Assessing the status and prospects of state and local health department information technology infrastructure

Although public health departments routinely capture and manage data electronically and use the Internet and system-to-system interfaces to transfer information, they struggle to establish integrated approaches to capturing, managing, analyzing and sharing information across programs and jurisdictions. Public health officials face common challenges, including variation and ongoing evolution of public health activities, lack of training on informatics and process re-design, shrinking funding and constraints that limit strategic investment and encourage data “silos”. Most agree that, in the future, public health practice will require an integrated approach to managing information and collaboration with health-care providers and other partners. The Patient Protection and Affordable Care Act (ACA), the Health Information Technical for Economic and Clinical Health Act (HITECH) and advances in health informatics bring opportunities while revealing important gaps and posing new challenges. HITECH motivates electronic reporting but does not emphasize the IT needs of public health practice. The ACA emphasizes population health goals but does not define a role for public health. Informatics projects break new ground, but have not yet benefited most public health departments. Many stakeholders await more direction before acting on opportunities from ACA and HITECH. Discussions with dozens of public health leaders suggest that public health departments need access to sustained and flexible resources supporting capital investments, workforce training, business process analysis and implementation. By articulating a strategic framework for using IT, some public health departments are pursuing a path that reduces unnecessary redundancy and improves the quality and scope of information available for public health practitioners. For example, by capturing demographic data one time to support multiple services; aligning data from multiple administrative and programmatic sources to help address service needs or using health-care provider generated data, public health departments can increase efficiency and innovation. Developing an effective strategic framework requires knowledgeable leadership to identify relevant data sources, document public health practice, understand legacy systems, work with vendors and visualize how to improve functions through better information flow. A framework helps agencies address known priorities as funds become available rather than simply react to funding opportunities. Stakeholders uniformly believe that the federal government, national organizations and funders of all kinds can facilitate progress towards improved use of public health IT by endorsing and fostering integration, common standards and business processes and increased collaboration between health-care providers and agencies with public health responsibility at all levels.