Progress Made in Federal Public Health IT Applications, But More Work Remains

CDC and DHS have made progress on federal public health IT initiatives,  including CDC’s PHIN initiative, which is intended to provide the nation  with integrated public health information systems to counter national  civilian public health threats, and two major initiatives at DHS—primarily  focused on signal interpretation and biosurveillance—one of which is  associated with three other programs. PHIN communications systems are being used, and improvements to  surveillance systems (disease, syndromic, and environmental monitoring)  are still being developed. Other PHIN applications are available for  optional use by state and local public health officials, but they are not  widely used because of system limitations. However, as initially  deployed, BioWatch required modification, because its three IT  components did not communicate with each other, requiring redundant  data entry. Although CDC uses BioSense for a number of federal bioterrorism  preparedness activities, BioSense is not extensively used by the state and  local public health officials with whom we spoke, primarily because of  limitations in the data and its presentation. Most DHS Biosurveillance IT Initiatives Are Still in Their Early Stages

DHS is also pursuing two major biosurveillance IT initiatives—the National  Biosurveillance Integration System and the Biological Warning and  Incident Characterization System (BWICS). The BWICS initiative, in  addition, is associated with three other biosurveillance programs. Of these  five, one is operational, but it has interoperability and other limitations, one  is a demonstration project, and three are in development. Challenges Need to Be Overcome to Strengthen the Information Technology That Supports the Public Health Infrastructure

Despite federal, state, and local government efforts to strengthen the public  health infrastructure and improve the nation’s ability to detect, prevent,  and respond to public health emergencies, important challenges continue  to constrain progress. First, the national health care IT strategy and federal  health architecture are still being developed; CDC and DHS will face  challenges in integrating their public health IT initiatives into these ongoing  efforts. Second, although federal efforts continue to promote the adoption  of data standards, developing such standards and then implementing them  are challenges for the health care community. Third, these initiatives  involve the need to coordinate among federal, state, and local public health  agencies, but establishing effective coordination among the large number  of disparate agencies is a major undertaking. Finally, CDC and DHS face  challenges in addressing specific weaknesses in IT planning and  management that may hinder progress in developing and deploying public  health IT initiatives. Federal agencies face many challenges in improving the public health  infrastructure. Until agencies address all these challenges, progress  toward building a stronger public health infrastructure will be limited, as  will the ability to share essential information concerning public health  emergencies and bioterrorism. Recommendations for Executive Action

In order to improve the development and implementation of major public  health IT initiatives, we recommend that the Secretary of Health and  Human Services take the following two actions:  ensure that the federal initiatives are (1) aligned with the national health  IT strategy, the federal health architecture, and ongoing public health IT  initiatives and (2) coordinated with state and local public health  initiatives and  ensure federal actions to encourage the development, adoption, and  implementation of health care data and communication standards  across the health care industry to address interoperability challenges  associated with the exchange of public health information. GAO staff who made major contributions to this report are listed in  appendix V.

Objectives, Scope, and Methodology

The objectives of our review were to  assess the progress of major federal information technology (IT)  initiatives designed to strengthen the effectiveness of the public health  infrastructure and  describe the key IT challenges facing federal agencies responsible for  improving the public health infrastructure. The Department of Homeland Security (DHS) is responsible for, among  other things, protecting the United States against terrorist attacks. 4.
Why GAO Did This Study

It has been almost 4 years since the anthrax events of October 2001 highlighted the weaknesses in our nation's public health infrastructure. Since that time, emerging infectious diseases have appeared--such as Severe Acute Respiratory Syndrome and human monkeypox--that have made our readiness for public health emergencies even more critical. Information technology (IT) is central to strengthening the public health infrastructure through the implementation of systems to aid in the detection, preparation for, and response to bioterrorism and other public health emergencies. Congress asked us to review the current status of major federal IT initiatives aimed at strengthening the ability of government at all levels to respond to public health emergencies. Specifically, our objectives were to assess the progress of major federal IT initiatives designed to strengthen the effectiveness of the public health infrastructure and describe the key IT challenges facing federal agencies responsible for improving the public health infrastructure.

What GAO Found

Federal agencies have made progress on major public health IT initiatives, although significant work remains to be done. These initiatives include one broad initiative at CDC--the Public Health Information Network (PHIN) initiative--which is intended to provide the nation with integrated public health information systems to counter national civilian public health threats, and two major initiatives at the Department of Homeland Security (DHS), which are primarily focused on biosurveillance. CDC's broad PHIN initiative encompasses a number of applications and initiatives, which show varied progress. Currently, PHIN's basic communications systems are in place, but it is unclear when its surveillance systems and data exchange applications will become fully deployed. Further, the overall implementation of PHIN does not yet provide the desired functionality, and so some applications are not widely used by state and local public health officials. For example, CDC's BioSense application, which is aimed at detecting early signs of disease outbreaks, is available to state and local public health agencies, but according to the state and local officials with whom we spoke, it is not widely used, primarily because of limitations in the data it currently collects. DHS is also pursuing two major public health IT initiatives--the National Biosurveillance Integration System and the Biological Warning and Incident Characterization System (BWICS). Both of these initiatives are still in development. The BWICS initiative, in addition, is associated with three other programs, one of which--BioWatch--is operational. This early- warning environmental monitoring system was developed for detecting trace amounts of biological materials and has been deployed in over 30 locations across the United States. Until recently, its three IT components were not interoperable and required redundant data entry in order to communicate with each other. As federal agencies work with state and local public health agencies to improve the public health infrastructure, they face several challenges. First, the national health IT strategy and federal health architecture are still being developed; CDC and DHS will face challenges in integrating their public health IT initiatives into these ongoing efforts. Second, although federal efforts continue to promote the adoption of data standards, developing such standards and then implementing them are challenges for the health care community. Third, these initiatives involve the need to coordinate among federal, state, and local public health agencies, but establishing effective coordination among the large number of disparate agencies is a major undertaking. Finally, CDC and DHS face challenges in addressing specific weaknesses in IT planning and management that may hinder progress in developing and deploying public health IT initiatives. Until all 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.