ORLANDO – Since its inception, the Office of the National Coordinator for Health IT has "defied physics to a certain degree," moving both "fast and slow at the same time," said Steve Posnack, deputy national coordinator for health IT, as he opened a thought leadership session Tuesday at HIMSS24 that featured Dr. Mandy Cohen, director of the Centers for Disease Control, and focused on the nexus of healthcare IT and public health.

"To know what our future looks like, we have to respect and understand how much progress we've made over the past 20 years, which I've played a large part in and had a great experience in being part of the ONC team from almost the beginning there," Posnack said.

While the care continuum still needs to make progress on digital transformation, he said, ONC will focus on the public health side of interoperability in the next edition of healthcare IT certification rules – HTI-2. 

While HTI-1 became effective Monday, Micky Tripathi, national coordinator for health IT told Healthcare IT News last month that ONC's 2024 interoperability roadmap includes the HTI-2 update, "because there is more business that we need to finish." The update will include better standardization for public health, so it's "more efficient and more effective," Tripathi said. 

Also on Tuesday, ONC published a blog post authored by Tripathi on the agency's commitment to "better health enabled by data," which noted that in developing the next iteration of the healthcare IT certification program, CDC and ONC will work with state, territory, local and tribal partners "to develop and implement a coordinated, phased approach to certification for public health use cases."

Health IT has made significant progress

Posnack reflected on how the stages of meaningful use "felt like it was taking forever," but he said when he looks back, he is impressed that in a span of about five or six years, there was a rapid surge in the uptake of digital health records by hospitals and the majority of office-based physicians.

"There was a very short period of time in which we made significant progress in our nation's health IT and digital health infrastructure," he said.

"That's really something to be proud of and something on which we built a lot more progress and change."

Later in the conversation, Cohen said that public health too experienced a similar physics-defying moment with the COVID-19 pandemic. 

"It's a hard lesson about the siloing of public health and the health delivery system," she said as she addressed rapid changes, like the "Kill the fax" program she spearheaded when she led the North Carolina Department of Health and Human Services during COVID-19.

"We now have integrated lab data exchange in every part of this country, which is fantastic," she said.

From a data perspective, public health data silos hamper the country's ability to respond and protect from viruses and other population health threats.

However, Cohen said that she sees public health "taking some big leaps forward to catch up, and maybe even leapfrog ahead." 

"Learn a lot of lessons, as [Posnack] said, fast and slow." 

Cohen added that she hopes that people see a difference now in the way the post-pandemic CDC operates.

"The most immediate: I hope you see us sharing information quickly, translating science into action more easily, prioritizing and monitoring how we speak and what we do with communication," she said. "We want to break down silos because public health cannot protect health alone. This has to be a team sport."

The "silver lining" of what public health experienced during the crisis was "incredible partnerships," Cohen added. "I saw it in North Carolina, where we had competitive health systems come together to achieve a common goal for the state … like I've never seen before."

Partnerships, TEFCA can boost public health

Where COVID-19 broke competition, Cohen said she does not want to see all the partnering entities go back to their corners.

To embed those lessons learned in public health, it "all nests within the overall [U.S. Health and Human Services] data strategy," she said. "The way that I think about knitting together public health and health delivery system is through our data systems," she said.

Cohen credited ONC and National Coordinator Micky Tripathi for being a great partner in moving data transformation forward. 

Public health has come to digital later than other parts of healthcare, "because we were under-resourced," she said.

"But TEFCA – thank you," she said, referring to ONC's Trusted Exchange Framework and Common Agreement interoperability effort.

TEFCA "can really accelerate us forward," she explained, adding her appreciation for the USCDI+ public health standards. 

Public health interoperability needs federal leadership

"I've really seen a ton of progress, first at the state level, and now had the opportunity to see it up close as a partner at CDC," Cohen said. 

While the partnership with the states is there, CDC is trying to understand what barriers exist for public health data systems at the local level. 

"Folks want direction," she said. "That's what I hear from leaders across the country … they want to make sure they're building in a way that feels aligned."

Posnack added: "That's an area of collaboration for us in terms of using both our levers together."

Where CDC has funding opportunities for state and local public health agencies, ONC can support their health IT on the certification side, he added.

The federal agency representatives also stressed that they do not intend to start over from ground zero.

"If I have one message for you to take home, it is about the fact that we are not building a public health infrastructure for data."

However, in order to detect and monitor public health threats and respond quickly, "we have to make these investments," she said. "I think we have seen that, when we can't do that, we are paralyzed, and we are not as healthy, and we are not as safe."

That's why, "I want folks in the health delivery IT space to articulate, 'Hey, public health is moving in the right direction here,' to our lawmakers," said Cohen.

In the 2025 budget, the Biden Administration included substantial funding for data modernization, but 80% of CDC funding goes directly to state public health agencies, she said.

"It's for the entire network – to make sure that we are ready for whatever next health threat comes."

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication