Without steady funding, public health agencies slow to upgrade old tech, report shows

Many state and local public health officials are hesitant to upgrade their IT systems, especially when funding to maintain newer technologies is inconsistent, according to a report published Thursday by the public policy nonprofit Pew Charitable Trusts.

All 50 states, and the District of Columbia, have laws that require schools, hospitals, medical labs, emergency rooms and urgent care centers to report anonymized health care information to public health agencies, according to the National Conference of State Legislatures. But officials are also sometimes hesitant to upgrade, the report notes, because while many state laws allow health data to be shared via phone or fax machine, none require it to be submitted using automated electronic technology.

The report examined policies governing how clinical data is shared with state public health agencies to better understand how jurisdictions are upgrading their technology in accordance with the Center for Disease Control’s push to modernize public health technology.

“These systems are costly, they’re expensive to purchase,” Margaret Arnesen, senior officer at Pew Charitable Trusts and co-author of this report, told StateScoop in an interview. “To maintain, you need a skilled and technical workforce. There are still entities under-resourced, rural providers and clinics that just don’t have the infrastructure to participate in these more advanced technological sharing systems.”

In 2019, the CDC launched the Data Modernization Initiative, a multi-billion-dollar effort to update computer systems used by federal and state public health agencies. The CDC last May announced it’s spent more than $1 billion updating IT systems of state, tribal, local and territorial governments.

‘A lot of manual errors’

Arnesen said that digitizing these systems will help improve the timeliness and accuracy of the data that public health agencies need to detect and prevent diseases.

“When we see people sending faxes or phone calls, we see a lot of manual errors,” Arnesen said. “There are mistakes, there’s missing information, missing phone numbers, missing demographic data, missing race, ethnicity data, that makes it hard to track impacts on vulnerable populations.”

However, the Pew report shows that smaller health care providers, often in rural communities, often rely on older technology, such as fax machines, to collect and share patient information and health care records.

“If there are low-volume providers, where it would be a very burdensome lift to get electronic connection and maintain it with the Public Health Department, there are places where maybe you do actually need a couple of fax machines,” said Genna Cohen, senior researcher at Mathematica, a research and data analytics consultancy that partnered with Pew on the report. “So I think just keeping an eye out on a couple of exceptions that make sense, but still trying to drive the overall public health relationship towards more automated and electronic.”

Kathy Talkington, director of public health programs at the Pew Charitable Trusts, told StateScoop that while the U.S. medical system has been slowly adopting electronic case management and data collection over the past decade, public health agencies have largely been left out of those efforts.

“Unfortunately, when that was all growing, public health was not part of that. There were not incentives in place to include sharing data with public health,” Talkington said. “I think that’s part of the reason that the infrastructure has not been matured on the public health side, because the resources and incentives that happened at a national level for the health care system did not include public health.”

Struggling for ‘sustained investment’

Under President Joe Biden’s administration, the American Rescue Plan provided $350 billion in emergency funding to state, local, territorial and tribal governments to recover from the COVID-19 pandemic. But Arnesen said that those funds have largely diminished, part of a ‘boom and bust’ pattern well known in the public health industry.

“There’s a disaster, everyone’s paying attention, there’s a lot of money flowing, and then — priority shift — and this funding starts to dry up,” Arnesen said. “That unpredictability makes it very hard for states to make the case for a sustained investment into more modernized data systems, and especially the workforce needed to maintain them.”

The Pew report found that incentive programs — such as Medi-Cal, California’s Medicaid program, which provides payment programs to health care providers that meet certain requirements — rather than punitive policy measures, were more successful at encouraging public health agencies to update their old technologies and processes.

“The federal incentives move people to kind of get ahead of the policy and become more modernized,” Arnesen said.

Some states have already taken action. Earlier this year, Utah enacted legislation to redefine the duties of its Department of Health and Human Services, including how it shares data with the state’s other public health agencies.

Last year, Maryland established the Commission on Public Health to recommend improvements for delivering public health services, including how to reform how it uses technology and shares data.