Assessing the Future of Public Health Data Exchange, Interoperability

As COVID-19 continues to underscore the need for an enhanced health interoperability infrastructure, a panel of past health IT coordinators and the current ONC leader discussed the future of public health data exchange at HL7's 35th Annual Plenary.

Micky Tripathi, PhD, MPP, ONC national coordinator for health IT, noted that COVID-19 highlighted the need for an enhanced public health data interoperability infrastructure.

“We don't yet have ubiquitously available participation in nationwide networks for public health in the middle of a pandemic,” Tripathi said. “You have public health struggling to get access to Continuity of Care Document (CCD)-like information.”

Tripathi noted that the clinical ecosystem and the public health ecosystem are really parts of the same system, so public health should not be based on one-way static reporting mechanisms. Instead, there should be infrastructure that allows push and pull of data between clinical settings and public health agencies.

Public health falls under the jurisdiction of states. That’s a common refrain from the EHR vendor community, of often complain that the ONC EHR certification program and meaningful use program certify the “pitchers,” but not the “catchers,” Tripathi explained.

“EHR systems are certified to send out data in a certain way, and then they have to go through different negotiations with public health agencies on how they want to receive it,” he explained. “So now, suddenly you've undermined the certification and the pitchers that we have.”

However, Tripathi noted that ONC and CDC are looking for ways to make public health data exchange more standardized.

“The CDC is looking at is the possibility of saying we should consider certification of the systems that are deployed by those who receive CDC funds,” Tripathi said.

Don Rucker, MD, MBA, professor of clinical emergency medicine & biomedical informatics at the Ohio State University and former ONC National Coordinator, noted that the country needs to rethink public health data at a basic level.

“We need to rethink public health data just as a very fundamental construct,” Rucker said.

This involves shifting a mandated reporting mindset to a data reuse framework, he explained.

Mandated reporting to public health agencies could be eliminated through syndromic surveillance FHIR for state HIEs using machine learning, he suggested.

“That could be built out where it's not in the country for way less than we're spending on all of the current mandated reporting, which even at the CDC level, is hundreds of millions of dollars,” Rucker said. “That doesn't include all of the work that every provider has to do in reporting that's essentially purely duplicative.”

Rucker suggested that FHIR could be the “lingua franca of this type of work, because of its plasticity.”

Tripathi noted that while FHIR is not fully ready for public health use, it has use cases that are ready for experimentation and piloting.

Karen DeSalvo, MD, MPH, chief health officer at Google and former ONC National Coordinator, noted that as the industry begins to bolster the public health infrastructure, it should also tend to the “weakly resourced” social care infrastructure.

“The pandemic has helped people see a bigger view of the fact that there are a lot of drivers to health and that those systems that support those various drivers need to be able to communicate on behalf of consumers,” said Desalvo. “We're going to have to sort out a way to create an interoperability between public health and social care systems in particular.”

She emphasized the importance of data security as the industry moves toward greater interoperability of SDOH data.

“As we're moving into this next generation of adding more complexity to the data sources, some that fall outside of traditional HIPAA like social care information, it is incumbent on us to really step up the game and make sure that we have true informed consent and that we have an appreciation for how people can be educated about who is seeing their data and when.”