Information Technology

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

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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