GAO-11-318SP: Health: HHS needs an overall strategy to better integrate nationwide public health information systems

Health

HHS needs an overall strategy to better integrate nationwide public health information systems

Why Area Is Important

Public health functions in the United States—such as disease surveillance and emergency detection and response—are conducted by public health officials from 59 state and territorial health departments; more than 3,000 local health departments; over 180,000 clinical laboratories; and multiple federal agencies. As the federal point of contact for public health initiatives, the Department of Health and Human Services (HHS) is responsible for coordinating nationwide efforts to detect and respond to disease outbreaks and other public health emergencies. Because of the many participants involved, the identification and management of public health emergencies call for effective communication and collaboration across all levels of government and the private sector. In addition, officials at HHS and other federal, state, and local agencies recognize the need to improve the use of information technology to collect, analyze, and share data that can be used to enhance nationwide public health situational awareness—that is, public knowledge of key health-related events and the availability of medical and emergency response resources.

What GAO Found

HHS has taken steps over the past decade to improve the ability of public health entities to electronically collect, analyze, and share information that supports early event detection and emergency response operations, but the department's initiatives have been undertaken without the strategic planning needed to coordinate and integrate the priorities, goals, and objectives of various related initiatives. HHS officials have identified at least 25 information technology systems that are key to the department's efforts to support public health situational awareness. In fiscal year 2009, reported costs for developing and implementing these systems were approximately $40 million. Additionally, other federal, state, local, and tribal public health entities throughout the country have expended scarce resources to develop and implement numerous other systems for conducting public health functions within their own jurisdictions.

HHS has also defined data and other technical standards intended to better enable public health entities throughout the nation to develop and implement interoperable systems for collecting, analyzing, and sharing data. However, the department has not developed and implemented an overall strategy that defines goals, objectives, and priorities and that integrates related strategies to achieve the unified electronic nationwide situational awareness capability required by the Pandemic and All-Hazards Preparedness Act.[1]Rather, HHS and the public health community have developed and implemented information systems to enhance public health situational awareness in an often stove-piped fashion, focusing on specific public health functions. Therefore, public health entities are limited in their ability to electronically collect, analyze, and share information needed to enhance public health situational awareness and improve the effectiveness of their efforts to prepare for and respond to public health emergencies.

In December 2006, the Pandemic and All-Hazards Preparedness Act mandated that the Secretary of HHS, in collaboration with state, local, and tribal public health entities, develop and implement a strategic plan for the establishment of an electronic network of interoperable systems to enhance nationwide public health situational awareness. GAO's December 2010 report on HHS's efforts to establish an electronic network for enhancing nationwide situational awareness of public health emergencies found that the Secretary of HHS had not developed and delivered a strategic plan within 180 days of the mandate as required (i.e., by June 16, 2007). Without an overall strategic plan that defines requirements for establishing and evaluating the capabilities of existing and planned information systems implemented throughout the public health community, HHS cannot be assured that its resources are being effectively used to provide a unified electronic nationwide public health situational awareness capability. Further, absent more effective planning, HHS runs the risk of expending additional funds for continued fragmented efforts without realizing the mandated goal.



[1]Pub. L. No. 109-417 (Dec. 19, 2006).

Actions Needed

GAO's December 2010 report recommended that the Secretary of HHS develop and implement a strategic plan that defines goals, objectives, and priorities for establishing an electronic public health situational awareness network. Such a plan should include performance measures for evaluating capabilities of existing and planned information systems. Additionally, the strategic plan should integrate related strategies and information technology initiatives within HHS for sharing information among federal, state, local, and tribal entities. In responding to the report, HHS stated that a complete strategy for health and public health situational awareness will be developed and incorporated into the Biennial Implementation Plan for the National Health Security Strategy, which will identify actions to be accomplished in the next 2 years. The department added that it intends to release this first biennial plan in early 2011. As discussed in GAO's report, developing a strategic plan that integrates the goals, objectives, and priorities of related strategies will be essential to establishing cohesiveness of HHS's related information technology initiatives, therefore better ensuring the success of the department's efforts to support and enhance nationwide public health situational awareness. To what extent future savings may be expected from this effort are unclear, but more effective planning has the potential to ensure more cost-effective efforts in the future.

GAO expects to complete additional work in the future assessing HHS's progress toward developing and implementing an overall strategic plan for establishing and evaluating an electronic network of systems that meets the information-sharing requirements for enhanced nationwide public health situational awareness defined by law.

Framework for Analysis

The information contained in this analysis is based on the GAO products listed under the "Related GAO Products" tab.

Area Contact

For additional information about this area, contact Valerie C. Melvin at (202) 512-6304 or melvinv@gao.gov.

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