Thread by @DrJayVarma

This @politico article is thankfully generating interest in public health data systems, an area many of us have been trying to sound the alarm about domestically & globally for decades. For context, let’s #ThinkLikeAPublicHealthOfficial /1
politico.com/news/2021/08/1…

As a public health official, what do I need for something as seemingly basic as counting all lab-confirmed #COVID cases? /2

First, you need a law passed by a state/local legislature or regulation from an administrative body with force of law (eg Board of Health) that requires all clinical labs to report confirmed cases /3

That law must specify: *electronic* reporting, minimum data elements, specific messaging standards, reporting within a defined timeframe, and penalties for non-compliance /4

Second, you need multiple staff with whose full-time job is to monitor labs for compliance & continuously upgrade systems when new tests, instruments, technology emerge. /5

Third, you need stable, annual funding to ensure these personnel have training, software, equipment, infrastructure to continuous support labs and upgrade to latest messaging standards /6

Fourth, you need political support to enforce non-compliance. Yep - if you’re a health agency penalizing a facility w/substantial political & economic clout in your jurisdiction, you better trust that your elected executive has your back /7

Fifth, you need staff whose full time job is to process and clean the data (eg, duplicate tests, age and birth year conflict) and can merge data with other data streams using complex matching algorithms /8

Sixth, you need another law specifying that providers (not just labs) must report cases diagnosed using point-of-care (eg antigen) tests with similar standards for reporting and penalties for non-compliance as with labs /9

Seventh, you need separate staff whose full time job is to survey and support providers (whose issues are different than labs) to ensure compliance with electronically reporting cases confirmed using point-of-care tests /10

All of these staff above must have training in epidemiology, microbiology, & informatics. And you must be able to provide them with software & IT infrastructure to merge data from all sources, analyze it, and prepare reports that are accurate and identify limitations /11

Eighth, you need a capital budget that you can tap (without prolonged delays) to continually upgrade systems & you need direct access to elected officials to continuously upgrade laws / regs to match latest disease (what happens when there is COVID-2022?) /12

Even with all that, what happens when lab doesn’t have the patient's address, date of birth, race? The lab only has what provider puts on requisition-can they order a test w/out that info? Do you have a system to help providers & labs solve multi-facility problems?/13

Starting 2009, public health budgets were decimated by the Great Recession. How many govts considered public health informatics specialists, software, data systems critical and untouchable when making budget cuts? /14

After the Great Recession, how many govts approved a sudden infusion of personnel & capital & annual funding because this is critical infrastructure? How many said we need to fix our laws to match the threat of emerging infections? /15

Oh - and even if a health agency got $ to upgrade - how do you hire & retain the best epidemiology, laboratory, & informatics personnel when they can make twice as much with free snacks & stock options at a tech company? /16

How do you use the $ to purchase software on the open market when commercial vendors want to sell you the "solution" they made for hospitals & doctor's offices, and want to shoehorn your public health needs into their system, creating more problems rather than solutions? /17

How long does it take a special request to get approval from govt budget & management agency to hire your own staff to develop a proper IT solution? And then have them develop & test it? After it’s done, what happens when you learn it’s using old tech that needs upgrading?/18

In a federated system, each State (and many big cities) needs to be going through this reckoning and decide if it’s going to upgrade its laws, budget, and personnel to match its health security needs. /19

So if you Think Like A Public Health Official in August 2021, how confident are you that you have the political commitment today & for the foreseeable future to make this happen in all 50 states (+territories), especially when several are curtailing public health authority? /20

This is why Federal leadership on this issue is so vital. Money, legal framework, standards, political attention, monitoring, accountability. We won’t transform US public health data systems without it, and articles like this will be written again and again. /21