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ACMI Symposium Outlines Public Health Interoperability Strategies

Experts said the public health interoperability infrastructure requires sustained funding and a workforce with skills to meet 21st-century health threats.

At the 2022 American College of Medical Informatics (ACMI) symposium, experts discussed strategies to improve the public health interoperability infrastructure.

An article published in JAMIA highlights three overarching themes discussed at the symposium.

First, experts discussed the need for sustainable funding for public health information systems (PHIS) infrastructure. It is generally accepted that state, local, and county public health capabilities vary, and funding gaps remain. Shortcomings highlighted during the COVID-19 pandemic have increased awareness of the essential role of public health and the country's underinvestment in this area.

While there was an influx of funding directed to jurisdictions to boost COVID-19 preparedness, prevention, and response efforts, the authors said these funds cannot replace long-standing gaps in policy and funding needed to strengthen PHIS infrastructure. 

"Funds should be leveraged, but they must also be sustained over time, not categorically and only in reaction to acute needs, to create common, shared infrastructure that is disease agnostic and more suited towards all essential services as opposed to individual public health Use Cases," the authors wrote.

Symposium participants discussed the possibility of establishing a central Federal authority to govern public health informatics within the CDC.

This office could include staff with public health law expertise to review existing regulations. Further, the entity would contribute to removing technical and legal barriers to data systems interoperability while ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA).

The second overarching theme of the symposium focused on leveraging existing heterogenous infrastructure for data exchange through formal state designation of HIE/HDU partnerships.

"The discussed outcome would be to simplify cooperation with federal agencies and dramatically lower barriers to exchanges serving as vital components of national interoperability," the authors explained.

State or public-private regulatory commissions would oversee partnerships to support coordination with public health departments to enhance connectivity.  Participants discussed that funding and coordination from across the federal government could be leveraged for PHIS strengthening by framing HIE/HDU as critical for securing national health.

For instance, one participant suggested that we equate PHIS with national security in the same way that President Eisenhower argued that interstate highways were critical infrastructure that required the federal government's power.

Another central theme discussed throughout the symposium was the need to support a public health workforce skilled in informatics and data science to maintain advanced data ecosystems.

"This support can be accomplished by reskilling, upskilling, recruiting, and retaining a workforce with the skills to meet 21st-century health threats," the authors wrote. "However, public health has historically faced notable challenges in finding and recruiting sufficient incoming talent, in educating and training the current workforce, and in weathering the high turnover rates in state and local public health for other, higher-paying domains."

A recent ASTHO survey of the public health workforce found that few health departments employ informatics specialists who can utilize the power of advanced computing systems.

The authors suggested that public health practitioners do not have to depend on their workforce alone. When initiating public health reporting, the field can leverage best practices from the healthcare community and industry, like United States Core Data for Interoperability (USCDI) data standards.

Public health practitioners can also partner with informatics experts to develop open-source and application programming interfaces (APIs) that enable rapid adoption for more efficient access to data.

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