The challenge begins with how our public health system is structured. Many people don’t realize that public health is not a single government agency. Because it’s a federated system, public health is actually a collection of several thousand agencies of varying sizes – none of which are regulated by the federal government or any single board of oversight. In the U.S., a public health agency can range from an office in rural New Mexico staffed by a few people, all the way to the New York City Department of Health, which is responsible for the health of one of the most populous areas in the world.
Although these public health agencies have similar responsibilities and mostly do the same work, they have tended to believe that they are more different than alike. There’s an old saying in public health that if you’ve seen one public health agency…you’ve seen one public health agency. In other words, no two agencies do things the same way. Often, no two programs within a single agency do things the same way. As a result, the information systems that support these agencies are often small, standalone applications that cannot effectively share data.
In order to build a robust, integrated IT infrastructure that allows the type of information sharing we take for granted in most other industries, public health first needs to develop a standardized set of business processes. With a shared understanding of how public health does its work, we can document how information systems can support that work and build a common set of information system requirements.
Identifying and documenting the work of public health is a critical step in creating the public health information infrastructure of the 21st century.