Strong Federal Leadership Needed to Modernize Public Health

“The United States lacks a national public health system capable of protecting and improving health, advancing health equity every day, and responding effectively to emergencies.”

That’s how the Commonwealth Fund Commission on a National Public Health System characterizes the nation’s failure to protect millions of Americans—not just from COVID-19 but also from chronic threats such as fatal overdoses, diabetes, and maternal mortality. The panel of health leaders and scholars, chaired by former Food and Drug Administration Commissioner Margaret Hamburg, released a series of detailed recommendations in June to help build “a robust and sustainable public health system.” They are worth reading.

Among the report’s recommendations, two are especially relevant to The Pew Charitable Trusts’ public health data improvement project: (1) The federal government must lead efforts to harmonize the way public health agencies collect, analyze, and use data and (2) public health and health care providers should share more data and insights with each other.

Fortunately, several efforts are underway to accomplish these goals within different parts of the U.S. Department of Health and Human Services (HHS). Among those:

ONC is improving data collection and sharing through standards development

Although the commission notes that the federal government cannot mandate the adoption of data-sharing standards, it does have tools to encourage their use. For example, the Office of the National Coordinator for Health Information Technology (ONC)—the federal agency that oversees technology such as electronic health record (EHR) systems—runs a health IT certification program that covers more than 800 products used by 97% of hospitals and more than 80% of doctor’s offices. ONC leverages that authority to require certified EHR systems to enable providers to easily share timely, standardized data with public health agencies. In too many instances, however, the products still perform inconsistently. Pew is researching policies that the office could enact to overcome these challenges.

ONC also has brought federal, state, and local health agencies together with businesses and academics to develop standards that ensure data is both shareable with and valuable to public health officials. One major initiative is known as the U.S. Core Data for Interoperability, a common set of information that all EHR systems must be able to share with each other. The office continually updates the set; last summer, it added information related to social determinants of health, sexual orientation, and gender identity, data points critical for identifying and reducing population-level inequities in care and outcomes. Another version, known as USCDI+, is further augmenting data-sharing standards to serve public health specifically.

CMS uses incentives to get health care providers to share data with public health

The Centers for Medicare and Medicaid Services (CMS) is also using its influence—Medicare and Medicaid spent more than $1.5 trillion in 2020—to improve data exchange between health care providers and public health entities. In November 2021, informed by comments from Pew and others, CMS finalized policies that will require health care providers who treat Medicare patients to share disease and immunization data with public health agencies. Although there is no requirement to contribute data for community-level disease tracking, known as syndromic surveillance, doctors who do so could see higher reimbursement rates under updated CMS rules. And in August 2022, the centers announced that hospitals can avoid cuts to Medicare payments if they take steps to share more data with public health agencies.

CDC is strengthening public health data infrastructure

Finally, the Centers for Disease Control and Prevention (CDC) is two years into its Data Modernization Initiative, which it describes as a “multiyear, billion-plus-dollar effort to create modern, integrated, and real-time public health data and surveillance.” Among the signs of progress, CDC reports that although only 187 health care facilities were using electronic case reporting before the pandemic, more than 13,000 do so today. That is allowing “many health care facilities to turn off their fax machines and send data to state, Tribal, local, and territorial (STLT) health departments more easily than ever before.”

Even though ONC, CMS, and CDC all operate within HHS, there is no single leader overseeing these initiatives. To remedy this, the commission urges Congress to establish a new undersecretary for public health. The report recommendations also call on lawmakers to invest about $8 billion to improve federal IT and public health infrastructure and $4.5 billion for STLT agencies to strengthen their own capabilities and build critical relationships with one another, health care providers, and the communities they serve.

There’s an old proverb: “The best time to plant a tree was 20 years ago; the second-best time is now.” EHRs were introduced just a few decades ago, and today health care providers have adopted them almost universally. Calls to invest in a 21st-century public health system are also decades old, but chronic underfunding has long stood in the way.

As America works to move past the COVID-19 pandemic, now is the time to encourage and support modernization. With the hard work and leadership of ONC, CMS, CDC, and myriad STLT agencies—and the guidance of entities such as the Commonwealth Fund Commission—public health can forge stronger partnerships with health care providers, overcome the obstacles that hinder data sharing, and achieve its ultimate mission—preventing deadly outbreaks, curbing chronic illnesses, and giving every American the opportunity to be as healthy as possible.

Kathy Talkington directs The Pew Charitable Trusts’ public health programs.