With billions available for public health, it’s time to rebuild

The government is spending billions of dollars to modernize health care and address a crumbling public health technology infrastructure. Yet a lack of clarity on funding allocation and internal coordination, as well as cultural resistance to change, present serious challenges.

The already vulnerable U.S. public health system has been struck with the cataclysmic impact of COVID-19. Without major investments and systemic changes, that system is at risk of failing when the next pandemic or crisis hits. With the government allocating billions of dollars to health care, however, there is a tremendous opportunity to fix one of public health’s biggest problems -- a technology infrastructure featuring aging legacy systems, enormous data silos, lack of interoperability and many other challenges.

Hurdles to success from this funding infusion include a public health culture historically slow to change, resistant to new technologies and with a preference to self-develop systems and platforms. There are also many other complexities -- from disparate systems with little ability to exchange and integrate data to health agencies at the state and local levels spending heavily on independent and manual processes. Witness the billions being spent on contact tracing based primarily on phones and faxes at all levels with no cohesive architecture. These factors may derail technology project funding, prioritizing and success, potentially setting back public health even further. 

In the last year and a half, the federal government has earmarked billions of dollars to the U.S. health care system to help it recover from the COVID-19 pandemic. From the CARES Act, the American Rescue Plan and the FY 2022 discretionary funding, the funding represents a game changer for public health, rural healthcare, provider organizations and others.  The CARES Act and the ARP are promising, yet there are many unknowns and ambiguities.

The ARP, which provides significant funding in response to the pandemic for public health, infrastructure and reporting, is vast at 600 pages long with vague program descriptions and allocation amounts. For example, depending on the analyses, the ARP allocates between $14 billion and $18 billion to upgrade the systems at the Department of Veteran Affairs. Additionally, according to various ARP analyses, either $40 billion or $70 billion is earmarked for COVID-19 vaccination outreach and contact tracing programs while another designates $21 billion. Additionally, there are billions in funds that crossover between these initiatives.  All of this begs the question, “Do we have a plan, and how are we going to knit all these infrastructure investments together for real value?”  We are at the point where the critical question has shifted from “how will we fund this?” to “how do we capitalize on these funding opportunities to build a public health technical infrastructure to support our society for the next 30+ years?”

Rethinking public health IT strategies 

With the ARP funds, the U.S. health system --  including private entities and public agencies -- has a once in a century opportunity to radically modernize the nation’s public health technology.  It is critical stakeholders work quickly across this health ecosystem to establish health system technology infrastructure to be able to respond to the next crisis. Three essential recommendations to maximize this opportunity include:

• Buy, don’t build. Purchase off-the-shelf applications or partner with proven agile development firms serving similar agencies. Public health must let go of its need to self-develop technology systems and data collection tools, which often take years to develop. Commercial technology can meet -- or adapt to -- the needs of public health. One of the most significant advantages these technologies offer is their speed to market. Buyers should know that 80% will be perfect out of the box, while 20% will need refinement. 
• Leverage common, standardized available platforms. With their improved interoperability and data collection capabilities, standard platforms can enable streamlined outreach between public health agencies and community health providers.
• Forge public-private partnerships. Large health systems have spent the last 15+ years working their way through system adoption, interoperability rules and regulations and major market shifts such as a focus on social determinants of health and patient experience. There has never been a better time for public-private partnerships.

Today, public health agencies have unparalleled funding to work with, so let’s build a high-functioning system. If we don’t, we put future generations at risk and task them with rebuilding this critical safety net.