Every day, public health officials use data from each other and from doctors, hospitals, and health systems to protect people from infectious and environmental threats. When these officials receive timely, accurate, and complete information from health care providers, they can more clearly detect disease, prevent its spread, and help people connect to care. To improve the quality of this information, the U.S. Centers for Disease Control and Prevention developed the Public Health Data Strategy (PHDS), which was updated in April, to facilitate data-sharing between these many stakeholders. As the director of the CDC’s Office of Public Health Data, Surveillance, and Technology, Dr. Jennifer Layden is responsible for leading, coordinating, and executing the strategy.
This interview has been edited for clarity and length.
It’s CDC’s two-year plan to provide accountability for the data, technology, policy, and administrative actions necessary to meet our public health data goals. We aim to address challenges in data exchange between health care organizations and public health authorities, moving us toward one interconnected system that protects and improves health.
The PHDS has four main goals: strengthen the core of public health data; accelerate access to analytic and automated solutions that support public health investigations and advance health equity; visualize and share insights to inform public health action; and advance more open and interoperable public health data. The plan sets milestones that help public health partners, health care organizations and providers, and the public understand what’s being done and what progress is being made toward these goals.
Electronic health care records (EHRs) and associated efforts at interoperability [the successful exchange of health information between different systems] have seen over $35 billion of investment over the last couple decades. This has led to robust and widespread use of EHRs, adoption of health IT standards, and improved data-sharing across health care. Public health, however, hasn’t seen the same investment. And this has contributed to gaps in the completeness of data and the timely exchange of information to support public health.
At the beginning of the COVID pandemic, we had race and ethnicity data on less than 60% of cases. New investments in public health, largely tied to the COVID response, allowed for advanced connectivity with the use of electronic case reporting, or eCR [the automated electronic reporting of individual cases of illness], as well as electronic laboratory reporting [the automated sharing of lab reports]. This led to a rapid improvement in the completeness of race and ethnicity data, which improved the nation’s ability to identify disparities in COVID burden and severity.
As we work to transform public health systems, we need to leverage existing health IT standards and technical approaches to ensure better connections between public health and health care. This benefits us all through more streamlined data-sharing, reduced burden on health care facilities and providers, and faster detection of health threats and outbreaks. And ultimately, improved bi-directional data-sharing [where data is available to health care providers who generate the information and health departments that receive the data] will benefit patients and those who care for them.
The PHDS was launched in 2023 with 15 milestones, such as increasing the number of critical access hospitals sending electronic case reports as well as increasing the number of jurisdictions inputting eCR data into disease surveillance systems. Twelve were met, and work continues on the remaining three. The milestones reached in 2023 have made it easier to share information, provided access to modern tools, and improved the real-time monitoring of health threats, all of which strengthened public health data systems. The latest version of the PHDS includes updated 2024 milestones as well as new ones for 2025 that will advance the nation’s public health data capabilities. Milestones for the next two years focus on improving the completeness and coverage of eCR, syndromic surveillance [which uses anonymized emergency room data to identify emerging threats quickly], and data on mortality and wastewater. [When wastewater contains viruses, bacteria, and other infectious diseases circulating in a community, it can provide early warning even if people don’t have symptoms or seek care.]
Collaboration is at the heart of the new milestones. The updated strategy focuses on accelerating the adoption of eCR to ensure timely detection of illnesses, expanding data-sharing initiatives to improve public health responses and decision-making, and driving innovations in analytics to address health disparities and promote health equity.
These new milestones aim to reduce burdens on public health agencies by reducing the need to manually input case data into disease surveillance systems and will mitigate the overhead for managing individual point-to-point connections with labs to support eCR. The strategy will also let public health agencies more effectively identify and address health disparities based on a wider range of health equity measures.
In addition, the Workforce Accelerator Initiative, launched by the CDC Foundation, will recruit, place and support more than 100 technical experts in public health agencies to achieve the strategy’s goals.
Successful implementation will require collaboration with public health agencies, public health partners, private industry, health care partners, and other federal agencies, as well as sustained resources. We will directly engage with public health agencies to understand their priority needs and work with public health partners to support their progress toward key milestones. We’ll also collaborate with private partners to encourage dialogue and promote data exchange pilots, as well as with providers and labs to gather feedback on how we can better support their progress.
The CDC is working with the Office of the National Coordinator for Health Information Technology (ONC) to create a common approach for data exchange among health care, public health agencies, and federal agencies. This effort involves a partnership with representatives from health care, health IT, states, and federal organizations that sets up an exchange system to make it easier for providers to send data to public health agencies and for public health agencies to receive it. The collaboration will provide data standards, common agreements, and exchange networks that will assist public health agencies in their data exchange needs. We’ll continue to collaborate with ONC, as well as the Centers for Medicare & Medicaid Services, to advance a shared understanding of activities that support our milestones and will reach out to other federal agencies to synergize our efforts.
We have ambitious goals to strengthen the connections between public health and health care. And other federal initiatives, like the movement toward the Trusted Exchange Framework and Common Agreement (TEFCA), adoption of USCDI+, and new data standards lay out a pathway to making this a reality.
In five years, we aim to have 75% of state and big city jurisdictions, along with CDC, connected to TEFCA. This can eliminate inefficient point-to-point interfaces and enable more reliable exchange of real-time information. We also want to have 90% of emergency room data connected and flowing to public health agencies and envision a future where eCR has replaced most manual reporting of cases of infectious diseases and other conditions.
Reaching these goals would mean having more complete data and faster reporting of threats that could put our nation at risk. This will lead to better detection of outbreaks, faster response times, and healthier communities—and ultimately result in an integrated public health ecosystem that produces and uses data to support healthier communities and keep people safe.