This guest post is presented by Maximus, sponsor of APHA’s Annual Meeting Blog. Its Center for Health Innovation offers programs and services to help governments improve public health infrastructure so that they can respond to population health needs and emerging public health threats.


Nomana Khan, MBBS, MPH, senior director of public health epidemiology at Maximus, shares ideas on the importance of a modern infrastructure for public health agencies.

The critical network comprising local public health agencies rests on a foundation of information systems that, although once cutting-edge, now show signs of aging. Two crucial elements of this infrastructure are immunization information systems and notifiable disease management systems.

Both are central to managing an array of vaccine-preventable diseases, from common maladies like chickenpox to formidable foes like COVID-19. Without the modernization of these systems, public health agencies will struggle to maintain their protection against widespread illnesses.

An old adage in public health declares that "all public health is local." This sentiment underscores the primary responsibility placed on local health departments in tracking immunization coverage and managing diagnosed cases to safeguard the health of all communities. Supported by state and federal agencies, public health departments collect data that gets submitted, aggregated and reviewed to determine the issue, the location, and the actions that need to be taken to protect the public’s health. It’s a process that needs to be accelerated.

The need for modernization
Despite advances in immunization information and disease management systems, public health departments rely too heavily on outdated methods like fax and phone calls, which hinders information sharing and affects the quality and validity of reporting. What’s needed is a seamless infrastructure with cloud computing, interoperable systems, and robust security measures for capturing and processing data, and analytics to quickly and safely identify what’s trending. A modern IT infrastructure will help public health agencies overcome current challenges associated with:

• Integration — Today’s legacy systems have varying data structures and standards that consume too much time and scarce expertise for data exchange, which delays the discovery of key findings.

• Data privacy and security — Compliance with regulations like HIPAA must be maintained, placing data security as a high priority.

• Resource constraints — Public health departments often lack funds, personnel or expertise for data projects.

• Fragmented legacy systems — Over time, additions to many systems have created silos, requiring substantial investment just to maintain their current operational state.

• Policy and governance misalignment — Disparate governance structures, standards and funding streams complicate meaningful modernization.

What needs to happen next?
Public health needs will increase along with expected growth in the population, so it’s time to address these challenges head-on. Critical strategies include standardizing data formats, using application programming interfaces for data exchange and ensuring data privacy.

At Maximus Public Health, we remain committed to supporting public health departments in these efforts. However, the onus doesn’t fall solely on one entity or sector. It demands a collaborative, multifaceted approach that aligns with overarching objectives like building the right foundation, using data for action, growing partnerships and managing change.

Just as the nation has nearly eradicated once-prevalent diseases such as rubella, tetanus and diphtheria with vaccines, it can confront the manifold challenges of modernizing public health infrastructure. This is a clarion call for data-driven, resilient and future-ready systems. Knowing the need creates the starting point for government and industry to achieve an environment with the necessary technology for improving public health.

Imperatives for immediate action
Here are three considerations that will keep public health agencies on track for efficient operations:

• Accelerate the transition to electronic reporting — The public health sector must jettison archaic paper-based and telephonic reporting. A unified rollout of electronic lab reports and electronic case reports is non-negotiable. This digitization will not only inject speed into data dissemination but will also mitigate errors and improve record keeping processes.

• Commit to comprehensive infrastructure modernization — IT modernization requires orchestrating a vision as well as deploying technology. Local and federal governments can deepen their partnerships and pool resources to overhaul immunization information systems and disease management systems. They can develop a modernization blueprint that cultivates a high-skilled workforce and strategically allocates funds for software and hardware enhancements. Ulitmately, they can work to achieve effective data utilization, valuable partnerships and robust data governance.

• Promote interoperability and cross-jurisdictional data sharing — The compartmentalization of critical health data across disjointed systems is a grave liability. We need a unified strategy to develop interoperable databases and communication protocols. This is especially crucial when considering the intricacies of data sharing across state lines and the evolving nature of public health threats.

Let these action points serve as a foundational framework for constructing a resilient, agile and citizen-centric public health system. With the right investments, coordinated efforts and a commitment to ongoing modernization, the nation can transform these systems into responsive, reliable pillars that support public health needs both for the moment and the challenges ahead.

Photo courtesy Maximus.