A High Altitude View of US Public Health Systems

The long-awaited second edition of Springer-Verlag’s Public Health Informatics and Information Systems was released this winter under the able editorship of JA Magnuson and Paul Fu.  I was privileged to write a chapter on US public health information systems, and took the perspective of a newcomer asking: “How did US systems come to be this way?”

That states perform surveillance, vital registration and other functions in divergent ways using non-interoperable systems is an artifact of an decentralized eighteenth-century constitution that delegated public health authority to state, not national government.   Today this lack of standardization is a source of aggravation in the face of increasing HIT interoperability driven by Meaningful Use and EHR certification.   The federal government has levers to increase standardization in public health just as it does in health care, including facilitating inter-state consensus, adopting industry standards, and making their use a condition of funding.  Inconsistency of priority, direction and funding over the past two decades has failed to deliver standardization now when it is most urgent.

Despite this, I was able to direct emerging informaticians to the products of several recent attempts to standardize public health business processes, vocabularies, and data formats across system domains as varied as chronic disease surveillance, immunization management, newborn screening, vital statistics and communicable disease surveillance.  I like to think there will be less “wheel re-invention” as a consequence.

On the other hand I was disappointed to see how few of these are reflected in the current CDC Public Health Information Network website.  PHIN ideally would provide “one source of truth” regarding standardized information exchange for health departments. If the website is any indication the plan to resuscitate national efforts for public health interoperability has stalled once more.   It would be wonderful if the textbook’s 3rd Edition could direct learners with confidence to a federal source for public health information exchange and interoperability specifications and profiles.

I’m delighted to see that my chapter is among those most often accessed online.  Nevertheless, I cannot help but hope that rapid progress in US public health information systems will push it quickly out of date!

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