This winter I sat looking out the window at the fresh snow. I could see a squirrel scurrying from place to place digging up isolated buried nuts. After a while he stopped, either satisfied that he had enough nuts or giving up at the meager results of so much effort.
As I watched this squirrel's frantic behavior, it occurred to me that we are not that different from this squirrel. We have hidden our buried treasures of data in separate systems, built program by program, jurisdiction by jurisdiction. If we know where the data exist, it may not even be possible to link data sets across programs or jurisdictions to gain a complete picture. As a result, it can be exceedingly difficult to transform data into information and ultimately informed action.
Public health needs a common information platform—being called the Public Health Community Platform1—to bring the numerous information systems together in a state-of-the-art cloud-based system so that we can achieve the full potential of our data systems. Rather than our frequent refrain of “public health has the data,” we must transform to a place where all recognize that “public health has the answers.”
There are a number of converging influences at this time that compel us to rationalize our public health data and information systems. This is an opportunity we must capitalize on and not let go to waste. These influences include political factors, leadership interest, health transformation, integration of health care and public health, and necessary improvements to the efficiency and effectiveness of public health.2
Politically, in the Fiscal Year 2015 Omnibus Appropriations bill, Congress directed the Centers for Disease Control and Prevention (CDC) to streamline state reporting across all CDC systems. They too saw that multiple channels of reporting existed where similar but slightly different data sometimes had to be reported multiple times to different programs. This is a result of the manner in which we in public health have built our data systems—again program by program. It is influenced by the categorical funding public health receives, making systematic approaches across the public health enterprise challenging.
The CDC leadership is actively pursuing a strategy to streamline these systems. CDC's overarching goal for federally supported surveillance activities is to get the right information into the right hands at the right time.3 The CDC launched the CDC Surveillance Strategy in 2014.4 Further impetus has been added by the Council of State and Territorial Epidemiologists adopting a position statement calling for the CDC to develop and implement a common data structure, vocabulary, format, and electronic transmission process for receiving notifications from jurisdictions in the National Notifiable Diseases Surveillance System by the end of the Healthy People 2020 cycle. The Council of State and Territorial Epidemiologists states that “this ‘one message, one vocabulary, one portal' approach would enhance efficiency of workflow, thus reducing costs and improving surveillance data quality.”5
Health system transformation driven by the triple aim of improving the experience of care, improving the health of populations, and reducing per capita costs is driving us to rationalize our information systems. To meaningfully improve the health of our population, we must improve the integration (and differentiation) of public health and health care. Under Meaningful Use clinical electronic health records (EHRs) and appropriate public health information systems must become interoperable. Given the multiple EHR vendors and the scores of public health information systems, this is a daunting challenge. We in public health need a common platform for the EHRs to “plug into” and exchange data and, importantly, clinical decision support. Imagine if an obstetrician were notified during a prenatal visit that there was a pertussis outbreak in the community and advised that the patient did not have a pertussis vaccine in the immunization registry. Imagine how hard that will be to achieve with at least 62 different immunization registries and multiple different EHR systems in use.
We have already been informed by a national pharmacy system that it is struggling to report the vaccines it gives. Only one-fifth of the vaccines it reports electronically are accepted. Imagine what this means when you are reporting 50 million vaccines. A common platform could greatly improve the efficiency and effectiveness of our system and importantly the prevention of vaccine-preventable disease.
As we work to have electronic reporting of reportable conditions, we will face a similar problem of multiple variations across the jurisdictions and programs. This will be compounded if we do not streamline the notifiable condition reporting to the CDC.
The CDC leadership, the Association of State and Territorial Health Officials, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories, and numerous other organizations are committed to development of a Public Health Community Platform led, as the name implies, by the public health enterprise. Over the last 2 years, the Association of State and Territorial Health Officials, with CDC support, has been spearheading this effort and a representative public health governance group has been launched.
Political factors, leadership interest, health transformation, integration of health care and public health, and necessary improvements to the efficiency and effectiveness of public health have all converged, providing us with a unique opportunity to build a Public Health Community Platform. Make no mistake, this is not just a technical change. We will all need to adapt our work. Things won't be perfect at first, and each of us will need to make some compromises. We should start small and have an early success. The bells and whistles can be added later. Building a community platform is as essential an improvement to the public health enterprise as any other we face.
There is a saying we all know: the best time to plant a tree is 20 years ago. The second best is now. This is the time.
1. Jarris PE, Soper P, Gordon GS, Huang M, Rennick M. Shared technology infrastructure for the public health enterprise: the time is now. J Public Health Manage Pract. 2015;21(3):308–309.
3. Richards CL, Iademarco MF, Anderson TC. A new strategy for public health surveillance at CDC: improving national surveillance activities and outcomes. Public Health Rep. 2014;129:472–476.
5. Council of State and Territorial Epidemiologists. (2015). Position Statement 15-EB-01. Atlanta, GA: Council of State and Territorial Epidemiologists.