When public health crises like communicable disease outbreaks or toxic chemical spills happen, state and local authorities have to work together to evaluate health risks and coordinate their response. A timely response to a crisis can mean the difference between life and death and can help curb rapidly growing health care costs as more individuals are affected. However, state and local public health departments face a range of barriers that slow down or impede efficient information sharing, including state laws that restrict data exchange, poor coordination between state and local departments, and poor adoption of technical standards for bi-directional data sharing. State policymakers and health officials should lead the way to improvement on some of these issues, and federal authorities should help fund interoperability efforts.
Some states have done a better job than others in facilitating data sharing. In South Carolina, state public health officials have developed a linking algorithm that enables querying across dozens of other agencies, which hold different kinds of data from localities across the state, including Medicaid claims, public health records, environmental information, and other relevant data. In New York, the Child Health Information Integration program collects and standardizes data on newborn screening, immunization, vital statistics, and other data sources and makes it available to local partners. In Maryland, the Montgomery County Department of Health and Human Services has developed a data sharing policy to integrate information from all clinics and medical programs countywide and make it available to individual providers.
Other states have had more difficulty sharing data. This can happen for a range of reasons including state privacy laws that restrict data exchange, poor coordination between jurisdictions, and a lack of state-level support for interoperability initiatives.
One of the major factors separating states with siloed public health systems from states with more integrated operations is state information privacy laws. Some states’ public health information privacy laws encourage data sharing, others do not explicitly prohibit it, and still others discourage it outright. Montana has a particularly clear pro-sharing policy, which provides that personally identifiable information may be transferred to (and between) state and local health departments for investigations into epidemic and communicable diseases without patient consent. Other states, such as Arkansas, Indiana, and West Virginia, do not even permit disclosures of personally identifiable information between state and local health departments for such purposes. These latter sorts of disclosure restrictions can profoundly hamper response efforts, because epidemics frequently do not conform to administrative boundaries and information from neighboring counties or states can be crucial in assessing the severity of an outbreak or planning a response. States policymakers should ensure that information privacy laws in their states permit data sharing for public health purposes so that health authorities can react quickly when outbreaks occur.
Another barrier to data sharing is poor coordination between local data users and state information system administrators. A 2014 study surveyed local health departments and found that local communicable disease staff had such trouble accessing certain kinds of state-provided data that each used at least one “shadow system,” a locally operated information system that existed solely to provide easy access to data the state provided through its own system. State public health authorities should fund new systems or updates to old systems that serve the needs of local partners in addition to the state’s needs. There are considerable positive externalities associated with bolstering the information technology that supports public health initiatives, so the federal government should also consider offering grants to state and local public health agencies to improve coordination between these jurisdictions.
Finally, the lack of standards in public health information systems offers a major roadblock to data sharing efforts. Some states have multiple incompatible systems at the local level. In Michigan, local departments conduct most patient services and then report to the state for surveillance and monitoring purposes. Although Michigan’s immunization registry and communicable disease reporting systems enable sharing between the state and local departments, other public health program areas remain siloed, meaning local agencies sometimes have to call or fax one another to view patient data from outside their jurisdictions. In Oregon, local departments are largely independent of the state health authority, receiving little funding, technical assistance, or oversight. As a result, local departments have developed their own information systems, which may report to the state but which are not interoperable with one another. In the short term, states can fix these problems by ensuring local systems within the state are interoperable. However, in the longer term it is crucial for states to work together, along with the U.S. Department of Health and Human Services, to develop national standards. For example, the National Association of County & City Health Officials and the Association of State and Territorial Health Officials could work together to adopt standards, such as those created by the nonprofit Public Health Data Standards Consortium. In addition to putting states on the right track to interoperability with their own localities, this could have the added benefit of making data interoperable across states.
Better state-local public health data exchange can come from many directions. State policymakers can make their citizens much safer with comprehensive, cross-jurisdictional public health data sharing efforts, and they should lead the way by making sure health data privacy laws support public health initiatives, funding interoperability efforts between state systems and their local partners, and working together to build nationwide standards for public health information exchange. The federal government should acknowledge the national benefits of strong state and local public health data systems and contribute funding to interoperability as well.