CDC Director Walensky on the Significance of TEFCA to Public Health

Feb. 14, 2023
Millions of health records flow through nationwide networks every day, yet most public health agencies have no access; CDC Director Rochelle Walensky, M.D., M.P.H., called that a “missed opportunity’

At the Feb. 13 announcement of the first Qualified Health Information Networks (QHINs), several speakers mentioned their hopes that TEFCA would have a beneficial impact on public health data sharing. Perhaps the most enthusiastic of these speakers was RochelleWalensky, M.D., M.P.H., director the Centers for Disease Control and Prevention.

Walensky began her comments by noting that in addition to being CDC director, she also has a 25-year clinical career. “I want to say that as enthusiastic as I am about this for CDC and for public health, I am equally enthusiastic for my fellow clinicians who are going to reap the benefits of these successes.”

She said the pandemic has made it clear that we must modernize our public health data and information systems and we have to do it now. “We can't do the basic work of public health without monitoring cases on laboratory reports of communicable diseases, without receiving data on who is dying and why, without receiving data from emergency rooms to track the earliest signs of that first hepatitis case in our community and understanding the extent of the chronic diseases that affect our nation's health and take too many lives every single day,” she said.

Walensky stressed that we have to have a nationwide approach to public health interoperability that gets our state, local, tribal, and territorial and public health federal public health professionals the data that they need, when they need it. “We must make that data available as quickly as possible for our healthcare providers who are working on the front lines every single day, for the policymakers to feed it back to the state, local and tribal, territorial and federal levels and for the public.”

Every day millions of health records flow through nationwide interoperability networks, yet most public health agencies have no access, Walensky noted, calling it a “missed opportunity and one that we at CDC recognize. I cannot tell you, having been in this job now for 25 months, how frustrating it is to be in this position. And it may be true for many of you as well. When you know the data exist that could help you make a better decision and you don't have access to them because of poor data flow because the systems aren't compatible.”

She described a CDC data modernization initiative, and its North Star architecture to bridge the gaps in the national data infrastructure system initiatives that will bring modern, scalable and responsive technical and management approaches to public health data.

Public health and clinicians can work better together as partners if public health is more directly integrated with the healthcare system, she said, reducing the heavy burden that reporting places on providers so that they can spend more time with patients on patient care. That would also allow those in state and local health departments to focus on interventions rather than doing data entry.  

“The cost of our current way of operating both in time and in dollars is just far too high,” Walensky said. "We’re spending too much time reinventing the wheel, negotiating data use agreements, building interfaces, and establishing security, and that work is ongoing even as we speak to try and improve our data systems. We often have records that are missing or incomplete. We lack a shared governance for our public health systems and our public health data. We shoulder too many costs in making different point-to-point connections, for example, with clinical data sources or between states or between counties within a given state and too much effort is spent on recruiting and on-boarding new data sources.”

But TEFCA can help, she stressed. “It gives us common rules of the road for data sharing, for use and governance. A common posture on cybersecurity helps us be more transparent and guides public health participation in the critical infrastructure that we will all rely on. Providers will be able to share information on public health using the same infrastructure they use to share information with each other for clinical care.”

Importantly, Walensky added, patients will have modern apps to directly send to and receive information not only from their healthcare providers, but their public health agencies. “It's an exciting future to think about. TEFCA presents us an opportunity and a means to advance towards our strategic objectives and accelerate nationwide connectivity in ways we have never had before. CDC and ONC are working with state, tribal, local and territorial communities to identify early adopters and to help forge the path so that the whole public health community can see how much there is to benefit from TEFCA and all that there is to offer.

With its federated architecture, TEFCA offers the flexibility to accommodate state and local policies and authorities around public health, while allowing all jurisdictions to benefit from the common rules of the road and the technical infrastructure, Walensky said. “While there is so much work that we have ahead of us, we recognize that we are ready to do it, we are excited to do it. I am so looking forward to our charting together a course forward.”