In its 2012 report on the current and future states of public health finance, the Institute of Medicine noted, with concern, the relative lack of capacity for practitioners and researchers alike to make comparisons between health department expenditures across the country. This is due in part to different accounting systems, service portfolios, and state- or agency-specific reporting requirements. The Institute of Medicine called for a uniform chart of accounts, perhaps building on existing efforts such as the Public Health Uniform National Data Systems (PHUND$). Shortly thereafter, a group was convened to work with public health practitioners and researchers to develop a uniform chart of accounts crosswalk. A year-long process was undertaken to create the crosswalk. This commentary discusses that process, challenges encountered along the way and provides a draft crosswalk in line with the Foundational Public Health Services model that, if used by health departments, could allow for meaningful comparisons between agencies.
State and local public health agencies collect and use surveillance data to identify outbreaks, track cases, investigate causes, and implement measures to protect the public’s health. We sought to better understand current practices at state and local public health agencies for collecting, managing, processing, reporting, and exchanging notifiable disease surveillance information. Over an 18-month period (January 2014-June 2015), we evaluated the process of data exchange between surveillance systems, reporting burdens, and challenges within three states (California, Idaho, and Massachusetts) that were using three different reporting systems. All three states use a combination of paper-based and electronic information systems for managing and exchanging data on reportable conditions within the state. The flow of data from local jurisdictions to the state health departments varies considerably. When state and local information systems are not interoperable, manual duplicative data entry and other workarounds are often required. The results of the assessment show the complexity of disease reporting at the state and local levels and the multiple systems, processes, and resources engaged in preparing, processing, and transmitting data that limit interoperability and decrease efficiency. Despite ongoing challenges, considerable progress has been made in implementation of electronic systems and as a result, efficiency has improved substantially in the last decade.
Public health is an information business. This maxim is most recently and dramatically evident in how all levels of the public health system require information to understand and respond to the COVID-19 pandemic. Furthermore, information is central to the fight against other public health threats and emergencies and to improving health equity.Unfortunately, public health suffers from the lack of a sufficiently funded, well-coordinated, and methodically organized approach to guiding, building, and maintaining the information systems it needs to accomplish multijurisdictional health challenges. As the COVID-19 pandemic painfully demonstrated, lack of timely and accurate information compounded the challenges and increased the difficulty of an effective public health system response. Furthermore, progress on health equity will require more complete, granular, multidomain (ie, justice, child welfare, transportation, etc), and timely data, thereby allowing for useful insights into both health and social determinants of health.In this column, we summarize the key findings and recommendations of a recent report from the Public Health Informatics Institute (PHII) supported by the Robert Wood Johnson Foundation designed to capture the present opportunity to strengthen the public health system in preparation for whatever the future may hold. 1 In addition, we add our own insights based on decades of experience in public health informatics and capacity building.
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