Thanks to new national health information technology (IT) and health policy initiatives, the health care and public health landscape are rapidly moving toward a system of greater public health and health care integration. To actively partner with health care and meet the demands of this new landscape, governmental public health needs to make smart decisions about investing in IT infrastructure and harness technology to manage the growing pool of health-related data. Instead of addressing these challenges as individual agencies, it is time to collaborate across all levels of public health to create a shared information platform that will serve common needs and leverage ideas and resources toward a common vision.
Recent national initiatives have centered around the concept of a Learning Health System (LHS)1 and highlighted the need for public health to develop modern, integrated systems. In February, the Office for the National Coordinator for Health IT released a 10-year plan to build the infrastructure for a fully functioning LHS. This Nationwide Interoperability Roadmap2 was developed with input from government, health care, public health, and industry stakeholders and describes the governance, policy, and technical advances necessary to realize the LHS. It specifically mentions ways that state and local governmental public health agencies will both use data to improve programs and community health and input data into the system to drive individual and population health activities.
The LHS will require that public health agencies strategically interact and engage across the public health and health care systems. However, because of limited investments in public health IT and infrastructure, the governmental public health enterprise is currently ill-prepared to be a player, let alone a leader, in this space. Under the HITECH Act, investments in the clinical health IT infrastructure have dwarfed public health funding, resulting in a health care system that is significantly ahead of public health.
Unlike many other industries, the public health enterprise is far from realizing the full potential of modern Internet technology and connectivity to revolutionize its business. Although most public health agencies use computers to manage public health data, technology use is often fragmented and varies widely according to agency capacity and resources. Even health departments with advanced technology solutions have functional silos, and electronic data exchange between jurisdictions is nearly nonexistent. It is time to modernize the way that public health collects, stores, uses, and shares the data that drive our program and policy decision making.
Public health's lack of integration and interoperability stems from years of public health information systems being built or bought as needed for a single purpose. Systems were made for one jurisdiction's use and rarely considered the need to exchange information outside of their siloes. While current initiatives such as the State Innovation Models and Million Hearts Collaborative are working to integrate health care and public health information to a larger degree than ever before, their focus is still primarily on specific topics and within jurisdictional boundaries. They do not aim to integrate health information throughout the enterprise.
To meet the high demands of an LHS, the public health enterprise must work to “de-silo” and integrate our information systems. While daunting, this need also presents an opportunity to move public health into the 21st century using creative solutions that overcome the inertia normally present in enterprises such as governmental public health. Public health agencies across the country face many of the same problems: limited resources, the need for technical expertise, and critical issues of data security, policy, and local, state, and federal laws. Collaboration is the key to developing common solutions to these shared problems and modernizing the public health enterprise.
To this end, a partnership of more than a dozen public health and key partner organizations representing state chief information officers, providers, and vendors, led by ASTHO and funded by the Centers for Disease Control and Prevention, has undertaken an initiative to modernize the technology infrastructure for governmental public health. Known as the Public Health Community Platform (PHCP), this infrastructure is being developed to provide an accessible, flexible, and secure public health IT platform governed by and responsive to the public health community. The platform will enable users to develop and implement interoperable shared solutions and facilitate cross-jurisdictional collaboration and effective resource use to address public health needs.
The PHCP's primary purpose is to promote resource efficiencies in the form of time and money saved or value added. Without the PHCP, developing the infrastructure necessary to modernize systems and fully engage in the LHS would require duplicative investments at all levels of public health. The PHCP prepares the public health enterprise by helping us do our work more efficiently and effectively through enhanced infrastructure, common services, and streamlined ability to exchange data within public health and with the rest of the health system toward the shared goal of improved personal and population health.
The PHCP is now in its second year of development. To date, the partnership has identified the need for a centralized platform, described best practices and development priorities, and established a representative Executive Committee that will direct the PHCP's strategic growth and sustainability. Eventually, the PHCP will become an independent entity that represents the diverse public health community and its stakeholders. This work has been directed through a stakeholder steering committee comprising public health practitioners, clinicians, subject matter experts, and vendors. The PHCP project team is also exploring 3 examples of seeded functionality that address specific public health domains with extensible components: end-to-end case reporting, immunization information system data sharing, and analysis and visualization tools to support community health assessments.
A current focus area for the PHCP is improving end-to-end case reporting, a pilot project that represents a public health priority and demonstrates core functionality for the platform. The complex notifiable condition case reporting process provides an illustrative example of the value of a centralized platform and opportunities for the PHCP to improve public health. In this model, the PHCP would host and maintain a common decision support tool and appropriate notifiable condition triggers that electronic health records and laboratories can use to identify cases to report to public health agencies. This would limit the need to maintain multiple code and rule sets and establish a trusted authority for the vendor community. The PHCP would also provide message routing to appropriate public health authorities to initiate an investigation. The platform would also include a Web form repository for agencies to capture additional data elements through direct interaction with a clinical care team, providing one point of interaction for health care and decreasing the need for each public health jurisdiction to maintain its own infrastructure for common needs. These shared services would make case reporting more timely and complete, allow public health authorities to make better decisions, and drive clinical care and population health improvements through sharing these data through the LHS.
The PHCP is a work in progress that represents a significant change in practice. In the coming 2 years, the PHCP team will work with the Executive Committee to build the technical components of the platform, test the system, and offer services to users. Governmental public health must integrate with clinical partners to create a seamless system of clinical and population health to serve individuals, communities, and the nation. Building PHCP into a common, robust, and community-managed entity will lead to a more efficient use of resources and allow the entire public health enterprise to fully participate in the LHS. This is essential to fully function as a 21st-century public health enterprise.