Can Technology Transform Public Health?

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October, 2017

By Robyn Alie, Manager, MMS Health Policy and Public Health

In what ways can technology help us prevent, contain, and manage disease? This is the theme of the Society’s 14th Public Health Leadership Forum on October 26. Keynoting the program will be John Auerbach, president and CEO of Trust for America’s Health (TFAH), a nonprofit that promotes public health policy and disease prevention as a national priority. Previously, Auerbach served as Boston Public Health Commissioner, Massachusetts Commissioner of Public Health, and director of the CDC’s Central Policy Office. Vital Signs spoke with John Auerbach in July about the state of technology in public health.

VS: What’s the role of technology in promoting an integrated approach to public health?

Auerbach: To truly move to what we’re calling Public Health 3.0, wherein the public health department is the chief health strategist for the community, technology provides easy and quick access to a range of different data. Public health needs access to the full gamut of information, from reports of infectious diseases, chronic diseases, and emerging issues like lead poisoning or drug misuse, to data from EHRs and payers and large health providers.

14th Public Health Leadership Forum

The Promise and Pitfalls of Transforming Health through Technology and Information

October 26, 2017,

1:00–5:00 p.m.

Featuring John Auerbach, president and CEO, Trust for America’s Health, and Monica Bharel, MD, MPH, state public health commissioner. Including panels on harnessing technology to improve health outcomes, and clinical and behavioral opportunities for IT and telehealth.

Find more information here, or call (781) 434-7373.

While at the CDC, we looked at aggregate information of EHRs, in fairly approximate to real time, on state-by-state prescribing of opioids. We could quickly ascertain what effect state legislation would have on prescribing practices. This is just one example. Think what public health could do to help guide policy, programs, and initiatives if we integrated all EHRs and insurance claims data into our population-level information.

Everything in a community is related to health, including transportation, education, public safety, city planning, etc. With all the information on social media sites, there must be ways to access this data to see what’s happening on a population level. For instance, have people posted to Facebook or Twitter a lot recently that they contracted food poisoning from the same establishments? We should be able to see what people are asking about health, and then public health can appropriately respond.

VS: What are the challenges?

Auerbach: Technology is constantly evolving and requires expertise. Public health has to keep up with this, while at the same time maintaining all of its core functions. For underfunded departments, investing in a robust technology component is not inexpensive, and makes decisions incredibly difficult — we shouldn’t have to choose between vaccines for needy children and up-to-date infrastructure.

In addition, while many people think data collection and analysis is easier now than ever — in public health, we’ve built data collection and storage systems across the states and within government agencies — it’s no small task to get all of these data sets integrated in a way that will provide relevant intelligence. And there can be an overwhelming amount of data. Unless there is a dedicated staff person with the relevant expertise and continued training who analyzes it all, it’s just not useful. It’s even more complicated to input data from other sectors (transportation, education, first responders, etc.) and translate it to health. And of course we must uphold patient privacy.

VS: In April, TFAH released a report highlighting the funding crisis in public health, and in July, a report identifying public health funding in jeopardy through potential ACA repeal, including $17.6 million in Massachusetts. Will technology and its benefits be a casualty of funding cuts?

Auerbach: Overall, the administration has signaled they want an 18 percent cut at HHS and 17 percent cut at the CDC. In addition, most Republican Affordable Care Act repeal proposals have fully cut the Prevention and Public Health Fund, which provides nearly $1 billion a year to the CDC, of which about $630 million goes directly to states.

My larger fear would be that, along with these potentially devastating cuts, there could be a dramatic weakening of the technological infrastructure across the state and country. When budgets are slashed, in my experience, infrastructure is the first thing that goes. When we need it, you can’t just plop a bag of money down and all of a sudden have the up-to-date and world class infrastructure needed to respond to a public health emergency, such as infectious disease outbreaks (Zika, Ebola, etc.) and climate-related disasters (hurricanes, wild fires, etc.) — yet we don’t typically put forth the resources to have a robust system. That’s not how it works. We need continual maintenance on infrastructure, and staff who are trained and experienced in using that infrastructure, from lab tests to disease surveillance reports and everything in between.

Health emergency preparedness funding for states has been cut from $940 million in fiscal year (FY) 2002 to $660 million in FY 2016, and health care system preparedness funding for states has been cut by more than half since FY 2005. We don’t fund our first responders this way, yet we yank public health funding around from year to year, and it has disastrous consequences.

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