A Trip in the Time Machine

What information management capabilities will future US health departments need?  Shaun Grannis (Regenstrief Institute), Torney Smith (Spokane Regional Health Department), David Ross (Public Health Informatics Institute) and I were asked to gaze over the horizon during a 2012 Public Health Accreditation Board think tank.  Our work was recently published online-ahead-of-print by the American Journal of Public Health.

We looked first at potential changes in health department function suggested by the Patient Protection and Affordable Care Act (“ACA”).  Some argue that health departments might exit direct individual health services, as uninsured populations fall and Accountable Care Organizations rise.   Perhaps health departments will no longer need to track individual clients and services?  On the other hand, others have proposed expanded health department roles in community-based preventive services.  Billing for individual services like vaccination is becoming more important than ever for department revenues.   Millions will remain uninsured even after ACA implementation, health departments will continue to track cases of reportable illness and injury, and will remain accountable for transparent and up-to-date data on population health trends.  In balance we found arguments that most health departments could jettison the responsibility for collecting and protecting individual health information unconvincing.  It is likely that faster, better and safer information management is needed instead.

We also looked at projected technology changes.  Perhaps health departments won’t need to collect surveillance data when interconnected electronic health records might make such data searchable on demand?  The slow pace of interoperability initiatives, and the likely demand that health performance data be independent, transparent and accountable made us skeptical that simply “grazing on others’ data” will be meet all needs within several decades.  Meanwhile numerous other information sources, for example data recorded by citizens and sensors, will probably be added to the floods of data obtained from health care providers.

Inevitably, then, most health departments will be subject to a growing glut of electronic information like other health organizations.  Indeed, if they will fulfill their mandates and avoid shrinking into vestigial remnants, they must manage information and knowledge more competently than ever before.   The good news is that as connectivity, standardization and cloud capabilities improve, it will be easier for individual local and state health departments to lease shared information systems rather than manage them locally.  By collaborating on such shared systems they will be able to focus more on how they want to use information to protect and improve the public’s health, and less on managing hardware and software.   However, this vision depends on goal-oriented collaboration and planning between local, state and federal agencies.

Every public health department will need certain capabilities to navigate the course ahead, making these capabilities appropriate for consideration in the process of health department accreditation.  We hope our article and will initiate lively discussion on what such capabilities should look like.  What do you think?

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