Public Health Information Technology:

Additional Strategic Planning Needed to Guide HHS's Efforts to Establish Electronic Situational Awareness Capabilities

GAO-11-99: Published: Dec 17, 2010. Publicly Released: Dec 17, 2010.

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A catastrophic public health event could threaten our national security and cause hundreds of thousands of casualties. Recognizing the need for efficient sharing of real-time information to help prevent devastating consequences of public health emergencies, Congress included in the Pandemic and All-Hazards Preparedness Act in December 2006 a mandate for the Secretary of the Department of Health and Human Services (HHS), in collaboration with state, local, and tribal public health officials, to develop and deliver to Congress a strategic plan for the establishment and evaluation of an electronic nationwide public health situational awareness capability. Pursuant to requirements of the act, GAO reviewed HHS's plans for and status of efforts to implement these capabilities, described collaborative efforts to establish a network, and determined grants authorized by the act and awarded to public health entities. GAO assessed relevant strategic planning documents and interviewed HHS officials and public health stakeholders.

HHS did not develop and deliver to congressional committees a strategic plan that demonstrated the steps to be taken toward the establishment and evaluation of an electronic public health situational awareness network, as required by PAHPA. While multiple offices within HHS have developed related strategies that could contribute to a comprehensive strategic plan for an electronic public health information network to enhance situational awareness, these strategies were not developed for this purpose. Instead, the offices developed the strategies to address their specific goals, objectives, and priorities and to meet requirements of executive and statutory authorities that mandated the development of strategies for nationwide health information exchange, coordinated biosurveillance, and health security. However, HHS has not defined a comprehensive strategic plan that identifies goals, objectives, activities, and priorities and that integrates related strategies to achieve the unified electronic nationwide situational awareness capability required by PAHPA. The department has developed and implemented information technology systems intended to enable electronic information sharing to support early detection of and response to public health emergencies; however, these systems were not developed as part of a comprehensive, coordinated strategic plan as required by PAHPA. Instead, they were developed to support ongoing public health activities over the past decade, such as disease and syndromic surveillance. Without the guidance and direction that would be provided by an overall strategic plan that defines requirements for establishing and evaluating the capabilities of existing and planned information systems, HHS cannot be assured that its resources are being effectively used to develop and implement systems that are able to collect, analyze, and share the information needed to fulfill requirements for an electronic nationwide public health situational awareness capability. HHS has engaged in collaborative efforts to improve information technology capabilities to share situational awareness information. For example, HHS has collaborated with public and private health care partners to establish standards, services, and policies that support the electronic exchange of interoperable health care and public health data to support electronic sharing of information for biosurveillance purposes. The department has also awarded funds through cooperative agreement programs to state and local public health entities intended to improve capabilities to detect public health emergencies and to identify emergency response resources. Although the act authorized the use of funds for the award of grants to states to establish statewide or regional public health situational awareness systems, to date, Congress has not appropriated funds pursuant to the authorization. GAO is recommending that HHS develop and implement a strategic plan to guide and integrate efforts to establish electronic situational awareness capabilities. In written comments on a draft of the report, HHS neither agreed nor disagreed with GAO's recommendation, but stated that a complete strategy would be developed.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: In commenting on the report, the Department of Health and Human Services Assistant Secretary for Legislation neither agreed nor disagreed with our recommendations. Nonetheless, in December 2014, HHS issued the National Health Security Strategy and Implementation Plan 2015-2018 which identifies objectives, priorities, and activities for establishing an electronic nationwide public health situational awareness network to share real-time information to help prevent devastating consequences of public health emergencies. For example, the plan identifies the establishment of a network that provides near real-time information on the status of the population's health, as a key component of its objective to ensure comprehensive health situational awareness. Additionally, the implementation plan prioritizes activities for establishing this network, such as addressing technology and policy challenges to ensure the compatibility of systems to collect, integrate, and share data. It also identifies activities to undertake in order to achieve these objectives, such as standardizing data elements and developing data-sharing agreements. By taking these steps, HHS has made important progress toward developing a coordinated strategic plan for establishing the nationwide public health situational awareness network mandated by the Pandemic and All-Hazards Preparedness Act.

    Recommendation: To address the requirements of PAHPA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to immediately lead efforts, in collaboration with other federal, state, local, and tribal public health officials, to develop and implement 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 the act. The strategy should define specific goals, objectives, priorities, and activities for establishing the network.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Not Implemented

    Comments: In commenting on the report, the Department of Health and Human Services Assistant Secretary for Legislation neither agreed nor disagreed with our recommendations. Nonetheless, in responding to this recommendation, department officials stated that the Biennial Implementation Plan for the National Health Security Strategy, issued in May 2012 and updated in December 2014, was to include a complete strategic plan for such a network. However, while the National Health Security Strategy and Implementation Plan 2015 - 2018 is intended to provide strategic direction for achieving national health security through 2018, it does not define performance measures necessary to evaluate the capabilities of existing and planned information systems. Furthermore, the department has not indicated that it intends to take actions to define such measures. Lacking a complete strategy and implementation plan that identifies and demonstrates measurable steps required by the Pandemic and All-Hazards Preparedness Act for establishing and evaluating network capabilities needed to enhance electronic information sharing, the department continues to fall short of meeting requirements stated in the law and cannot have reasonable assurance that the outcomes of its actions meet the goals and objectives for enhanced nationwide public health situational awareness.

    Recommendation: To address the requirements of PAHPA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to immediately lead efforts, in collaboration with other federal, state, local, and tribal public health officials, to develop and implement 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 the act. The strategy should identify steps and performance measures for evaluating capabilities of existing and planned information systems to establish the network.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Not Implemented

    Comments: In commenting on the report, the Department of Health and Human Services Assistant Secretary for Legislation neither agreed nor disagreed with our recommendations. Nonetheless, in responding to this recommendation, department officials stated that the Biennial Implementation Plan for the National Health Security Strategy, issued in May 2012 and updated in December 2014, was to include a complete strategic plan for such a network. However, while the National Health Security Strategy and Implementation Plan 2015 - 2018 defines strategies for better coordinating federal, state, local, and tribal activities to achieve nationwide situational awareness, it does not describe how elements of various departmental information technology strategies and initiatives could be integrated to better support the sharing of information among public health entities. Furthermore, the department has not indicated that it has plans to address this recommendation. Lacking a complete strategy that integrates related strategies, the department will not be able to ensure that the various offices across HHS coordinate their strategic planning efforts to meet the requirements of the Pandemic and All-Hazards Preparedness Act.

    Recommendation: To address the requirements of PAHPA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to immediately lead efforts, in collaboration with other federal, state, local, and tribal public health officials, to develop and implement 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 the act. The strategy should integrate elements of related strategies to achieve unified electronic public health situational awareness capabilities defined by PAHPA.

    Agency Affected: Department of Health and Human Services

 

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