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The
Public Health Data Problem |
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Authors:
Rasneet Kumar, Health
Informatics Manager, Tarrant County Public Health Tarrant County Public Health (TCPH) is a local health department (LHD) that serves approximately two million residents in north Texas. To put that in perspective, 98 percent of all LHDs serve populations of one million or less1. As one of the larger LHDs, we have a robust Epidemiology division focused primarily on outbreak response and disease prevention. In addition, TCPH provides immunization health services, refugee care, HIV and STD testing and treatment, preventative health care, family nutrition support, laboratory services, emergency preparedness planning, pool and restaurant inspections, and many additional services. With this expansive repertoire of public health services comes a mass of data, varying in type and format. Managing the volume of these data poses significant challenges, predominately, turning these data into actionable insights. Chronic underfunding of public health has left public health agencies (PHAs) working with outdated technology and with the inability to efficiently collect, analyze, exchange, and disseminate health information. This became apparent in 2020 when PHAs struggled to respond to the COVID-19 pandemic. In a world where technology can tell you what you are thinking before you think it, most PHAs were only equipped to fight the pandemic on paper, and TCPH was no exception. While the TCPH workforce produced a history-making response, the inadequate data infrastructure created challenges during every aspect of the response. Some key challenges include: Notifiable conditions such as COVID-19 are reported from health care providers to TCPH primarily via fax, prompting manual entry into the TCPH disease surveillance system, disease investigations and contact tracing, when applicable. Disease investigation data are then shared with the Texas Department of State Health Services (DSHS) by manual data entry into the state’s disease surveillance system. DSHS in turn shares those data with the Centers for Disease Control and Prevention (CDC). As the COVID-19 pandemic surged, TCPH was faced with tens of thousands of daily case reports to manually enter into two systems. Delays at every step in the process made efficient outbreak response and real-time situational awareness impossible at the local, state and national levels.
Prior to the pandemic,
public health information was generally shared through static reports
updated periodically. The pandemic created public demand for accurate,
real-time and near-real-time health information. The lack of technology
and resources to process, analyze and visualize data in real-time, posed a
major challenge.
Since the onslaught of the
COVID-19 pandemic, Tarrant County has made a significant investment in
Public Health Informatics and the department’s data infrastructure.
Informatics is the science of how to use data, information, and knowledge
to improve human health and the delivery of health care services. The TCPH Health Informatics program is dedicated to making it easier and faster to collect, store, share, visualize and interpret data for better public health decision making and action. Over the past two years, Informatics has worked with consultants to conduct a comprehensive assessment of the current data infrastructure across the department, develop a roadmap, and acquire the resources to implement and support modernization. Current efforts are on building the right foundation. We are replacing or enhancing systems to better meet the needs of modern public health practice and developing or procuring new systems where nothing existed before. We are also focusing on electronic data exchange within TCPH and with outside entities to replace manual processes and increase timeliness and accuracy. Simultaneously, we are working on accelerating data to action. By taking the data we collect and transforming it into actionable insights, we will enable better decision making, and more meaningful communication with our community. The goal is to enable an open data platform which allows stakeholders and the public to access curated dashboards and open datasets. Most importantly, we are working to develop a highly skilled workforce, not only within Informatics but across the department. Three years ago, informatics was a staff of four, and now we have 40 of the most talented, motivated and brilliant minds to support this initiative. Not only are we focused on upskilling the Informatics staff to better support our systems and data processes, but we are also focusing on training the entire TCPH workforce in utilizing new technologies and tools to become a more data savvy public health department. The public health data problem is systemic and needs funding changes and data modernization at all levels of public health. Not only do PHAs need increased funding, but the categorical way public health is funded also needs to be addressed. Funding is generally tied to the current emergency at hand which inhibits long term prevention and infrastructure planning. While Public Health professionals advocate for this change at the national level, locally, investment in Public Health Informatics, and technology are a start to modern public health practice guided by accurate and timely health information. ■ |
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