Last week National Health IT Week was celebrated by a number of health associations, government officials and other community members. This effort, primarily sponsored by HIMSS, provides a national, and increasingly international forum on health IT and how it can be used to support better health outcomes. It’s a great week to reflect on past accomplishments, focus on current and future needs and celebrate some of the key national figures who have helped achieve specific goals. I have been privileged to support the effort over the years, first during my time at CMS and most recently as a member of the HIMSS Public Policy Committee. However, my focus for this blog is not on the events of the week but actually a policy priority that was highlighted during last week’s events — the desperate need to modernize the nation’s public health data systems. This is one health issue that has good bipartisan support and HIMSS, along with others in the public health community, are reaching out to the executive and legislative branches of government to support a major upgrade to the national public health surveillance infrastructure.
It’s a problem that’s all-to-familiar to those of us in the public policy arena. Aging, siloed systems at all levels of government, exacerbated by workforce skills shortages, are not able to provide the levels of support needed to effectively deal with the major public health challenges of the 21st century. Lack of sufficient and consistent funding streams, as well as fragmented ecosystem-wide strategic planning have helped create the current situation. The Centers for Disease Control (CDC) and local governments have been forced into reactive positions to deal with the crisis of the day (e.g., opioids, measles, vaping etc.) rather than being able to leverage enterprise-wide proactive approaches. The challenges of public health data systems are not new but they are getting worse and there is an increasing concern that a major epidemic could overwhelm the existing resources. Systems are not interoperable, even within the CDC itself, which causes and sustains manual processes and duplicate efforts. Delays in getting timely, accurate, and complete information surrounding an outbreak, along with the lack of real-time updates, can have deadly consequences.
HIMSS, working with the public health community and key lawmakers, has proposed a strategy to create a “21st Century Public Health Surveillance Highway” that will modernize and create an interoperable public health surveillance system across the national, state, and local levels. Part of this effort is also recruiting a skilled workforce to help manage, analyze, and action the data and systems. The HIMSS ask is for Congress to provide up to a $1 billion over ten years, with $100 million for FY20. This is a very tall order, but the House Appropriations Bill for HHS does include the initial $100 million to be used to begin the modernization work at CDC. It’s not clear whether there is sufficient support in the Senate to carry this effort forward, although the initiative has the support of key senators such as Senators Blumenthal and Murray.
I wholeheartedly support the HIMSS effort. I dealt with some of the issues around public health systems several times in my career, most notably when I headed up the government-wide E-Vital effort around modernizing the death reporting system. The national plan we came up with over 15 years ago, the Electronic Death Registration (EDR) System, still has not been fully implemented in all 50 states, largely because of the lack of funding. Limited funding has allowed the implementation of EDR in only 3-5 states per year. In the meantime, technology has evolved, and other conditions have changed. Lack of an overall strategic plan and no long-term sustained funding will continue the current piecemeal reactive efforts to deal with major public health crises.
One hundred years ago, just as the world was recovering from the impact of World War I, the US and other countries were overwhelmed by the Spanish flu epidemic. Far more American soldiers and others died from the flu than all of the WWI combat deaths. No one wants this type of outbreak to happen again. Unfortunately, at least from a public health perspective, the world today is much more intertwined than 100 years ago, and diseases can spread more rapidly. A modernized public health reporting system is critical to preventing disease spread and minimizing its effects. Here is more information on the HIMSS effort. We welcome your thoughts and support.