Public health IT still getting the short end of the stick

From the inception of the government's health IT program in 2004, one of its major goals has been to increase the country's emergency preparedness and the ability of public health agencies to monitor incipient epidemics. But this is one area where the reality has fallen far short of the vision.

The good news is that the Department of Health and Human Services has finally allocated $137 million for public health infrastructure, including new technology and staff training, as part of an overall investment of $750 million for disease prevention efforts.

But this overdue move follows years of federal and state neglect of public health agencies' IT capabilities. In fact, according to the Government Accountability Office, HHS still hasn't developed a strategic plan to build a national electronic network for public health emergencies, four years after Congress ordered it to do so.

Meanwhile, U.S. emergency preparedness programs have serious gaps in a number of areas, including infrastructure, a recent Robert Wood Johnson Foundation report found. Among other things, the report noted that seven state health departments can't transmit electronic health information to healthcare providers and community centers, and 10 state public health agencies don't even have an electronic syndromic surveillance system.

Then there's the curious case of public health's role in meaningful use. In the draft version of the meaningful use rules, physicians would have had to send syndromic surveillance data to public health agencies. That was demoted to an optional menu item in the final rule. Then, last fall, the Office of the National Coordinator for Health IT (ONC) discovered that the EHR specifications for transmitting data to public health departments were erroneous. So ONC rescinded those specs, leaving software developers in limbo.

Currently, most providers don't have a mechanism for interchanging data with public health departments unless they happen to participate in a community health data exchange or an enterprise HIE that uses certain kinds of middleware. But that might be changing with the advent of the Direct Project, which has enabled Hennepin County Medical Center in Minneapolis, for instance, to send vaccination records to the Minnesota Health Department.

Disease prevention and emergency preparedness cannot be left solely to individual healthcare systems, or even accountable care organizations. Achieving these objectives requires a high degree of coordination at the state and federal levels. Moreover, the Centers for Disease Control and Prevention (CDC) can't do its job properly unless it receives adequate input from the states. As EHRs become widespread--and as they begin to interoperate through HIEs--let's give public health IT the attention it deserves. - Ken

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