Public Health Information Technology: HHS Has Made Little Progress toward Implementing Enhanced Situational Awareness Network Capabilities
Highlights
What GAO Found
The Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA) required the Secretary of Health and Human Services (HHS) to establish an electronic nationwide public health situational awareness network and to develop an implementation plan to guide its efforts. The law further required HHS to include in its plan specific activities for incorporating data into the network. HHS developed an implementation plan that identified several actions related to enhancing existing information-sharing capabilities needed to establish the network. However, the actions identified in the plan did not address all of the required activities, such as defining data elements and standards. Until the department addresses all required activities, it will lack an effective tool for ensuring that public health situational awareness network capabilities have been established in accordance with all of the requirements defined by the law.
In addition, HHS did not identify measurable steps for completing and tracking the status of the activities required by the law. PAHPRA required HHS to include in its plan the measurable steps to be taken to establish the network. Federal guidance also suggests that implementation plans identify timelines of tasks, cost and resource estimates, and performance metrics that can be used to track and monitor progress toward completing tasks and delivering expected outcomes. According to HHS officials who developed the implementation plan, the department established a committee of policy and planning experts from various federal agencies to define the measurable steps for completing the actions identified in the plan. However, HHS did not assign responsibilities for defining such steps to the committee, and the committee had not done so. Until the department defines measurable steps, it will not have the information and planning tools it needs to make progress toward establishing a network that provides information-sharing capabilities needed by public health entities to prepare for and respond to emergencies, as required by PAHPRA.
GAO identified other weaknesses in HHS's planning efforts that have contributed to the department's lack of progress toward establishing the network. Specifically, HHS did not follow guidance developed by its Chief Information Officer (CIO) for managing information technology (IT) resources. According to the guidance, officials who manage IT initiatives are to involve a governance organization led by HHS's CIO and designate a project team that includes a project manager and business owner. The team is to manage and oversee initiatives according to the guidance, including the development of a project management plan that identifies timelines and schedules, estimated project resources and costs, and performance metrics for tracking any progress made toward completing tasks and delivering expected outcomes. However, HHS did not designate such a team and did not involve the CIO in its planning efforts. As such, the department lacks the structure and mechanisms needed to plan, manage, and oversee actions for establishing the network. Until HHS adheres to its own guidance for managing the IT resources necessary to improve electronic information-sharing capabilities of systems and networks in use by public health entities throughout the country, it will likely continue to fall short in its efforts to establish the nationwide public health situational awareness network required by PAHPRA.
Why GAO Did This Study
A public health event, such as a widespread disease outbreak or health problems resulting from a weather-related emergency, could have catastrophic consequences for the nation. These potential threats can be partially mitigated by having a national public health situational awareness capability—that is, a capability for public health officials to be able to access real-time information about emerging threats to enable them to make timely, responsive decisions to prepare for and respond to emergencies. PAHPRA required HHS to establish a near real-time electronic nationwide public health situational awareness capability through an interoperable network of systems.
PAHPRA also included a provision for GAO to evaluate HHS's progress in developing such a capability. This report addresses what progress HHS has made toward establishing the network. GAO analyzed documents describing HHS's plan for enhancing public health situational awareness and evaluated evidence of actions taken by HHS to establish the network required by PAHPRA. GAO also examined the department's IT planning and management processes and guidance, and interviewed HHS officials.
Recommendations
GAO is recommending that HHS complete a plan that includes all actions for establishing the network, develop a project management plan that identifies measurable steps for completing the actions, and conduct IT management processes according to CIO guidance. HHS had no comments on the report or recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | To ensure progress is made toward the implementation of any IT enhancements needed to establish electronic public health situational awareness network capabilities mandated by PAHPRA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to task an integrated project team, made up of an IT project manager and business owner, with including specific actions in the Public Health and Medical Situational Awareness Strategy Implementation Plan for conducting all activities required to establish and operate the network. |
In April 2023, HHS officials stated that they considered HHS Protect to be the public health situational awareness system that meets the requirements within the section of PAHPRA requiring a situational awareness capability. According to HHS officials, for the COVID-19 pandemic, HHS Protect has served as the common operational picture for HHS. The officials added that HHS Protect has enabled sharing data in near-real time across federal agencies, state, local, territorial, and tribal stakeholders since 2020. HHS stated that in 2020, the Administration for Strategic Preparedness and Response (ASPR), Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services, and the Office of the Chief Information Officer formed a working group for public health data. They stated that this group is co-led by CDC and ASPR and is being leveraged primarily in the hospital data space. In addition, HHS officials stated that both an executive board and steering committee have been created for situational awareness for public health emergencies. The executive board has representation from ASPR, CDC, and the HHS Deputy Secretary's Office and the Steering Committee is co-led by ASPR and CDC. However, HHS Protect does not currently meet the requirements of the network required by PAHPRA. HHS plans to expand HHS Protect beyond its current capabilities, but the department had not developed plans detailing those efforts. In addition, the working group, executive board, and steering committee have not been tasked with specific actions to develop plans for conducting activities needed to ensure that HHS Protect will achieve the capabilities of the network required by PAHPRA. As of March 2024, the agency had no further updates on their efforts. We will continue to monitor the actions HHS takes to implement this recommendation.
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| Department of Health and Human Services | To ensure progress is made toward the implementation of any IT enhancements needed to establish electronic public health situational awareness network capabilities mandated by PAHPRA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to task the integrated project team with developing a project management plan that includes measurable steps--including a timeline of tasks, resource requirements, estimates of costs, and performance metrics--that can be used to guide and monitor HHS's actions to establish the network defined in the plans. |
As of April 2023, HHS officials stated that the HHS Protect system is currently serving as the common operating picture (COP) for public health emergencies to meet the goals of a public health situational awareness network mandated by PAHPRA. According to the officials, the COP is to build on the successes of HHS Protect and fully establish an all-hazards near real-time, electronic, nationwide public health COP for 24/7 situational awareness data for use during and in between emergency responses. Officials added that the FY 2024 President's Budget includes $60 million for supporting the next generation of HHS Protect, called the Response Ready Enterprise Data Integration platform, to enhance their efforts for realizing the vision laid out in PAHPRA. However, HHS has not developed a project management plan for their efforts to enhance HHS Protect through the Response Ready Enterprise Data Integration platform. As of March 2024, the agency had no further updates on their efforts. We will continue to monitor the actions HHS takes to implement this recommendation.
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| Department of Health and Human Services | To ensure progress is made toward the implementation of any IT enhancements needed to establish electronic public health situational awareness network capabilities mandated by PAHPRA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to conduct all IT management and oversight processes related to the establishment of the network in accordance with Enterprise Performance Life Cycle Framework guidance, under the leadership of the HHS CIO. |
As of April 2023, HHS officials stated that next generation of HHS Protect, called the Response Ready Enterprise Data Integration platform, will enhance their efforts for realizing the vision of an electronic public health situational network capability mandated by PAHPRA. HHS stated that the platform is awaiting notification of available funding, which will enable the department to ensure that all IT management and oversight processes related to the establishment of the network are in accordance with Enterprise Performance Life Cycle Framework guidance. As of March 2024, the agency had no further updates on their efforts. We will continue to monitor the actions HHS takes to implement this recommendation.
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