Traditionally, health departments rely on limited funding sources, often only federal funds with some state and/or other jurisdictional general or targeted funds. Yet, in any field, having multiple funding sources is key to sustainability.
Diversifying funding. Many health departments leveraged Medicaid funding to respond to the Center for Medicare and Medicaid Services (CMS) priorities for the Meaningful Use program. While that specific match funding program has sunsetted, Medicaid programs still have available mechanisms to cost-share in information infrastructure that can meet both public health and Medicaid priorities. Other health departments have leveraged financial or in-kind contributions from health plans because of shared interests and common goals. Building such relationships will likely require engaging senior leadership at the health department, which can be a critical element to strategic sustainability. Refer to the Make the Value Case section of the toolkit for tips on engaging and communicating priority to senior leadership.
Sharing staff. While public health funding tends to be program-specific, many of the data science/informatics skills needed cross programs. Cost sharing in positions for data analysis and visualization, business analysis, project management or communications can contribute to both increased program effectiveness and sustainability.
Root cause identification
Root cause analyses (RCA) identify the starting cause (or root) of problems to create a solution that will not only fix the problem, but prevent it from happening in the future. This framework moves away from merely putting out fires when issues arise, to making sure that once the fire is put out, the same fire doesn’t arise again. Within root cause analysis, it is highly common that multiple interventions—instead of a single one—are needed to get at the root cause.
Additionally, root cause analysis aims for quality improvement over the life cycle. Therefore, interventions will constantly take place to improve the system and prevent future problems. As with data modernization, identifying problems and continually completing root cause analyses will ensure that the health department can adapt the solutions as technology and human nature changes over time. Complete the Root Cause Analysis worksheet using the 5 Why practice.
Resource: Root cause analysis
The Washington State Department of Enterprise Services created a web page devoted to root cause analysis including the goals, benefits and principles and how root cause analysis can be applied within the health department. Additionally, specific information on RCA methods like the “5 Whys” and the Fish-bone or Ishikawa Diagram are included.
The entire data modernization team plays a part in staying up to date on new technology, partnerships and processes. Participation in work groups and membership organizations will help to connect the state or local health department to those who represent agencies across the data life cycle. Participation in work groups and membership organizations allow health departments to learn from one another and push collective thinking further. A few examples of membership organizations working on data modernization currently are Health Level Seven (HL7) International, Association of State and Territorial Health Officials (ASTHO), CSTE and Healthcare Information and Management Systems Society (HIMSS).
Determine which staff from the data modernization team should attend specific meetings for membership organizations. For example, onboarding staff might be best suited to participate in the HL7 meetings and epidemiologists might be best to participate in CSTE. Membership organizations tend to be at the forefront of upcoming technology and discuss with members solutions and tweaks to the current data infrastructure that could be used within the jurisdiction. Furthermore, many membership organizations and workgroups have message boards or other tools to ask questions across the community. Because of the interactive nature of the groups, new staff, those who work in smaller departments with few colleagues and those who serve as subject matter experts within the health department may gain the most from the virtual peer environment.
To gain the largest benefit from workgroups and , health department staff should be encouraged to actively participate in discussions, lead or participate in subcommittees and implement some of the strategies shared by peers. In addition to participating in membership organizations, staying updated with the CDC DMI work as well as the Office of the National Coordinator for Health Information Technology (ONC) is important.
Finally, the most valuable asset for sustainable data modernization is the data modernization team, as discussed in the Establish a Data Modernization Team section of this toolkit. Building a team with the right mix of leaders, inspiring staff members and future-oriented thinkers can lay the foundation for a sustainable data modernization plan.
Resource: Program sustainability assessment tool
This tool assesses the sustainability of the health department and helps to plan for the future. Within the tool are three sections for understanding the components of sustainability, assessing the sustainability of the current program and developing a sustainability action plan. The tool offers definitions, resources and action steps to prevent dissolution of a program's activities.
Resource: Sustainability thinking
This course provides short, under-ten-minutes lessons for sustainability thinking. Provided by the Business School at the University of Colorado Denver, this Coursera training is applicable to data modernization projects, specifically when building longevity with new or current systems.