We are at an important crossroads for public health in this country. The COVID-19 pandemic has highlighted that our woefully underfunded public health infrastructure is in desperate need of modernization, starting with data exchange infrastructure.
In public health, we are used to receiving data and protecting it. Maybe data sharing isn’t as natural. But the lesson from the pandemic is clear: we must leverage advances in interoperability to lay the foundation for meaningful exchange of health data in preparation for the next pandemic and to address the harsh reality of inequities. health in our country. In the age of self-driving cars, it’s almost inconceivable that public health departments across the country still rely on manual call-and-fax methods to exchange health information, especially in situations where every minute counts.
The challenge now is to maintain the momentum and advance the urgency of health information exchange, to be able to share data and establish modern, precision-focused public health collaborations, not only at the within counties, but also between counties and even between states. If we are to continue to commit to an integrated approach to care, we must start by building a strong, long-term infrastructure that will support it. Core health data infrastructure is key to the practice of precision public health, using insights gained from data to develop targeted programs and innovative practices, resulting in better health and reducing health disparities between populations.
Where do we start? Here are what I consider to be the basics:
- Update technology — Over the past decade, we have seen how medicine has rapidly digitized, in part due to mandates and funding to adopt EHRs. During the pandemic, we saw basic tools like immunization information systems struggling to manage the volume of COVID-19 vaccinations. In a situation like this, the health information exchange (HIE) technology that already exists today can allow public health services to move from outdated systems to the cloud so that it is scalable (to that time and down) as community needs change and it becomes easier to connect to other systems. Investing in the right technology and leveraging health information exchanges as public health data services – utilities like water and electricity – gives public health the functionality it needs to modernize and adapt to the ever-changing landscape of diseases and needs around us.
- Financing a skilled workforce — Staffing is an essential part of the “human” infrastructure that public health needs to function to its full potential. Public health organizations need an in-house funded workforce; few local health departments have dedicated computer scientists on staff or well-resourced organizational structures to support their work. Clinical Collaboration Systems were built over a 10-year period, so every major healthcare system now has an army of people overseeing EHRs, data systems, training, and superuser programs. , ensuring that those who use the technologies use them well. Public health is just beginning the work of building an integrated system like this, but the vision is clear when looking at lessons learned from the clinical side. This type of investment probably makes the most sense at the state level, where systems can then be provided to regional public health offices with fewer resources and also connected to other states for national collaboration.
- Preparing for a specific future — There are so many things that we can exploit today for public health with what is happening in the exchange of clinical data. For example, a Southern California county launched a pilot program in 2021 that helped prevent the devastating consequences of congenital syphilis by using real-time hospitalization notifications from a nonprofit HIE at the statewide to coordinate testing and treatment before a pregnant patient or her baby leaves the hospital. . It was a program that reached exactly the people who needed it most at an exceptionally critical time – all powered by the availability of accurate information when a patient is admitted. This is one example among many others. However, we can’t leverage anything without aligning public health policies with how we want to use this data, and it’s not always policies that prevent us from achieving our goals. Often there are also a lot of fears and old habits that need to be tackled. We need to discuss our workflows and use cases, advocate for supportive policies, and have really honest conversations to make sure all stakeholders are comfortable and ready to launch both the public health and politics in the modern era.
We need to start working incrementally towards a new public health future. Modernizing our approach to public health means giving it access to richer data in real time to guide decision-making and inform the public more quickly and with more precision. I hope that in this evolution, we will put in place the health data infrastructure for public health to operate effectively and fulfill its primary purpose of protecting and improving the health of people and their communities. Armed with data-driven insights, state and local public health systems have the opportunity to effectively improve health equity and invest limited resources where they will save the most lives. This is precision public health.
Mimi Hall, MPH, recently left a career in local public health departments, including Santa Cruz, Yolo, Plumas and Sierra counties, to lead public health innovation with the largest health data network of California, Manifest MedEx, a nonprofit organization providing medical records for nearly 32 million people.
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