Information Technology: Federal Agencies Face Challenges in Implementing Initiatives to Improve Public Health Infrastructure

U.S. Government Accountability Office

Information Technology:

Federal Agencies Face Challenges in Implementing Initiatives to Improve Public Health Infrastructure

GAO-05-308: Published: Jun 10, 2005. Publicly Released: Jul 11, 2005.

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It has been almost 4 years since the anthrax events of October 2001 highlighted the weaknesses in our nation's public health infrastructure. Since that time, emerging infectious diseases have appeared--such as Severe Acute Respiratory Syndrome and human monkeypox--that have made our readiness for public health emergencies even more critical. Information technology (IT) is central to strengthening the public health infrastructure through the implementation of systems to aid in the detection, preparation for, and response to bioterrorism and other public health emergencies. Congress asked us to review the current status of major federal IT initiatives aimed at strengthening the ability of government at all levels to respond to public health emergencies. Specifically, our objectives were to assess the progress of major federal IT initiatives designed to strengthen the effectiveness of the public health infrastructure and describe the key IT challenges facing federal agencies responsible for improving the public health infrastructure.

Federal agencies have made progress on major public health IT initiatives, although significant work remains to be done. These initiatives include one broad initiative at CDC--the Public Health Information Network (PHIN) initiative--which is intended to provide the nation with integrated public health information systems to counter national civilian public health threats, and two major initiatives at the Department of Homeland Security (DHS), which are primarily focused on biosurveillance. CDC's broad PHIN initiative encompasses a number of applications and initiatives, which show varied progress. Currently, PHIN's basic communications systems are in place, but it is unclear when its surveillance systems and data exchange applications will become fully deployed. Further, the overall implementation of PHIN does not yet provide the desired functionality, and so some applications are not widely used by state and local public health officials. For example, CDC's BioSense application, which is aimed at detecting early signs of disease outbreaks, is available to state and local public health agencies, but according to the state and local officials with whom we spoke, it is not widely used, primarily because of limitations in the data it currently collects. DHS is also pursuing two major public health IT initiatives--the National Biosurveillance Integration System and the Biological Warning and Incident Characterization System (BWICS). Both of these initiatives are still in development. The BWICS initiative, in addition, is associated with three other programs, one of which--BioWatch--is operational. This early- warning environmental monitoring system was developed for detecting trace amounts of biological materials and has been deployed in over 30 locations across the United States. Until recently, its three IT components were not interoperable and required redundant data entry in order to communicate with each other. As federal agencies work with state and local public health agencies to improve the public health infrastructure, they face several challenges. First, the national health IT strategy and federal health architecture are still being developed; CDC and DHS will face challenges in integrating their public health IT initiatives into these ongoing efforts. Second, although federal efforts continue to promote the adoption of data standards, developing such standards and then implementing them are challenges for the health care community. Third, these initiatives involve the need to coordinate among federal, state, and local public health agencies, but establishing effective coordination among the large number of disparate agencies is a major undertaking. Finally, CDC and DHS face challenges in addressing specific weaknesses in IT planning and management that may hinder progress in developing and deploying public health IT initiatives. Until all these challenges are addressed, progress toward building a stronger public health infrastructure will be impeded, as will the ability to share essential information concerning public health emergencies and bioterrorism.

Recommendations for Executive Action

Status: Closed - Implemented

Comments: HHS has taken steps to improve the development and implementation of major public health IT initiatives. The department is aligning public health initiatives with its national strategy for health IT, the federal health architecture, and ongoing health IT initiatives, and has improved its efforts to coordinate with state and local public health agencies. As part of its strategy, HHS established a population health workgroup to bring together federal, state, and private sector entities to develop IT solutions for public health emergencies and other areas of concern. The workgroup is considering ongoing public health IT initiatives, such as components of the Centers' for Disease Control and Prevention CDC) Public Health Information Network (PHIN), as it develops requirements for public health IT solutions. The workgroup includes representatives from many of HHS's divisions, the departments of Veterans Affairs and Defense and other federal agencies, and state and local public health agencies. HHS also awarded contracts for security and privacy solutions relevant to the implementation of federal, state, and local health and public health IT and for addressing variations between the various federal and state laws and regulations. The outcomes of these contracts have resulted in initial steps to address and resolve these variations and to coordinate solutions. Additionally, the CDC has taken steps to more effectively consider input from state and local public health entities in its design and development of a major component of PHIN, a biosurveillance initiative called BioSense. HHS's inclusion of public health strategies within its overall strategy for health IT, the inclusion of state and local entities in it contracts to develop specific solutions for variations in federal, state, and local practices, and increased involvement of state and local public health entities in system design and development has increased the level of coordination between federal, state, and local public health IT initiative and could help improve the development and implementation of major public health IT initiatives.

Recommendation: In order to improve the development and implementation of major public health IT initiatives, the Secretary of Health and Human Services should ensure that the federal initiatives are (1) aligned with the national health IT strategy, the federal health achitechture, and ongoing public health IT initiatives and (2) coordinated with state and local public health initiatives.

Agency Affected: Department of Health and Human Services

Status: Closed - Implemented

Comments: HHS implemented this recommendation by taking steps to improve the exchange of clinical and public health data. Specifically, HHS awarded a contract for standards harmonization across the public and private health care sectors to a panel made up of public and private members. HHS charged the panel to select standards that satisfy requirements for improving the exchange of both clinical and public health data. To date, the panel has identified about 90 industry-accepted standards and is developing implementation guidance for data and communications standards to support interoperability throughout the health care industry, including the exchange of public health information. The implementation of the standards by the health care industry is encouraged by another HHS initiative which defined initial criteria and processes for certifying that certain electronic health information products meet these standards.

Recommendation: In order to improve the development and implementation of major public health IT initiatives, the Secretary of Health and Human Services should ensure federal actions to encourage the development, adoption, and implementation of health care data and communication standards across the health care industry to address interoperability challenges associated with the exchange of public health information.

Agency Affected: Department of Health and Human Services

Status: Closed - Implemented

Comments: HHS, through its Office of the National Coordinator for Health IT, awarded a contract for standards harmonization between the public and private health care sectors, including public health. In July 2006 the contractors selected 90 data and communications standards to address requirements defined by the American Health Information Community, which HHS Secretary Leavitt chairs. The requirements include

Recommendation: The Secretary of Homeland Security should align existing and planned DHS IT initiatives with other ongoing public health IT initiatives at the Department of Health and Human Services, including adoption of data and communications standards.

Agency Affected: Department of Homeland Security