GAO Says More Needed On Public-Health IT Network

Among the initiatives examined: the Public Health Information Network, which is aimed at furnishing the nation with integrated information systems.
Remember the anthrax scare that occurred a month after the Sept. 11, 2001, terrorist attacks? That scare exposed serious weaknesses in the U.S. public-health infrastructure. Since then, new infectious diseases have appeared, making preparation and readiness even more critical, according to a 68-page report made public Monday by the Government Accountability Office, the investigative arm of Congress. And, according to that report, a major factor in detecting and responding to public-health emergencies, including bioterrorism, is IT.

The House Government Reform Committee asked the GAO to review the progress of major federal IT initiatives aimed at strengthening the ability of government at all levels to respond to public-health emergencies, as well as to describe key challenges facing agencies pursuing these initiatives. In its report, the GAO says federal agencies have made progress on these initiatives, though significant work remains.

These initiatives include one broad program at the Centers for Disease Control and Prevention--known as the Public Health Information Network--intended to furnish the nation with integrated information systems. Two other initiatives at the Department of Homeland Security are focused on biosurveillance.

The GAO says the Public Health Information Network initiative has progressed by establishing communications systems and promoting standards, but still has work to do on associated surveillance systems. For example, public-health officials told the GAO that they didn't find the network's BioSense application useful because of limitations in the data collected.

Both of Homeland Security's major public-health initiatives are still in development. A system associated with one of those initiatives--BioWatch--has been deployed. BioWatch is an early-warning environmental-monitoring system that collects air samples in order to detect trace amounts of biological materials. It recently underwent modification to solve an interoperability problem: Its three IT components required redundant data entry in order to communicate with one another. The department told the GAO that it has developed a solution to this interoperability problem and implemented it at two locations; Homeland Security plans to install that solution in the remaining BioWatch locations.

According to the GAO, challenges faced by the CDC and Homeland Security in planning and implementing their major public-health IT initiatives include integrating current initiatives into a national health IT strategy and federal architecture to reduce the risk of duplicative efforts, developing and adopting consistent standards to encourage interoperability, coordinating initiatives with states and local agencies to improve the public-health infrastructure, and overcoming federal IT management weaknesses to improve progress on IT initiatives.

"Until these challenges are addressed, progress toward building a stronger public-health infrastructure will be impeded, as will the ability to share essential information concerning public health emergencies and bioterrorism," writes David Powner, the GAO's director of IT management issues.

The GAO recommends that Health and Human Services Secretary Michael Leavitt establish clear links between the initiatives and the national health-care strategy and federal health architecture and also encourage interoperability through the adoption of standards for health-care data and communications.

HHS acting inspector general Daniel Levinson responded that the department concurs with the GAO's general findings but says the situation isn't as bad as congressional auditors suggest. "Strategic pieces of a nationwide health IT architecture are in place," Levinson writes. Still, he outlines some key challenges the department faces, including:

  • In emergencies, overcoming large inconsistencies in the type and coverage of data that accumulates at state and local levels

  • Making available baseline data against which emergency information trends need to be compared for situational awareness

  • Eliminating differences in the process and technical infrastructures required to exchange the emergent data versus routine data, which can cause a loss of critical time to respond to emergencies
  • Public health's role in preparedness and response has been seen as limited to data collection and communications, Levinson says. "Public health plays a far larger role, not only in detecting the event, but in managing, containing, and mitigating the event and its impact on the public," he argues. "This larger role includes early event detection, outbreak management, countermeasure response and administration, laboratory results exchange, and partner communications and alerting."

    Still, he says, some organizations have failed to invest in standards-based solutions. That creates interoperability problems among partners. Levinson says: "Information and data, two items essential to decision-makers in an emergency, are often not exchanged in the most efficient and time-sensitive manner."