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Interoperability Key

December 1, 2007
by Richard Edwards
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Public health departments dealing with legacy systems should look to connect

Richard Edwards

Richard Edwards

America has been challenged to improve the quality of its public health. Our federal, state, and local public health agencies are facing a crisis in developing the capacity to respond to terrorist events, emerging infectious diseases, and other public health threats and emergencies. These potential events emphasize the importance of gaining access to that data, collecting and safely storing it, and developing a vigorous national public health informatics system.

Though it appears many states are implementing IT to streamline and improve public health services, there are disparate IT systems from state to state and within the federal government. Having such a large number of different platforms that do not have the capability to intercommunicate certainly hampers communications with other federal, state, or local public health agencies.

State-to-state Web-based communications could allow stakeholders to interchange electronic medical and financial transactions within a comprehensive data delivery system without disclosing privacy information.

A federal system infrastructure should provide the core elements of public health technology. To facilitate veterans' health access and interoperability with the civilian medical sector, the Veterans Health Administration (VHA) should strive to improve resource integration and healthcare service delivery between the VHA and the civilian medical sector.

Similar to civilian healthcare facilities, the VHA should reduce the burden of manual reporting by developing an electronic data system that can provide comparable informatics functions for the veteran population. By implementing this as a model, the veteran population's health services will no longer be geographically limited.

When assessing the need for national and statewide systems, an effective public health informatics system can be significant in responding to new public health challenges and threats. There are enough problems sharing information internally and more difficulties when attempting to transmit data to county agencies. Establishing an interlinked IT system between the VHA and the civilian medical sector could facilitate statewide communication expansion through the Internet. This should enhance the potential for nationwide communication through a unified or symmetrical informatics system.

This infrastructure should include specifications for broader functional needs as well as establish the necessary components to support interoperability. Interoperability defines system ability to securely and automatically send and receive information through a live network for public health data interchange between federal, state, and local public health agencies. This creates the ability to access health information virtually in real time, thus creating an additional need for interconnected systems.

An effective public health informatics system requires the system-level infrastructure that permits additional system connections. It also permits later integration of unplanned components, such as additional state or local government public health agency systems. The success of this type of infrastructure is crucial to integrating, interlinking, and adapting this system into a national public health informatics network. If this is implemented, then public health informatics could merge the veteran and civilian populations into a unified national database.

There have been billions of public dollars, such as grants, invested in informatics, but each year more of those dollars are diverted to other government programs such as the Department of Defense, social, and welfare programs, rather than public health informatics systems. And investments have not been commensurate with initial expectations and needs. Obviously, simple implementation of an informatics system does not translate automatically into an asset. Newer systems that are proving to be efficient, safe, and functional across the national public health continuum are promising for integration.

Many organizations own heterogeneous collections of computing equipment that may be unique to the public health agency's needs. Because of these incompatibilities in public health informatics, dissimilar systems could only function in isolation. Exchanging information between systems usually requires some form of reformatting or manual reentry of the information. The demands for public health system unification between the veteran and civilian population have led to a significant demand for system interconnectivity. However, basic connectivity is not enough. With so many public health agency interactions, hardware and software applications demand true interoperability.

The need to combine legacy systems with new systems is a continual source of problems for public health agencies. These agencies have invested large sums in information technology. They cannot afford to dispose of their antiquated systems and invest in current systems. However, it is the innovation of newer systems that should diminish the continual perpetuation of heterogeneous systems. This will enhance the probability that all of these systems could be interlinked. The databases and operation applications embedded within current systems are strategically important assets which are integrally related to the respective agency's operations.

The growing need for a national public health system has prompted public health agencies to search for new applications and sources of system integration and interconnectivity. The advent of newer systems should inspire governmental and local agency organizations to quickly apply the technology.