Public health practice has benefited from health information systems much before the widespread use of the term “public health informatics” (PHI). Claiming its leadership in highlighting and disseminating evidence for public health practice, the Journal of Public Health Management and Practice (JPHMP) started recognizing the significance of PHI early on. From its very inception in 1995, the JPHMP seemed to have made PHI a central area of interest, evident from the title of the very first commentary in its volume 1, issue 1, “Six Principles of Public Health Information” by John R. Lumpkin. The subsequent 3 commentaries included in this very first issue covered topics in PHI such as “... framework for integrated public health information and practice,” “... integrated public health information system ...,” and “... centralized health care databases,” authored by leaders in informatics including Edward L. Baker and Garland Land. The term “informatics” was used in an original JPHMP article heading: “Beyond Informatics: An Electronic Community Infrastructure for Public Health” that year in volume 1, issue 4. In recognition that health departments (HDs) were preparing to be fully connected with an “information superhighway,” the author, Nancy Milo, highlighted the barriers and the value of informatics that would eventually lead to improvements in essential public health services, as well as the promotion of population health and health equity. The topic selection for the first volume of the JPHMP signified the visionary leadership of the founding editor, Dr Lloyd Novick, in intuiting that informatics was perhaps bound to be recognized as a foundational capability1 for public health practice a couple of decades later due to its benefits for population health through improved efficiencies in public health surveillance, assessment, and communication.
The JPHMP's focus on informatics continued throughout its publication years, with landmark publications in the first decade of its launch2–4 covering topics such as a national informatics agenda; issues and opportunities in PHI; and the potential of health informatics in improving and transforming public health. Beginning with volume 10, special issues on topics in informatics became a regular feature of the JPHMP. The first special issue on child health information systems, published in 2004, showcased 15 original articles and an editorial. With Dan Friedman as the lead guest editor, the entire issue 2 of volume 12 in 2006 was dedicated to “Web-based data query systems,” introducing the what, why, how, and who of this extremely important topic to the readers in public health practice and policy.
Since the inaugural issue of the JPHMP in 1995, the momentum toward the 21st-century modernization of the public health and health care system was mainly triggered by technological innovations that were largely anticipated to decrease costs, improve care coordination, and improve public health outcomes. In 2001, the Institute of Medicine released “Crossing the Quality Chasm: A New Health System for the 21st Century,” which foretold the vital role the Internet would play in creating a paradigm shift in public health and health care practice through electronic applications in administrative, clinical and financial transactions, and biomedical and health services research.5 In addition, several initiatives from the federal government sparked the state and local open data initiatives, a central aspect of the information age and the beginning of the transformation of public health management and practice. Diffusion of informatics was initially spurred by the Office of Management and Budget's Government Paperwork Elimination Act of 1998 that mandated electronic data transactions and management with federal agencies, by October 21, 2003, to allow individuals or entities that deal with government agencies the option to submit information, transact with the agency, and maintain records electronically.6 The American Recovery and Reinvestment Act of 2009, which was the seminal catalyst of the age, infused the health care system with billions of dollars supporting the adoption of electronic health records and health IT, including secure health information exchange, open data, big data, and an emphasis on population health research.7
The resulting consequences of these national health transformation measures have challenged the public health community to consider opportunities for integration with health care and to look beyond traditional practice models, as discussed in the JPHMP's November 2016 special issue on public health informatics (volume 22, supplement). The special issue presented an inclusive collection of articles highlighting the current landscape of informatics needs and capacities of HDs. In their editorial for this issue, Gibson and colleagues8 argued that superior health informatics had the potential to facilitate partnerships, allow for greater accountability, and improve efficiency, eventually leading to improved health outcomes. The leading challenges were perceived to be health informatics capacity building for smaller, resource-poor HDs, leadership mobilization, and effective workforce training.
Governmental public health practitioners at all levels now have at hand an abundance of data and information to improve research, interventions, and health policy decision making. Yet, due to the lack of infrastructural capacity and resources for HDs, public health continues to struggle to modernize its information systems and to hire, train, and retain informatics staff to make the best use of the abundance of health data. Furthermore, state and local governments are challenged by fiscal austerity measures and expanding population health needs due to new demands arising from global climate shifts, health ramifications from natural disasters, the rise of resistant infectious diseases, and emerging threats such as the opioid epidemic.9 The imminent need to address these crises is intensified by a rapidly changing health care landscape. The push toward value-based care has challenged primary care to deal with population health issues such as health disparities, chronic disease prevention, and community health, thus initiating a renewed interest in public-private collaborations among the public health and private health care agencies.
Recommendations from the call to transition to “Public Health 3.0” urge the public health practice and management community to explore new pathways toward the evolution of a strong and adaptable public health system.10 DeSalvo and colleagues envision “vibrant, structured, cross-sector partnerships designed to develop and guide Public Health 3.0–style initiatives and to foster shared funding, services, governance, and collective action.”10 Moreover, this paradigm shift calls for rethinking the role of PHI, encouraging public health agency leadership to serve as “Chief Health Strategists,” a role that would work with public and private sectors “to enable more real-time and geographically granular data to be shared, linked, and synthesized to inform action in policy and practice.”10
The push toward Public Health 3.0 may be ideal, given recent shifts among state and local governments to leverage new technological innovations described as the Internet of things and the rising use of mobile health technologies, telehealth, interest in “smart cities,” and the use of artificial intelligence in governmental operations. Furthermore, recent legislative actions, such as the 21st Century Cures Act, provide some support to public health by supporting advancements in health IT infrastructure, including interoperability and limiting data blocking.11 These novel approaches have prompted state legislators, mayors, and county officials to reimagine how they could use technology to upgrade legacy systems and address complex issues contributing to health outcomes. Public health leaders and practitioners may also consider leveraging these opportunities to build and solidify a Public Health 3.0 infrastructure. Health department leaders will need to redefine their business processes to ensure that multisectoral collaborations, the use of data, and technological innovations are prioritized and aligned with “smart health” strategies.12
Overall, health informatics has become a priority skill set for governmental public health agencies. For 25 years, the JPHMP has covered the impacts of the drastic information and technological changes within the public health community. As we look into the future, we envision public health practice elevating to new levels through improved technical infrastructure, supported by a qualified PHI workforce. In turn, clinical and business intelligence will be enabled that will support public health surveillance by means of improved reporting and analysis capabilities. Data-driven decision making resulting from this enhanced analytical infrastructure will enable focused, intelligent strategies and informed assessments for public health. Recent investments in key initiatives, such as The Digital Bridge project, exemplify a bright future for PHI. The Digital Bridge initiative is serving as an “incubator” for projects enabling real-time data exchange between clinical care providers and public health practitioners.13 Electronic case reporting, designed to enable cross-jurisdiction sharing of notifiable condition reports, is a good example of such national public health information-sharing projects.13 Such initiatives are incentivizing advances in health information sharing, leading us into the Public Health 3.0 future.
1. Leider JP, Juliano C, Castrucci BC, et al. Practitioner perspectives on foundational capabilities. J Public Health Manag Pract. 2015;21(4):325–335.
2. Yasnoff W, OʼCarroll P, Koo D, Linkins R, Kilbourne E. Public health informatics: improving and transforming public health in the information age. J Public Health Manag Pract. 2000;6(6):67–75.
3. Kukafka R, OʼCarroll P, Gerberding J, et al. Issues and opportunities in public health informatics: a panel discussion. J Public Health Manag Pract. 2001;7(6):31–42.
4. Yasnoff W, Overhage M, Humphreys B, et al. A national agenda for public health informatics. J Public Health Manag Pract. 2001;7(6):1–21.
5. Committee on Quality Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
6. Office of Management and Budget. Implementation of the Government Paperwork Elimination Act. https://obamawhitehouse.archives.gov/omb/fedreg_gpea2/
. Accessed September 1, 2018.
7. The American Recovery and Reinvestment Act of 2009. H.R.1. http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h.r.00001
. Accessed September 1, 2018.
8. Gibson J, Shah GH, Striechert L, Verchick L. Urgent challenges for local public health informatics. J Public Health Manag Pract. 2016;22(6):S6–S8.
9. Yasnoff W. The promise of public health informatics. J Public Health Manag Pract. 2001;7(6):iv–v.
10. DeSalvo K, Wang Y, Harris A, Auerbach J, Koo D, O'Carroll P. Public Health 3.0: a call to action for public health to meet the challenges of the 21st century. Prev Chronic Dis. 2017;14:170017.
11. The 21st Century Cures Act of 2016, Pub L No 114-255, 130 Stat. 1033.
12. Solanas A, Patsakis C, Conti M, et al. Smart health: a context-aware health paradigm within smart cities. IEEE Commun Mag. 2014;52(8):74–81.
13. Sharing data to improve clinical care and public health. https://www.digitalbridge.us
. Published 2016. Accessed August 24, 2018.