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Highlights

A catastrophic public health event could threaten our national security and cause hundreds of thousands of casualties. Recognizing the need for efficient sharing of real-time information to help prevent devastating consequences of public health emergencies, Congress included in the Pandemic and All-Hazards Preparedness Act in December 2006 a mandate for the Secretary of the Department of Health and Human Services (HHS), in collaboration with state, local, and tribal public health officials, to develop and deliver to Congress a strategic plan for the establishment and evaluation of an electronic nationwide public health situational awareness capability. Pursuant to requirements of the act, GAO reviewed HHS's plans for and status of efforts to implement these capabilities, described collaborative efforts to establish a network, and determined grants authorized by the act and awarded to public health entities. GAO assessed relevant strategic planning documents and interviewed HHS officials and public health stakeholders.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services To address the requirements of PAHPA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to immediately lead efforts, in collaboration with other federal, state, local, and tribal public health officials, to develop and implement an overall strategic plan for establishing and evaluating an electronic network of systems that meets the information-sharing requirements for enhanced nationwide public health situational awareness defined by the act. The strategy should define specific goals, objectives, priorities, and activities for establishing the network.
Closed - Implemented
In commenting on the report, the Department of Health and Human Services Assistant Secretary for Legislation neither agreed nor disagreed with our recommendations. Nonetheless, in December 2014, HHS issued the National Health Security Strategy and Implementation Plan 2015-2018 which identifies objectives, priorities, and activities for establishing an electronic nationwide public health situational awareness network to share real-time information to help prevent devastating consequences of public health emergencies. For example, the plan identifies the establishment of a network that provides near real-time information on the status of the population's health, as a key component of its objective to ensure comprehensive health situational awareness. Additionally, the implementation plan prioritizes activities for establishing this network, such as addressing technology and policy challenges to ensure the compatibility of systems to collect, integrate, and share data. It also identifies activities to undertake in order to achieve these objectives, such as standardizing data elements and developing data-sharing agreements. By taking these steps, HHS has made important progress toward developing a coordinated strategic plan for establishing the nationwide public health situational awareness network mandated by the Pandemic and All-Hazards Preparedness Act.
Department of Health and Human Services To address the requirements of PAHPA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to immediately lead efforts, in collaboration with other federal, state, local, and tribal public health officials, to develop and implement an overall strategic plan for establishing and evaluating an electronic network of systems that meets the information-sharing requirements for enhanced nationwide public health situational awareness defined by the act. The strategy should identify steps and performance measures for evaluating capabilities of existing and planned information systems to establish the network.
Closed - Not Implemented
In commenting on the report, the Department of Health and Human Services Assistant Secretary for Legislation neither agreed nor disagreed with our recommendations. Nonetheless, in responding to this recommendation, department officials stated that the Biennial Implementation Plan for the National Health Security Strategy, issued in May 2012 and updated in December 2014, was to include a complete strategic plan for such a network. However, while the National Health Security Strategy and Implementation Plan 2015 - 2018 is intended to provide strategic direction for achieving national health security through 2018, it does not define performance measures necessary to evaluate the capabilities of existing and planned information systems. Furthermore, the department has not indicated that it intends to take actions to define such measures. Lacking a complete strategy and implementation plan that identifies and demonstrates measurable steps required by the Pandemic and All-Hazards Preparedness Act for establishing and evaluating network capabilities needed to enhance electronic information sharing, the department continues to fall short of meeting requirements stated in the law and cannot have reasonable assurance that the outcomes of its actions meet the goals and objectives for enhanced nationwide public health situational awareness.
Department of Health and Human Services To address the requirements of PAHPA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to immediately lead efforts, in collaboration with other federal, state, local, and tribal public health officials, to develop and implement an overall strategic plan for establishing and evaluating an electronic network of systems that meets the information-sharing requirements for enhanced nationwide public health situational awareness defined by the act. The strategy should integrate elements of related strategies to achieve unified electronic public health situational awareness capabilities defined by PAHPA.
Closed - Implemented
In commenting on the report, the Department of Health and Human Services Assistant Secretary for Legislation neither agreed nor disagreed with our recommendations. Nonetheless, in responding to this recommendation, HHS submitted to Congress the Public Health and Medical Situational Awareness Strategy in May 2014 and, in September 2015, an accompanying implementation plan. The strategy and implementation plan included key elements of related strategies and information technology initiatives within HHS that were identified in GAO's December 2010 report. For example, the strategy's implementation plan includes actions intended to address objectives of a key component of HHS's Office of the National Coordinator's (ONC) Health IT Strategy--the ONC Interoperability Roadmap. The strategy also references situational awareness needs emphasized by CDC's National Strategy for Biosurveillance, such as information sharing and private sector integration. By taking these steps, the agency is better positioned to identify opportunities for and further support sharing of information among public health entities on a nationwide basis and, thus, to reasonably assure that outcomes of its actions contribute to progress toward meeting the goals and objectives for enhanced nationwide public health situational awareness.

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