
“Physicians only had records of the vaccines they had administered. Patients carried little yellow immunization cards, filled in by hand by healthcare workers.” 
Now, those data are sent directly to the state health department. The complete immunization records of patients, no matter where they received their vaccines, are automatically transmitted back from the state registry into their electronic medical record. 
“We can review our own data and do outreach to those who haven’t been vaccinated. The investment made in this system has increased our immunization rates and dramatically reduced the time physicians spend recording and reporting the data.” 
The sharing of data from medical records electronically among healthcare providers, and between providers and patients, has come a long way since the Health Information Technology for Economic and Clinical Health (HITECH) Act began providing about $35 billion to promote the development and adoption of health information technology. 
The broad attention paid to public health data as a result of the COVID-19 pandemic and other public health emergencies has made it very clear that we must modernize our nation’s public health data and information systems as well. 
We cannot do the basic work of public health — identifying outbreaks, novel threats, and changes in disease burden or severity — without timely data and information. The speed and quality of the data impact the ability to identify threats and share important information with clinicians and the public. This includes basic information on case and laboratory data, which helps identify who is getting sick and how they are being infected. Emergency department data allow us to detect early trends in hospital burden and are one of the earliest signs of disease in a community. 
And those are data that start with you, our colleagues in healthcare. 
Data generated in healthcare settings drive early detection and monitoring of new diseases. Ensuring that we have strong connectivity between healthcare and public health systems is essential if the nation is to be response-ready during a health crisis. 
To make this possible, we must have a nationwide approach to public health interoperability with healthcare. Fortunately, the work already accomplished to modernize healthcare systems paves a tremendous path to allow this to happen. Building this momentum will enable our nation to have robust early warning systems, the ability to detect threats promptly, and the capability for real-time monitoring. 
We have momentum, and we all have a role to play. Depending on where you are in your healthcare organization, you can: 
Work with your state or local health department to participate in syndromic surveillance through the National Syndromic Surveillance Program;
Engage with your electronic health record vendor to accelerate adoption of electronic case reporting;
Partner to advance FHIR-based solutions (Fast Healthcare Interoperability Resources) to public health data exchange, which can be applied to multiple use cases such as electronic case reporting; and
Participate in the Trusted Exchange Framework and Common Agreement to reduce the complexity and improve the efficiency of public health data exchange.
Working together, we can put science and data into action to help people and communities stay healthy. 
Public Health Data Strategy
Public Health Data Interoperability
Vision for Public Health Data
 
Public Information from the CDC and Medscape