A coalition of public health advocacy groups working to preserve and strengthen public health investments is proposing that the federal government commit $1 billion over 10 years to modernize public health surveillance. The group noted that the nation’s public health data systems are “antiquated, in dire need of security upgrades and rely on obsolete surveillance methods leading to delayed detection and response to public health threats of all types.”
The effort is being led by HIMSS, the Association of Public Health Laboratories (APHL), the National Association for Public Health Statistics and Information Systems (NAPHSIS) and the Council of State and Territorial Epidemiologists (CSTE).
Federal public health agency efforts include improving access to care and care quality, lowering costs, enhancing safety, preparing for and responding to emergencies and discovering new cures. The coalition argues that these goals are only achievable with strong and sustained funding for a continuum of biomedical, behavioral, social and health services research; community-based prevention strategies; healthcare services for the medically underserved; and education of a robust health professions workforce.
The coalition states that development of 21st century data systems and the public health workforce needed to operate and maintain them have been woefully underfunded. Degree programs and early- and mid-career workforce development overhauls are needed for epidemiologists, vital registrars, laboratorians and other public health professionals. A $1 billion investment over the next decade at the Centers for Disease Control and Prevention (CDC) — and through it, funding to directly support state, local, tribal and territorial health departments — would transform today’s public health surveillance into a state-of-the-art, secure, and fully interoperable system.
There are five core data systems that need modernization, according to the group:
• National Notifiable Disease Surveillance System (NNDSS). The secure national disease reporting system and infrastructure collects vital individual case investigation data at state, local, tribal, and territorial public health agencies from hospitals, physicians and labs. NNDSS then sends case investigation data to CDC to create a national snapshot of health, used to respond to public health outbreaks and act as the first line of health security defense.
• Electronic Case Reporting (eCR). eCR is the automatic submission of disease reports directly from electronic health records at clinical care organizations (e.g., hospitals, health systems, community health centers) to state, local, tribal and territorial public health departments. eCR reduces physician burden in fulfilling their legal responsibility to report, and dramatically improves disease/condition reporting, which leads to early implementation of public health interventions and limits further spread of infectious agents.
• Syndromic Surveillance. Syndromic surveillance provides near real-time data on every hospital emergency department visit for hourly detection and continuous monitoring of community health incidents, such as the impact of natural disasters, including hurricanes, flu pandemics and opioid overdoses. It provides public health professionals the ability to monitor the pulse of the community, and identify health threats as they emerge.
• Electronic Vital Records System. The electronic vital records system is a national system of 57 vital records jurisdictions that provide secure electronic collection of birth and death data from hospitals, funeral homes, physicians and medical examiners. It allows timely and accurate reporting of birth outcomes and causes of death, which serve to monitor and respond to public health crises as they arise in communities, including reducing preventable deaths and infant and maternal mortality rates.
• Laboratory Information Systems. Laboratory Information Management Systems (LIMS) are the backbone of how laboratory data is collected, managed and shared to inform public health decision-making. The Laboratory Response Network (LRN) is comprised of specialized laboratories that can respond to biological and chemical threats and other public health emergencies with advanced testing capabilities. Electronic Laboratory Reporting (ELR) is the electronic reporting of laboratory results from private and public labs to disease detectives and investigators in state, local, tribal and territorial public health departments.
