Bolstering the nation’s public health infrastructure will be a cross-departmental effort in government, and the Office of the National Coordinator for Health Information Technology is carving out the role it will play related to data sharing.
Speaking at a virtual Health Affairs Policy Spotlight event on Thursday, ONC head Dr. Micky Tripathi said that the agency is working closely with the Centers for Disease Control and Prevention to break down the data silos that exist between clinical systems, administrative systems and public health systems.
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During the Covid-19 pandemic, for example, state and local public health entities had challenges sharing information with both the CDC and each other across jurisdictions, Tripathi said.
There are several ways in which the ONC can help further integration, starting with the Trusted Exchange Framework and Common Agreement, or TEFCA. Released in 2019, TEFCA aims to provide a nationwide governance framework for interoperability. One of the goals the ONC has with TEFCA is to enable not only providers to share information with each other, but also have public health agencies be a direct participant in that network, Tripathi said.
“[We want to remove] silos and independent pipes for public health, [so that] they are a part of the general information-sharing infrastructure that is already up and running,” he said.
To include public health agencies in that infrastructure, there will need to be better data standardization.
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For example, the pandemic made clear that laboratory data standardization is severely lacking across the country, Tripathi said.
“The CDC had identified two very specific lab codes that labs were supposed to use for Covid tests,” he said. “And what got reported by a number of organizations was that public health systems were receiving 200 different types of lab codes representing Covid because there was no monitoring, no enforcement.”
Another area that needs to see improvement for true data integration is patient matching.
During the pandemic, public health agencies would receive case reports from hospitals and a separate feed of electronic lab results, Tripathi said. But there was not enough demographic information — and nor is there a nationwide patient identifier — to match the data with certainty.
To help improve data standardization and patient matching, the ONC is working with the CDC to extend the United States Core Data for Interoperability, or USCDI, to directly apply to public health entities.
The USCDI is a set of standards that EHRs must follow when displaying certain data sets. Extending these standards to public health entities would allow for greater standardization of data and interoperability with provider and lab systems, Tripathi said.
At the moment, there is a renewed focus on public health and resources are being poured into enhancing its infrastructure, which will help government agencies achieve their goals. But Tripathi believes there needs to be a more consistent approach.
“[There is] a historic pattern of feast or famine that as a country we’ve had with public health,” he said. “After crises we tend to inject a whole bunch of money, and then that money starts to fall away, and then there are long periods of time in between crises where we underinvest in public health systems.”
“And that presents a challenge for making a rational, sustained investment to create the kind of public health information system that everyone living in the United States deserves,” he added.
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