The Office of the National Coordinator for Health IT has been leading federal efforts in making electronic health records more interoperable to advance better health information exchange, set U.S. Core Data Interoperability standards and more. While clinical care interoperability has made leaps and bounds, public health systems are trying to get ahead too.
Public health systems across states and localities collect data in different ways and have different system infrastructure, making federal collection and aggregation of national-level public health data difficult. When COVID-19 emerged, the siloed nature of public health data in the U.S. became a challenge for agencies like the Centers for Disease Control and Prevention.
The CDC launched its Data Modernization Initiative in 2020 to help the national public health system modernize and rise to the level of interoperability that the rest of the U.S. health care industry is moving toward. Now, working alongside ONC, CDC hopes to modernize core data and surveillance infrastructure across the federal and state public health space to streamline data collection and use.
CDC Deputy Director for Public Health Science and Surveillance Dr. Daniel Jernigan and National Coordinator for Health IT Micky Tripathi presented their efforts in the partnership to improve public health data interoperability and modernization during the HIMSS conference in Orlando, Florida, Tuesday.
Jernigan shared that DMI — an overall $30 billion initiative — has five main priorities driving an ultimate goal of getting to better, faster, actionable intelligence for better decision-making across public health. These are to:
- Build the right foundation and focus on getting automated data into state health departments and public health systems
- Accelerate data into action
- Develop a state-of-the-art workforce to leverage public health data
- Support and extend partnerships
- Manage change and governance
CDC is zoning in particularly on the first priority. In fiscal year 2022, CDC is spending 50% of its data modernization funding on building out the infrastructural foundation and automated real-time data collection.
“That’s us working to get vital statistics information in line lost approaches, using new standards. Immunization data coming in in different ways,” Jernigan said. “Second is getting the cloud-based services. It’s easy. We’re actually migrated to the cloud. We’ve had a number of different cloud contracts and forays into that, but we now have a focused approach to doing that. We’re also supporting states to be able to migrate to the cloud.”
Jernigan said that throughout this process, he wants to give CDC programs a shared environment using shared tools, helping them migrate their systems to the new environment and reducing standalone silos.
With the right foundation in place, Jernigan envisions actionable capabilities improving, such as electronic case reporting, advanced data pipelines to inform decision-making and streamlined electronic lab data from health departments to CDC.
CDC is investing in keeping its workforce up to speed, investing $3 million over the next five ears to ensure the workforce across states, localities, territories and tribes can upskill and hire new personnel. To manage change and governance, CDC is also adjusting change management and procurement processes to allow the modernization initiative to accelerate faster.
While CDC is pursuing its own DMI plans, it is also leveraging the data interoperability foundation that ONC has been developing. Tripathi emphasized four areas across ONC’s scope of work that will uplift the public health data modernization that CDC has set.
For one, ONC and CDC launched in November 2021 a FHIR Accelerator with HL7. The effort, called Helios, aims to rapidly design, test and scale FHIR-based solutions for high-priority public health use cases. Helios follows groundwork ONC has set to make HL7 FHIR application program interfaces a standard to enable efficient and fast health data exchange. Helios will bring this groundwork to the public health level, aiding CDC in its pursuit of interoperable data capabilities in public health.
Last year ONC also launched a new effort under its U.S. Core Data for Interoperability, USCDI+, to expand on data standards required for ONC-certified EHRs to support specific data standard needs across federal agencies like CDC.
“One of our USCDI initiatives, we’re working with the CDC and [state, local, and territorial] partners to say, ‘How can we have the USCDI be the core of what we would think of as a nationwide public health data model?’” Tripathi said. “Let’s try to use USCDI as the basis and extend from that.”
USCDI+ will align data sets, standards and implementation specifications with similar efforts across public health, such as CDC’s DMI, to adopt greater national public health data standards, while also supporting advancement of EHR certification.
Tripathi added that the Trusted Exchange Framework and Common Agreement (TEFCA) — which ONC stood up in January as a common set of terms to support national exchange of health information — will also help CDC realize public health data interoperability. He said that ONC is working with public health stakeholders to build standard operating procedures and implementation guides for public health use cases in TEFCA. This will involve developing use cases and requirements for integration of health care delivery and public health systems.
Finally, ONC is assisting CDC and the public health community with infrastructure approaches to ease burden and increase efficacy of public health data systems and applications. This effort, called the North Star Architecture, is a cloud-based service model that integrates shared data repositories and applications, hosted STLT infrastructure and collaborative governance — components that compliment the CDC’s work to establish a new data modernization foundation.