Group calls for modernizing public health IT infrastructure

A workgroup of the American Health Information Community has recommended a series of steps to modernize the country’s public health infrastructure.

AHIC’s chairman, Health and Human Services Department Secretary Mike Leavitt, called the recommendations “very big thinking” and said some would take acts of Congress to accomplish. But he applauded them and said HHS would start developing budgets and timetables to get the modernization under way.

Despite spending in recent years to equip public health departments at the state and local levels with new systems, the spending has continued to be targeted for specific purposes such as HIV surveillance or food-borne illness reporting, the workgroup said in a report to Leavitt.

The resulting siloed systems cannot communicate with one another within a jurisdiction or with their peers in other jurisdictions, the workgroup said. It called for interoperability, security and functionality standards to ensure that spending results in a more robust and flexible infrastructure.

When HHS agencies award grants for new systems development, it said, the grant-making agencies should insist that the new systems adhere to the standards.

Public health authorities are hampered by a lack of information technology expertise within their domain, the letter states, and more money should be spent on workforce development.

The workgroup also recommended that the Centers for Disease Control and Prevention lead an effort to upgrade outbreak management systems for use in the event of a public health emergency. The result should be a nationally interoperable network of systems, it said.

It called for more harmonization of laboratory systems and an integrated approach to reporting veterinary, environmental, public health and other lab results that would help in responding to a public health emergency. In the current environment, considerable manual processing is required to get a complete picture of the relationship among various kinds of lab data and other public health systems.

The national identification system for health care providers, now being implemented, should be enhanced to provide a single number for each practitioner and other medical-service providers to aid in the routing of data and make it easier to relate lab results to a specific location or office.

The workgroup also said supply chains for medical supplies and countermeasures such as vaccines should share more data with one another and with national authorities during emergencies. “By June 2008, HHS should facilitate development of national administrative or legal approaches for routine and emergency interstate data exchange of countermeasure and immunization information,” the letter states.

Dr. John Lumpkin, who heads the health care group at the Robert Wood Johnson Foundation and is a co-chairman of the workgroup, said the drug industry’s supply chain “is a system that is vital to the security of our nation.”

The workgroup also called for using data from existing registries such as those of patients with particular diseases or those with immunizations during emergencies.

Although systems exist to handle some of the functions the workgroup outlined, Lumpkin said many of the systems were developed locally using PC software such as Access or Excel. “They just don’t scale” to the level where they would handle the loads during a major public health incident, he said.

Dr. Julie Gerberding, CDC director and the other co-chairwoman of the workgroup, said modernization would not happen very soon because of the effort and money required. But she said using existing funds more wisely would help.

“This is a very large project,” Leavitt agreed. “But it’s the right project.”

AHIC, Leavitt’s high-level health IT advisory panel, will consider acting on the recommendations at a future meeting, he said.

About the Author

Nancy Ferris is senior editor of Government Health IT.

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