In May 2022 Executives for Health Innovation (EHI) released a new report, Creating a Modern Public Health System, generated by its Public Health Modernization Task Force. The brief, but succinct, report seemed largely to be a response to a HIMSS21 conference presentation by Dr. Micky Trepathi, the current National Coordinator for Health Information Technology. Dr. Trepathi described the inconsistencies and fragmentation of core public health systems used by state, territorial, local, and tribal (STLT) public health agencies. He then pointed out that not only has the US not made the same investments in these systems as it has in electronic health records (EHR), but that the Centers for Disease Control and Prevention (CDC) which funds most STLT public health initiatives has little authority over what systems are deployed outside of the Federal government.
The report goes on to describe what the public health system should look like, including more timely and automated submission of data, better alignment of Federal and STLT policies, health equity, and better collaboration across stakeholder groups. The policy recommendations include support for the emerging TEFCA implementation, a stronger tie between Federal funding and more stringent systems requirements, better coordination between health services and other social services, and better education and advocacy from the Federal government precisely because of inconsistencies at the STLT levels. The report goes on to conclude that Federal certification of public health systems may be one result of the current fragmented state of affairs (for a good example of this see the American Immunization Registry Association Measurement & Improvement initiative).
While the most notable thing about the EHI Public Health Modernization Task Force is the utter lack of public health representation among its members, its conclusions are not unreasonable. While we have not yet seen a “post pandemic commission” examining the successes and failures of the US response, clearly Congress and many citizens are not pleased with the way public health response to COVID-19 was conducted. The CDC Data Modernization Initiative (DMI) is poised to make significant investments in both Federal and STLT infrastructure and workforce to better prepare the country for future large-scale public health emergencies. But a push for more Federal oversight and control may be met with resistance from those who believe the Federal government already interferes too much in local affairs, and lacks the authority to demand that STLT agencies implement systems or operations in a particular manner.
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