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 respond to population health needs and emerging public health threats and improve public health infrastructure. 

The Maximus Public Health team conducted a comprehensive study of existing systems. Corinna Dan, RN, MPH, Maximus vice president, offers recommendations from the team for modernizing U.S. public health infrastructure over the next decade.

Immunization and disease surveillance systems play a critical role in helping public health and clinical professionals address vaccine-preventable diseases. The recent mpox epidemic and the ongoing COVID-19 pandemic have highlighted to the public the importance of public health systems, infrastructure and overall surveillance activities in detecting, responding to and mitigating diseases and conditions of public health significance. 

Data from these systems provide public health professionals with invaluable insights into disease transmission, trends and distribution, as well as aggregate data on vaccination that is essential for effective decision-making and program operations. Furthermore, accurate, representational and up-to-date data is crucial for better understanding the health of our communities, identifying vulnerable groups, making informed decisions and implementing fitting interventions, including working with communities with low vaccination rates and evaluating the real-world effectiveness of vaccines.

To modernize our public health infrastructure, the Maximus Public Health team has identified five strategic investments.

Establish a dynamic infrastructure
As we work with the public health community to create a robust public health data infrastructure, it is essential to understand the data ecosystem problems that have been highlighted repeatedly during the pandemic and recent infectious disease events. 

The current infrastructure was not built to handle the demand for high-volume data management or to quickly and efficiently expand to use new data sources, leading to the development of new systems during the pandemic. Such data overload resulted in several critical issues, including system malfunctioning, data stream aberrations, and delayed or inaccurate analysis and reporting. 

One successful solution is the Immunization Data Lake, a cloud-based repository of de-identified data of COVID-19 vaccination that integrates information from multiple sources, including local, state and federal agencies, as well as commercial pharmacies. 

This system allows for efficient data management, aggregate reporting and analysis, secure data sharing, and sets a strong example for future infrastructure development. To create a comprehensive and reliable data infrastructure, it will be crucial for health departments to adopt a similar approach to the IZ Data Lake in future systems.

Incorporate longitudinal data
The current public health data infrastructure often categorizes data in a fragmented manner, based on health care use, event or organization. This fragmented data requires cumbersome and time-consuming data-linking processes by data scientists. 

Adopting a person-centric, longitudinal approach has the potential to simplify the process, reducing wasted time and effort. This approach will also provide a big-picture understanding of health to public health decisionmakers without worries about inaccurate data matching, duplication and underreporting, enabling authorities to effectively target interventions.

Engage stakeholders at every step
The urgency of the COVID-19 pandemic accelerated the deployment of many services and infrastructure solutions, primarily to address the urgent need to manage pandemic response activities. While this speed was necessary, it was challenging for public health departments to implement and sustain these services or solutions. 

A few of the challenges were that staff interfaces were not user-friendly, training for these systems was limited, jurisdictional use was sometimes limited due to local policy restrictions, and data resolution and quality were limited. To ensure that future advances are not derailed before full implementation, the entire ecosystem of users must be engaged at each step. 

Future epidemics will bring similar urgency as the clinical and surveillance systems take on emergency operations, and rightly so. For that reason, stakeholders should have input in the design, implementation, regulation and recovery processes to ensure the end products work for all users, and the impact of infrastructure investments is maximized. 

Invest in infrastructure innovation
The public health data ecosystem is fragmented due to disjointed funding sources, funding unpredictability and data-sharing policies. These factors required health departments to create siloed systems and disconnected data streams that are not interoperable, optimized or integrated. 

The lack of reliable maintenance funding can lead to sustainability and expansion challenges, resulting in inefficient workarounds, faulty analytics to inform decision-making, ineffective program management and overall increased costs. 

To address these issues, additional state and federal investment will be needed to promote modernized infrastructure, innovative solutions, a response-ready workforce, and technology-driven services that result in superior, standardized and interoperable surveillance systems.

Encourage transparency and collaboration across jurisdictions
Transparency and collaboration across jurisdictions are critical prerequisites for effective disease reporting, management and intervention efforts. However, the specificity of local policies and procedures can pose challenges for cross-jurisdictional disease reporting and the exchange of essential data. 

This can be problematic when patients travel across county or state lines to get tested for COVID-19. The public health data, such as test results, are being received into a surveillance system different from that in the patients’ county or state of residence. Some states, such as Utah and Kansas, have found success through collaboration via the EpiTrax Consortium, which is a group of health departments committed to working together to maintain and continue to develop the EpiTrax open-source surveillance system.

To encourage collaboration on a larger scale, local health authorities should actively make efforts to collaborate through information sharing, development of mutually agreed-upon policies and procedures, and ongoing communication and consensus building. 

This might include sharing templates and resources for surveillance systems, relevant data sharing, and strategies to manage outbreaks. These efforts will establish a baseline for collaboration while allowing individual locales to expand requirements based on their unique needs. 

Additionally, public health department staff can participate in topic-specific forums, including communities of practice, to share resources, challenges and successes across programmatic, strategy and policy domains. It is important to review, share and learn from both successes and failures, because knowing what did not work is equally vital for growth and development. 

Sharing failures can help peers avoid recreating ineffective solutions and enhance the public health community's ability to identify and resolve common issues, ultimately fulfilling their mission of serving the public.

Revitalizing public health
Modernizing America's public health infrastructure presents a challenge to federal, state and local governments and their partners, stakeholders and collaborators. Still, we have a historic opportunity to make a meaningful investment that has the potential to tremendously improve public health outcomes nationwide. 

The strategic investments described also result in data system efficiencies gained from improved interoperability and public health workforce engagement and development. By following these five recommendations, we can ensure that our public health infrastructure is fully equipped to meet the challenges of the future and protect the health of our communities for decades to come.

Photo captions from top: The Maximus Public Health team conducted a comprehensive study of existing systems to modernize public health infrastructure over the next decade. Corinna Dan.