Public health agencies at the state, county, and municipal levels have worked together to stop the deadly COVID-19 virus for over two years. During this time, they’ve had successes and failures as they labored to keep their citizens safe while dealing with one of the most significant public health crises in history. Many lessons were learned during this time, especially about the importance of a coordinated effort and the vital need to share data. These agencies now want to turn these lessons into institutional knowledge by making it easier for departments to collaborate and share information.
The unprecedented spread of COVID caught many agencies flatfooted, and they needed to move exceptionally quickly to mount a response. In most units, there is one team dedicated to recording immunization records and another one focused on tracking the spread of diseases. The immunization team uses Immunization Information Systems (IIS), which tracks which vaccines citizens have been inoculated with, from COVID-19 to childhood vaccines like MMR (measles, mumps, and rubella). The disease experts use the Electronic Disease Surveillance System (EDSS) to collect vital information to monitor communicable infections ranging from COVID and monkeypox to STIs and hepatitis.
Pre-pandemic and across jurisdictions, these two teams varied in how closely they worked together. In most situations, the IIS and the EDSS as applications had little interoperability—limited to no systemic integration or sharing of data. However, once the multiple COVID vaccines were approved, it became apparent how necessary coordination and collaboration between these two teams would be. The limited interoperability forced many health departments (and these teams) to try and create workarounds. Some would use manual means, like paper or faxed forms, or attempt to jury-rig code to make two different systems communicate, with corresponding quality and capacity concerns. Today, many health units are seeing an influx of money, and leadership should prioritize the modernization of this vital infrastructure to help manage future health crises.
Modernization should include interoperable EDSS and IIS systems, which would provide several benefits to assist a public health department in being agile. Integration of these systems can track vaccine efficacy, detect, and predict hotspots, and generate better outcomes for citizens.
Knowing the efficacy of a vaccine is essential to understanding risk and creating a schedule for follow-up or booster shots. One method of tracking efficacy is through identifying breakthrough infections — where a vaccinated person still contracts the disease. This requires the EDSS system to collect data about the infected individual and cross-reference it with the IIS to see when or if they were inoculated and with which vaccine.
The disease surveillance and immunization teams must accomplish this task quickly to disseminate the data to local, state or federal leaders. Those leaders need this data to develop an understanding of how effectively the vaccine prevents sickness. This entire process can have complexities to it. For example, there are four COVID vaccines approved by the FDA (Pfizer-BioNTech, Moderna, Novavax, and Johnson & Johnson). Some people got one shot of Moderna and one of Pfizer with yet another booster option now available.
Integrating EDSS and IIS also will allow public health units to respond to outbreaks more efficiently. When the disease surveillance team sees an indicator that an area will become a likely hotspot, the immunization team can spring into action and attempt to mitigate the issue in several ways, depending on the disease. If a vaccine is available, a vaccination campaign will help protect as many people as possible. As seen with COVID’s new variants (BA.5) or monkeypox, this becomes even more important.
If no vaccine is available, public health teams can raise awareness about the disease and educate people in avoidance and safety. Having the ability to be aware of where or who is affected can lead to sharing information with those most at-risk. COVID, for example, could best be avoided by maintaining social distancing, masking wherever possible, and maintaining good hand hygiene. With a better integrated EDSS and IIS systems, this sort of information can be shared by the public health teams with a community-specific focus.
An interoperable EDSS and IIS will likely lead to better outcomes for citizens, especially for future health crises. Identifying a potential outbreak early and minimizing its spread will prevent illnesses, lower the strain on the local healthcare system, and potentially reduce deaths. When an outbreak does happen, the public health unit will have the data and insights to focus on areas with the greatest need instead of using a haphazard approach. That will reduce costs and have a more meaningful impact on its response.
Pandemics are, thankfully, rare events. But they are random, so we never know when the next one will strike. Lessons learned from COVID will help public health departments respond to future outbreaks. The best course of action is to be vigilant in identifying when one might occur as early as possible. Optimized integration between public health systems and teams will greatly assist leadership in taking the correct action at the right time.
Ted Hill is a senior vice president at SSG, where he specializes in digital transformation and interoperability in the public health sector. He has successfully led a variety of IT initiatives, including Early Intervention, healthcare exchange (HIX), and MMIS, and manages programs that ensure the effective implementation of systems and business process innovation for the agencies SSG partners with. He holds a Bachelor of Science degree in political science and government from MIT.
Ted Hill is SVP at SSG.
