DPH 850 Module 2 Public Health Information Systems Example

Many Systems, One Mission: The Information Systems Behind a State Health Department

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Doctor of Public Health Program, Aspen University

DPH 850: Health Informatics for Public Health Leaders

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Month Day, Year

Many Systems, One Mission: The Information Systems Behind a State Health Department

A state health department operates many information systems, each built at a different time for a different program. Together they detect outbreaks, track vaccinations, record births and deaths and guide prevention. This paper describes the major information systems of a composite state health department whose jurisdiction covers 4.2 million people, how data move through them and where gaps limit their usefulness.

Notifiable Disease Surveillance

State law requires clinicians and laboratories to report certain diseases, from measles to hepatitis to foodborne illness. The surveillance system receives these reports, supports investigation by local health departments and sends data to national programs. It is the backbone of communicable disease control.

Systems at a Glance

The table summarizes the department's main information systems.

Electronic Laboratory Reporting

Electronic laboratory reporting sends test results automatically from laboratory systems to the health department. It improved timeliness and completeness compared with paper and fax, but laboratory results often lack clinical details such as symptoms, pregnancy status or treatment, which investigators must then obtain by phone.

Electronic Case Reporting

Electronic case reporting generates case reports automatically from electronic health records when certain diagnoses or results appear, adding clinical information that laboratory reports lack. Federal incentive programs encouraged hospitals to adopt electronic public health reporting, which Lenert and Sundwall (2012) saw as an opportunity for public health, provided agencies could build systems able to receive and use the data.

Syndromic Surveillance

Syndromic surveillance analyzes emergency department visit data, often within a day, to detect unusual patterns before diagnoses are confirmed. The department uses it for influenza-like illness, heat illness, overdoses and events such as mass gatherings. Data typically arrive within 24 hours of a visit, far faster than confirmed case reports.

Immunization Information System

The immunization information system records vaccinations from clinics and pharmacies, supports reminder and recall, provides records to schools and families and estimates coverage. During the pandemic, it expanded rapidly to track COVID-19 vaccination, revealing both its value and its limits in handling large volumes.

Vital Records

Vital records systems register births and deaths and provide the data for mortality statistics. Delays in death certification, especially for overdoses awaiting toxicology results, can slow public health response. Electronic death registration has shortened some delays.

How Data Flow

A positive laboratory test for a reportable disease moves from the laboratory system to the state through electronic laboratory reporting, is matched to an existing case or creates a new one, and is routed to the local health department for investigation. Aggregated data then flow to national surveillance programs. Each handoff is a point where delays and errors can occur.

Gaps Exposed by the Pandemic

The pandemic strained every system. Many hospitals faced barriers to electronic public health reporting, including limited capacity at health agencies to receive data and lack of interoperability (Holmgren et al., 2020). In the composite state, some results arrived by fax, race and ethnicity were missing from many reports and systems could not easily share data with each other.

Electronic Health Records and Population Health

Electronic health records hold data that could support population health beyond reportable diseases, such as blood pressure or diabetes control. A systematic review found that electronic health records have been used for surveillance, identifying at-risk populations and evaluating interventions, though data quality and interoperability limit their use (Kruse et al., 2018).

Integration

Most systems were built separately, so the same person may appear in several without being linked. Integrating systems, for example linking surveillance and immunization records, allows analyses such as vaccine effectiveness and helps investigators see a person's full history. Integration requires common identifiers, standards and governance. A master person index shared across systems is the usual starting point.

The Burden on Reporters

Clinics and laboratories must report to many systems, sometimes in different formats. Reducing their burden, by accepting standard electronic formats and eliminating duplicate reporting, improves compliance and data quality.

Priorities for Modernization

The department's priorities are to replace the aging surveillance system, expand electronic case reporting to all hospitals and large clinics, improve completeness of race and ethnicity data, link surveillance with immunization and vital records and build capacity to analyze data quickly.

Surveillance Beyond Communicable Disease

Information systems increasingly support surveillance of chronic disease, injury and behavioral health. Overdose surveillance draws on emergency department data, death records and prescription monitoring programs. Chronic disease surveillance may use electronic health record data on blood pressure or diabetes control. Each new use raises questions about data access, standards and privacy.

The Public-Facing Layer

Dashboards and open data portals turn internal data into public information. During the pandemic, the department's dashboard became one of its most visited web pages. Public-facing tools require careful attention to small numbers, clear explanations of data limits and regular updates, since outdated dashboards erode trust.

Local Health Department Access

Local health departments investigate most cases, yet in the current system they cannot easily run their own reports. The modernization will give local users role-based access to their jurisdiction's data and analysis tools, reducing requests to state staff and speeding local action.

Workforce for Systems

Each system needs people who understand both the data and the program: data managers, interface analysts and epidemiologists who can use the outputs. Vacancies in these roles, common after the pandemic, weaken every system regardless of its technology.

Mapping the Current State

Before modernizing, the department mapped every system, its data sources, interfaces, owners and costs. The map revealed 41 separate databases, several duplicating one another, and interfaces maintained by a single retiring employee. The exercise gave leaders a concrete basis for setting priorities and for explaining the need for investment to legislators.

Costs of Fragmentation

Running dozens of separate systems is expensive. Each needs its own licenses, interfaces, security reviews and staff expertise. Consolidating overlapping databases and sharing common services, such as identity matching and address geocoding, could lower costs while improving data quality across programs. The department estimates that consolidation could save several hundred thousand dollars a year in maintenance.

Conclusion

The state health department relies on a network of information systems for surveillance, laboratory and case reporting, syndromic surveillance, immunization and vital records. Each serves a function, but gaps in timeliness, completeness, interoperability and integration limit their collective value. Modernization priorities focus on automated reporting, linkage and data quality.

References

Holmgren, A. J., Apathy, N. C., & Adler-Milstein, J. (2020). Barriers to hospital electronic public health reporting and implications for the COVID-19 pandemic. Journal of the American Medical Informatics Association, 27(8), 1306-1309. https://doi.org/10.1093/jamia/ocaa112

Kruse, C. S., Stein, A., Thomas, H., & Kaur, H. (2018). The use of electronic health records to support population health: A systematic review of the literature. Journal of Medical Systems, 42(11), Article 214. https://doi.org/10.1007/s10916-018-1075-6

Lenert, L., & Sundwall, D. N. (2012). Public health surveillance and meaningful use regulations: A crisis of opportunity. American Journal of Public Health, 102(3), e1-e7. https://doi.org/10.2105/AJPH.2011.300542