Needs of State and Local Public Health Partners

Letitia Dzirasa (Baltimore City Health Commissioner), Gillian Haney (Massachusetts Department of Public Health), & Jen Layden (Chicago Department of Public Health)


State and local health departments need information very quickly, typically within 24 hours, so they can act on it. Federal stakeholders, in contrast, need data at more aggregated levels. The COVID-19 pandemic has proven that a general investment in modernizing public health IT infrastructure is needed, particularly at the state and local level. Without investing in scalable approaches, based on modern web standards, public health will continue to suffer from lags and incomplete data. Additional resources and manpower will be needed to use data robustly in real-time.

Key Takeaways

The Needs of Public Health Organizations at the State and Local Level are Distinct from the Needs at The National Level

Across public health, there are multiple levels of information sharing from the state and local level up to the federal level. At the state and local level, there is a particular interest in understanding the social determinants of health and how they can be linked to both individual and population health outcomes for the residents served. These data can help make the case for why the health department is performing a particular intervention for a particular population and also help ensure that the health department is not providing duplicative services. During infectious disease and other time-sensitive outbreaks, state and local health departments need information very quickly, typically within 24 hours, so they can act on it promptly. They need detailed, patient-level data so they can better understand the populations affected and the burden of disease so that they can conduct case investigations and implement proper prevention and control measures. Federal stakeholders, in contrast, typically need data at more aggregate levels.

One panelist added that sometimes public health gets stuck in the “disease du jour” versus thinking through more generic capabilities that could help provide enough information to point decisionmakers in one direction or another. She added, “helping us know what we don’t have to pursue would allow us to prioritize the information that’s coming in.”

During COVID-19, detailed laboratory data are a common need at the state and local level. The initial case notifications are very lab-based; however, basic demographic information doesn’t typically flow from the ordering EHR to the laboratory information system. Consequently, necessary data elements needed to help initiate a case investigation are missing when the labs report their results to public health. This hinders public health’s ability to respond in real time.

Public Health Needs Modern Data Capabilities that are Flexible, Dynamic, and Can Work Seamlessly with Systems Used in Healthcare Settings

It has been a challenge for state and local public health partners to balance their needs with the needs of national requestors, such as CDC. The systems that are currently in place at the state and local level could not easily extract the information that is requested to be reported up the chain, especially information contained in clinical text. It is extremely time consuming for state and local public health departments to manage the massive amounts of laboratory data that are being reported to them during the COVID-19 pandemic. It is not easy to ingest the line-level data, and it has been burdensome for state and local partners to report the line-level data to the federal level.

The panelists agreed that a flexible mechanism is needed whereby multiple organizations can submit various types of data to accommodate various levels of information sharing. They also agreed that standardization could help, especially in terms of exchanging data more seamlessly with one another and with both federal as well as health system partners. Ideally, this data exchange mechanism would scale up and scale down nimbly, particularly when it is no longer prudent to collect certain data elements and send them up the chain.

Intelligence Derived from Public Health Data can be Useful to Clinical Care

The panelists agreed that bi-directional information exchange between public health and healthcare is important, particularly for data elements that directly impact clinical care, such as vaccination history or key laboratory data. Additionally, linking to data held in public health registries or deriving intelligence from data captured in public health surveillance systems can help provide necessary context to help inform immediate decisions in clinical care settings. These types of bidirectional information exchanges would benefit from more user-friendly ways (such as CDS Hooks) to alert the clinician at the right time and in an effective manner to help support any immediate interventions that could be taken.

One panelist cited an example where a single patient presented at 10 emergency departments within a matter of 48 hours and was tested for COVID at least four times during that time period. Fortunately, the individual did not have COVID, but recognizing this pattern early on and altering health systems to take certain safety precautions could help to reduce costs, protect the public, and save lives.