Back in 2004, when President George W. Bush launched the federal health IT initiative that has now morphed into Meaningful Use, it was clear that the terrorist attacks of Sept. 11, 2001, served as a major driver of the program. The National Health Information Network (NHIN) was conceived partly as a way to improve access to healthcare information across the country in the event of a bio-terrorist attack. And the "strategic framework" of David Brailer, the first National Coordinator for Health IT, included a major role for population health management, including the unification of "public health surveillance architectures."
But the public health agencies of the country, which would be the focal points in a national emergency, have received short shrift in terms of health IT funding. The HITECH Act provides up to $27 billion to incentivize hospitals and eligible professionals to show Meaningful Use of electronic health records. The legislation also allocates substantial sums to HIT regional extension centers, health information exchanges, community college training programs, Beacon Communities and Strategic Health IT Advanced Research Projects (SHARP). The parties that get the short end of the stick are public health agencies.
Ironically, the Stage 1 criteria for Meaningful Use includes an optional-menu requirement to send "electronic syndromic surveillance data" to public health agencies. Specifically, providers must perform at least one test of data submission and follow-up submission. But the ability of public health agencies and state health departments to receive such data is spotty at best.
All of this is an old story. The government has always underfunded research on prevention and health promotion. For example, in 2000, the Agency for Healthcare Research and Quality received $5 million to study how to improve links between the healthcare delivery system and public health agencies in case of national emergencies. The program continued at more or less the same funding level until this year, when it was stopped.
To be sure, Washington has begun work on expanding links between providers and public health agencies with help from the private sector. Last winter, the Centers for Disease Control and Prevention provided a grant to Surescripts, the American Hospital Association, and the American College of Pathologists to link hospital laboratories with public health agencies so that the labs can electronically transmit reportable test results.
Nevertheless, at a time when state and local governments are as financially pinched as they have been in decades, it is absurd to think that most of them will fund a major expansion of their public health IT infrastructures. That money must come from the federal government. And, whatever the outcome of the current battle over the budget deficit, any national health IT campaign that truly aims to bring the benefits of information technology to the public must pay attention to public health. - Ken