States Aim to Improve Public Health Data in Various Ways

State and local public health officials need timely, accurate data from a wide range of sources—including hospitals, doctors’ offices, and clinical labs—to detect and effectively respond to disease outbreaks, contaminated food and water, and other threats. As part of The Pew Charitable Trusts’ work to advance Americans’ health and well-being, Margaret Arnesen leads state-level research and policy work for the organization’s public health data improvement project, which focuses on enabling the rapid and effective use of health care data to produce better outcomes and lower costs.

This interview has been edited for clarity and length.

Q: How does Pew’s public health data improvement project work with states?

Arnesen: In a few different ways. Partnering on research is one major category of collaboration. And that can take a variety of forms—from multiyear, multifaceted assessments of policies and practices throughout all 50 states and Washington, D.C., to more focused examinations of specific challenges and opportunities to improving states’ reporting and use of public health data.

Our team also provides technical assistance to specific states, working hand in hand with in-state teams that are interested in pursuing various types of policy updates to improve the way public health data is reported. For example, incentivizing automated electronic reporting of key data.

Q: What does that mean?

Arnesen: When time-sensitive threats emerge, public health officials shouldn’t be waiting on and wading through manually transmitted data such as faxes or mail, which can be incomplete and error-prone. Automated electronic reporting helps avoid that by using health information technology—electronic health record systems, for instance—to quickly send priority clinical data such as symptoms, lab results, diagnoses, and demographic details to public health agencies in standardized formats. But sometimes there are barriers, such as competing priorities or limited resources, that make it challenging for health care providers to adopt and implement these systems.

Our research has shown that a mix of approaches that can help drive uptake, from state requirements to federal support of financial incentives, such as the Medicare Promoting Interoperability Program. We are also working with states to better understand and elevate promising data sharing practices, highlighting the potential of what we call cross-sector data sharing.

Q: What’s cross-sector data sharing?

Arnesen: Traditionally, a lot of data relevant to public health has been compartmentalized. Cross-sector data sharing refers to various ways that data can be exchanged or integrated. That could be across programs within a public health department, among different agencies within a state, or even between a state and external partners such as community-based organizations, regional initiatives, or other states or Tribes. The cross-sector approach is really a way that states can get a more comprehensive picture of health issues in their state without creating additional data reporting requirements or otherwise adding to the already hefty administrative burdens of health care providers and public health agencies.

Q: What does this look like in practice?

Arnesen: So, rather than just relying on data from health care settings, the idea is that a state could also pull in data it already has from government departments or programs for housing, family services, poison control, transportation, education, criminal justice, or other areas. This information has traditionally been kept separately. Connecting these different types of data can add more detail and context and can help public health leaders see things and respond in ways that they may not have otherwise. For example, having access to poison control information can help public health teams get a better, more timely understanding of opioid or other drug use and how the opioid epidemic is evolving in their communities.

Q: So why is sharing data across agencies and departments important for public health in particular?

Arnesen: Singular data streams often cannot provide answers to the more complex public health questions that states are trying to answer. There are a lot of benefits when states are intentional about understanding what data they have and exploring how they can use it more effectively. A more complete picture can help public health teams more effectively tackle problems and target improvements. That fuller view of health issues and needs also helps states maximize often limited resources to better focus efforts where they can have the most impact—something that feels particularly crucial in public health, where funding often ebbs and flows dramatically from year to year.

Cross-sector data sharing can also help states see if their public health interventions are making a measurable difference and to what degree—or, conversely, if a program isn’t moving the needle. As a person who spent years working in public health at the state level, I have to say this ability to inform program evaluation is particularly exciting and so valuable.

Q: Why is Pew working with different states versus pursuing improvements at a federal level?

Arnesen: Well, it’s not an either-or choice from our perspective. State-based work is important and so is federal-level work. Pew’s public health data improvement project focuses on both.

States are where much of the public health authority resides in the U.S. That includes the legislative and regulatory power to determine when, how, and what public health data is reported, which also means that states are typically leading on-the-ground responses to public health threats—whether it’s an outbreak of food-borne illness or contagious disease, or a spike in opioid overdoses or unusual symptoms among people drinking a town’s water. So any effort to improve public health data reporting really has to include state-level action. And every state is different. Although there are certainly similarities and insights that can be applied across the country, considerations and needs in a large state with lots of remote areas like Alaska are going to vary greatly from a small and compact state like Rhode Island. And whether it’s geography, health infrastructure, available resources, or other factors, states need to be able to customize their approach in a way that best meets the needs of their people.

Q: What has Pew heard and learned from states that have been working to improve public health data?

Arnesen: Over the past few years, we’ve talked to hundreds of providers and public health leaders in all 50 states and in Washington, D.C. Every jurisdiction is different, but we’ve seen a few common threads worth highlighting.

Smart policies and modern technologies are essential to improving public health data, but they alone are not enough. We’ve heard time and time again about the critical role of relationships, leadership commitment, and organizational culture, each of which can be a barrier to or a facilitator of effective public health data collection, reporting, and use.

We’ve also heard that public health data sharing needs to be a two-way street. If health care providers are going to have to report data to public health, they want to benefit as well. And increasingly, states are finding ways to make that happen while still prioritizing privacy and ensuring sensitive data is protected. For example, when providers can access a dashboard or public health data portal with timely information about outbreaks or seasonal disease, like flu in their region—beyond what they may know from just their practice or local network—that additional information and context can help inform decisions on testing or screening and improve patient care. And the advantages of such efforts can go beyond data access. We’ve heard from leaders of state agencies participating in cross-sector data sharing initiatives that those agencies also valued associated improvements to data infrastructure, more regular communication with other agencies, and other benefits related to but separate from the data sharing itself.

Q: What do you hope state policymakers and public health leaders will take away from Pew’s work in this space?

Arnesen: There is a lot of good coming from states’ leadership on public health data improvement. Whether they’re bringing different agencies and data sources together in new ways or leveraging technology to make data reporting faster and more useful, states are making changes that are benefiting their people and their budgetary bottom line.

Every state truly is unique and there is no single approach to data improvement. That said, there is something that every state can do. Maybe it’s piloting a small change with a community health system or updating a data sharing agreement between two government agencies. And I hope state leaders continue to see the promise of these efforts and pursue them—because the opportunity is great and they know their communities best.

And, in that vein, I also hope states will check out Pew’s resources, reach out to have a conversation, and consider working with us toward longer-term change. We relish the opportunities to partner with states and to use our expertise and capacity to help improve not just the data but ultimately people’s health.