We are at an important crossroads for public health in this country. The COVID-19 pandemic has highlighted that our woefully underfunded public health infrastructures are in desperate need for modernization, starting with data exchange infrastructure.
In public health, we’re used to receiving data and protecting it. Perhaps sharing data doesn’t come as naturally. But the lesson learned from the pandemic is clear: We need to leverage advances in interoperability to build the right foundation for meaningful health data exchange in preparation for the next pandemic and to address the stark reality of health inequities in our country. In an era of self-driving cars, it’s almost inconceivable that public health departments throughout the country still rely on manual methods of calling and faxing to exchange health information, especially in situations where every minute counts.
Now, the challenge is sustaining the momentum and moving the urgency for health information exchange forward, to be able to share data and build modern, precision-focused public health collaborations not only within counties, but also across counties and even across states. If we’re going to continue engaging in an integrated approach to care, we need to start by building long-term, sound infrastructure that will support it. Foundational health data infrastructure is the key to practicing precision public health, using insights gleaned from data to develop targeted programs and innovative practices, resulting in better health and reducing health disparities across populations.
Where do we begin? These are what I consider the basic building blocks:
- Update technology — In the past decade, we’ve seen how medicine has rapidly digitized, in part from mandates and funding to adopt EHRs. During the pandemic, we saw basic tools like immunization information systems that struggled to handle the volume of COVID-19 vaccinations. In a situation like this, health information exchange (HIE) technology that already exists today can enable public health departments to move from outdated systems to the cloud so that it’s scalable (both up and down) as community needs change and easier to connect with other systems. Investing in the right technology and leveraging health information exchanges as health data utilities — utilities much like water and electricity — gives public health the functionality needed to modernize and flex to the ever-changing landscape of disease and need around us.
- Fund a skilled workforce — Staffing is an essential element of the “people” infrastructure public health needs to operate at its full potential. Public health organizations need a funded in-house workforce; few local health departments have dedicated informaticists on staff or the well-resourced organizational structures to support their work. Clinical collaboration systems were built up over the span of 10 years to where every large health system now has an army of people that oversee the EHRs, data systems, training, and super-user programs, ensuring those using the technologies are using it well. Public health is just now beginning the work to build an integrated system like this, but the vision is clear when looking at the lessons learned on the clinical side. This kind of investment likely makes the most sense at the state level, where the systems can then be provided to regional public health offices with fewer resources and also connected to other states for national collaboration.
- Prepare for a precise future — There’s so much we can leverage today for public health with what is happening in clinical data exchange. For example, one 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 statewide HIE to coordinate testing and treatment prior to a pregnant patient or their baby leaving the hospital. It was a program that reached exactly the people most in need at a time that was exceptionally critical — all powered by having the exact right information when a patient is admitted. This is one example of many. 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 are blocking us from our goals. Often, there’s also a lot of fear and old habits that need to be addressed. We need to discuss our workflows and our use cases, advocate for supportive policies, and have really honest conversations to make sure all stakeholders are comfortable and prepared to launch both public health and policy into the modern era.
We have to start working incrementally toward a new public health future. Modernizing our approach to public health means enabling it to access richer data in real time to drive decision making and inform the public more quickly and with greater precision. My hope is that as we go through this evolution, we will put the health data infrastructure in place for public health to work effectively to fulfill its core purpose of protecting and improving the health of people and their communities. Armed with data-driven insights, state and local public health systems have an opportunity to impactfully improve health equity and invest limited resources where they will save the most lives. This is precision public health.
Mimi Hall, M.P.H., recently moved from a career in local public health departments, including Santa Cruz, Yolo, Plumas, and Sierra counties, to leading Public Health Innovation with California’s largest health data network, Manifest MedEx, a nonprofit delivering health records for nearly 32 million residents.
