Recently, I’ve been reflecting on where and how successful, large-scale public health system implementations happen. I concluded there are three critical elements:
- The problem: To be successful with an enterprise approach in public health, experience tells me that a sufficiently large number of people must agree they are solving the same problem and that solving the problem in a robust manner is essential. For problems that are universal, but demand for their solution is local, an enterprise approach just won’t catch fire. However, when the problem is widely-shared, causes political pain and angst when it isn’t solved well, and information directly links to dealing with the problem, a large-scale system might work for public health.
- The community: Experience also tells me that enterprise in public health means a lot of people working together. It’s not like an industry that can direct and command a CIO to build a system that benefits the bottom line or is necessary to advance a strategic business advantage. In public health, we must bridge the federated design divide by compelling a large group of states and localities to join together. If and when that community unites, we have a successful enterprise opportunity.
- The technology: And of course, there must be a scalable, technically feasible, cost-effective solution that compels people forward.
As I applied these three criteria to past experience, they helped explain why immunization information systems and cancer registries evolved. Each of these enterprise systems developed standards because of the sheer willpower of the community of users and developers working to make it happen. They needed consistency to realize the solution to their health information problem. Their stakeholders needed consistency. And, they had a compelling information problem to solve that links directly to an understanding of the health problem at issue.
If we apply these three criteria to the whole of public health, we should expect to see the practice community fuse together to establish enterprise systems built upon common standards and developed in partnership with essential partners, like health care. I believe we should look to those health problems and health threats where citizens and policy makers demand almost instantaneous information at a very granular level. This kind of information response can’t happen if it is built upon a patchwork quilt of locally defined, owned and operated systems. It can only happen if we have a unified approach using technologies that scale to need and have the flexibility to interact with thousands of disparate users.
