Enabling the future of US public health through technology

| Article

The COVID-19 pandemic tested the technological and personnel capacities of state public-health systems across the United States. In some cases, these systems struggled to meet stakeholder and constituent expectations around speed, confidence, and agility. Even where states have upgraded their systems in response to the pandemic, investment in areas such as disease surveillance and case reporting was often focused largely on crisis response rather than integrated into the broader health ecosystem. But as COVID-19 shifts toward becoming an endemic disease, state and local jurisdictions have a rare opportunity to marshal federal funding and stakeholder attention to modernize their data and technology infrastructure to become nimbler, more efficient, and more effective at achieving key public-health objectives.

The challenge now is to build an integrated public-health infrastructure that brings together relevant authorities, healthcare facilities, and laboratories while allowing states to apply hard-won lessons learned from recent history to other public-health arenas, including future pandemic preparedness, behavioral and mental health, chronic disease management, and maternal and infant health.

The case for change

During the COVID-19 pandemic, state and local public-health personnel used available data and technology resources to selectively modernize their most critical infrastructure related to testing, contact tracing, vaccine scheduling, and vaccine management. These investments were vital to immediate COVID-19 response efforts, but they were often fragmented and reactive, leaving the public-health system with infrastructure gaps, outdated technology, deep data siloes, and serious bottlenecks in information flow. State and local agencies often have to grapple with one or more of four types of tech-related challenges that may impede effective crisis response and stand in the way of achieving core public-health goals: outdated systems, insufficient automation, too little interagency communication, and underinvestment in organizational development.

Outdated systems

As the technology landscape continues to evolve, public-health systems may need to keep pace to drive better outcomes. For example, existing disease-reporting systems in many states may need to be phased out and replaced with more scalable systems that can generate more powerful insights.

Public-health departments are aware of the technological challenges they face. In a 2021 McKinsey survey of 171 public-health data and IT decision-makers, 60 percent reported having average or below-average capabilities on system flexibility, comprehensive ability to track patient journeys, and standardized data processes, policies, and programs.

Insufficient automation

More than 60 percent of state and 70 percent of local respondents reported that their data-collection processes were not automated enough. Data processing in some public-health settings still relies on paper documentation or manual data entry with limited quality control.

For example, many agencies used stand-alone spreadsheets for syndromic-surveillance reporting during the pandemic, often a different one for every day. This highly manual method had multiple drawbacks, including challenges in determining trends data, inaccuracies in reporting and information silos, and exposure to knowledge drains when employees departed.

Vaccination providers also often relied on manual data entry to record key information about target populations, which resulted in significant data gaps and inaccuracies for several states.

Too little interagency communication

A lack of clearly established processes for information sharing between agencies can impede coordination among health departments and hobble responses to public-health crises. Siloed state systems can make it more difficult for agencies to see the big picture and track the spread of communicable diseases.

Underinvestment in organizational development

Many public-health agencies suffer from chronic underinvestment in the capacity and capabilities of their tech talent.

As a result, technical and analytics capabilities have often been stretched thin to meet the demands of COVID-19 reporting, drawing resources away from other reporting efforts. When subject-matter experts are overwhelmed, it leaves them little time to engage and participate in key technology and data decisions.

Since IT staff are typically funded by and tied to unique systems, talent often cannot be deployed across programs, which undermines efforts to make public-health agencies flexible and agile.

The tech talent at public-health agencies spends so much time maintaining redundant legacy applications that they rarely have the opportunity to participate in reskilling or upskilling programs to gain experience working at the cutting edge of their field.

Potential actions for state, public-health, and technology leaders

State, public-health, and technology leaders could play a vital role in making the public-health sector more resilient, responsive, and effective using technology and data. We have identified five distinct areas that could help leaders drive this effort.

State, public-health, and technology leaders could play a vital role in making the public-health sector more resilient, responsive, and effective using technology and data.

Establish joint leadership across the governor’s office, the public-health agency, and IT

Successful transitions often start with a vision that sets a North Star for all stakeholders, and the same may hold true for accelerating the future of public health. To articulate this vision and keep efforts focused, senior executives could establish a joint leadership team bridging the governor’s office, the public-health agency or department, and the central IT and analytics teams. This committee could define a vision for how to transform the public-health technology infrastructure across critical domains in a way that aligns with the priorities of each organization. For example, the governor’s office could prioritize public-health outcomes, the public-health agency could focus on improved programs and processes, and the IT department could push for the technical capabilities needed to enable the agency to act effectively while making informed, data-driven decisions. Together, these leaders could lay a strong foundation for successful transformation by distilling a clear, shared, compelling vision that shows all parties which tech investments should be prioritized and establishes an effective operating model for implementing them.

Focus on human capital alongside infrastructure and applications

Human capital is a critical enabler of a solid public-health infrastructure. Identifying the right talent often entails a significant commitment from both technology and agency leaders. Leaders can have a big impact by stepping up and taking responsibility for modernizing tech infrastructure, while also giving HR the resources and flexibility to recruit and retain talent capable of developing high-priority use cases. This could include reassigning or reskilling existing staff, hiring new staff, and bringing in vendors or contractors.

In this effort, two types of workers may prove supremely valuable: those with the skills and agile mindset to develop and scale digital solutions, and those who can harness insights and take on leadership roles to drive policy and program decisions.

Hiring processes for many public-sector roles are often slow because of bureaucratic procedures. As states initiate talent-development plans to attract and retain employees, they could make themselves more appealing to prospective hires by streamlining job descriptions, accelerating hiring processes, and experimenting with various incentives.1

Of course, before agencies look for external talent, it may make sense to evaluate their existing staff to see where training programs, applied learning, and coaching could fill in skills gaps and deepen their internal talent pool. Inspirational leadership can help with retaining in-demand tech workers. To this end, agencies may need to invest in hiring and developing leaders with the skills and temperament to manage challenging modernization programs.

Modernize technology capabilities and infrastructure while achieving quick improvements

The current technology landscape in most states is complex and generally reliant on duplicative legacy applications. For example, one northeastern state runs 450 enterprise applications within its department of health. This means that agencies have plentiful opportunities to consolidate, rationalize, and standardize the application stack. By streamlining the application stack, agencies could increase the speed of delivery, decrease time to market, and open opportunities to deploy cutting-edge technologies in areas such as artificial intelligence and robotic process automation. By modernizing their tech infrastructure, agencies could also reduce the costs, security concerns, and privacy risks associated with ongoing maintenance of outdated legacy systems (see sidebar “Quick improvements can build momentum toward broader tech-modernization goals”).

Drive progress with prioritized use cases

States could benefit from looking at their existing list of use cases, including those identified during the pandemic, and prioritizing those with the greatest potential to build momentum and generate quick wins while laying the groundwork for a broader long-term transformation (see sidebar “The five essential parts of a use case”). Major prioritization criteria could include the importance of use cases to a state’s priorities, the measurable impact and return on investment within six months, and the ability to drive impact regardless of future funding.

Although these prioritization criteria can be equally useful from one state to the next, each state may still come to different conclusions about which use cases to pursue first. For example, one state that invested in automation to quickly identify viral surges during the COVID-19 pandemic decided to leverage its experience and expand this automation to other communicable diseases. Another state decided to look beyond infectious diseases and pursue use cases around health equity, maternal and child health, mental and behavioral health, environmental health, and opioid-use disorders.

Set up an integrated program management office

Agencies may achieve the greatest impact by driving the public-health transformation through a centralized team to ensure ownership, build capabilities, monitor organizational health, put necessary enablers in place, and make sure stakeholders are on the same page. By setting up a public-health transformation management office (TMO), agencies could lay the foundation for broad strategic-planning initiatives while also incorporating lessons from past public-health crises into current planning efforts. The TMO could also serve as the intermediary, promoting seamless integration between use-case initiatives and operational capabilities such as HR and finance. Having an agile TMO may allow leaders to adapt priorities quickly in the face of a rapidly changing technology landscape. And agile transformation could help public-sector leaders achieve success in improving service delivery.

Agencies could create an effective operating model for the TMO by crystallizing answers to key design questions, which might include: What defined scope and vision will the TMO oversee? Who has the decision-making authority? Who is responsible for delivery and how will they be held accountable? How should impact be tracked and evaluated over the course of the transformation? Various answers are possible and will need to be tailored to the agency in question, but getting to clarity and alignment is critical so that the TMO can operate smoothly and be empowered to drive change within the organization.

Public-health agencies have been tested and can expect more trials in the future. Technology has a place at the forefront of public-health operations: integrating COVID-19 activities into day-to-day operations, preparing for new pandemics, and addressing long-standing public-health priorities. It can serve as an enduring force multiplier, particularly in the face of ongoing workforce and funding challenges. While the above actions entail additional costs and effort, implementing them could yield outcomes that benefit a broad constituency of users—improving other government agencies’ efficiency, timeliness, and visibility of information, as well as citizens’ health and wellness outcomes.

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