ONC, CDC Envision Public Health IT Infrastructure of the Future

CDC and ONC are collaborating on public health IT infrastructure and standards to promote interoperability after COVID-19 highlighted flaws in public health data exchange, ONC lead Micky Tripathi, MD, MPP, said in a press availability earlier this month.

In July, the HITECH Public Health Data Systems Task Force issued a report with 22 recommendations related to public health data systems infrastructure and standards.

Tripathi said that the agencies are still going through the recommendations.

“They're certainly enormously helpful and pretty expansive,” Tripathi said.

He noted that the agencies have pulled several recommendations as high priority elements.

First, he said that ONC and CDC are working together to discern what a public health infrastructure of the future might look like.

“Right now, there's a tremendous amount of heterogeneity across the jurisdictions,” Tripathi explained. “The constitution has the states in charge of public health, so you have jurisdictional challenges there.”

However, he noted that ONC may be able to create an infrastructure that would help streamline the collection of public health data to support greater interoperability.

“There still may be opportunities to think about more enterprise type approaches to architecture that will provide greater consistency in the way data is captured, the way data is stored, and the ability to share tools and analytics, but still preserves the opportunity to have individual control and local control of their data and applications by the jurisdiction,” Tripathi explained.

Tripathi also said that ONC is working with CDC to see how the Trusted Exchange Framework and Common Agreement (TEFCA) interoperability infrastructure could support public health data exchange.

Currently, public health agencies do not participate in national interoperability frameworks such as Carequality, CommonWell, or eHealth Exchange, Tripathi said.

TEFCA, which is expected to go live in the first quarter of 2022, could be a way for public health agencies to become direct participants in a nationwide interoperability network to support COVID-19 case reporting and prepare for future public health emergencies.

If public health agencies were integrated into a national interoperability framework, the agencies would  be able to gather clinical data more easily, instead of “standing on the sidelines trying to get clinical data at a time of national and global emergency, such as we've had and are still having this pandemic,” Tripathi noted.

“What we're hoping is that TEFCA can be a uniform floor of interoperability that applies to everyone,” he explained.

The ONC is also working with CDC on the development of a Fast Healthcare Interoperability Resources (FHIR) roadmap.

“We've been doing a lot of work pushing and promoting FHIR and making sure that it's available in the market as rapidly as possible,” Tripathi said.

“The CDC has some specific use cases that may lend themselves to FHIR-based approaches and FHIR-enabled technologies,” Tripathi said. “We're working with them on creating a FHIR roadmap for public health, and that could also be a part of a FHIR accelerator that we work on with HL7 as well.”

Tripathi concluded discussing the creation of a uniform public health data model.

Tripathi explained that the CDC and ONC are approaching this by expanding the US Core Data for Interoperability (USCDI), the minimum healthcare delivery system dataset required in certified EHR systems.