With the end of the pandemic and the change in administration, public health informatics is at a crucial crossroad. Much of the focus has been on Interoperability, but much more is at stake. Here are five key issues facing public health agency informatics programs as they consider their data needs moving forward:
- System modernization. Many core public health systems were developed fifteen to twenty years ago, and they are using technologies and architectures that show their age. Over time these applications may become increasingly unsupportable as vendors step back and it becomes increasingly difficult to recruit staff with the necessary skills to support older architectures.
Perhaps we need to consider modernizing these systems in a more Agile way, with a focus on modularity, reusability of components, and use of standards. Many jurisdictions will face challenges procuring the types of solutions and services needed as their agencies still think monolithic, licensed products are appropriate. Agencies can align these modernization efforts with “efficiency in government” initiatives and leverage IT as an agent of positive change. - System sustainability in the post-pandemic era. Even as systems become modernized, there is still the ever present need to adjust to changing requirements and uncertain funding. Some things do not change (pun intended
Sustainability has always been a key consideration to system development, but the challenges are not “problems to be solved,” but rather issues to be managed in an ongoing manner. For many systems, continuous development is the name of the game. It will be increasingly difficult to fund systems without dedicated legislative appropriations, but more importantly, agencies need to change their attitude toward cost: For example, if an agency wants to get the benefit of sharing expenses through a COTS/GOTS solution it must minimize its expectations surrounding custom-development features. And with DMI, comes more agencywide opportunities for shared services and shared costs.
- Impact of HTI-4 (5? 6?) Final Rule. The HTI-2 Notice of Proposed Rulemaking explored many new aspects of potential regulation for core public health systems and the interoperability with clinical systems they support. The nature of federal rulemaking may now be changing with a new administration; it is less clear how many of the proposed new areas will be published in a Final Rule, or if there will even be a final rule. While it’s hard to plan in this kind of uncertain environment, agencies need to continue to monitor this area carefully to anticipate where compliance might be necessary.
- Role of AI. AI – especially Generative AI – has begun to creep into almost all aspects of our work. While it is clear that AI can be useful for certain functions (like assistance with help desk responsiveness, project management, and the like), it will start to become better at scanning the environment and making better recommendations about the existence of disease outbreaks and other risks. Federal, state, local, tribal and territorial governments are taking different approaches to controlling (or not controlling) its use in the public sphere. For some staff, it may seem threatening as the potential for their replacement by AI feels imminent and real. It will take some time for these issues to work themselves out, and public health agencies may need to develop new expertise to help manage the transition.
- Improving health equity. We have spent years improving the recognition of inequities in health investment and outcomes not only in clinical care but with public health activities as well. We have worked hard to try to recognize biases in our systems and technology and eliminate them where feasible. But now these efforts are threatened and agencies will need to make some hard choices about how to talk about these issues and how to address them in a very challenging political environment.
Only time will tell how impactful these challenges will be on public health systems and practice. We can only hope that information technology is viewed as an agent of change by the new administration and positioned as something for investment rather than reduction.