Page 29 - Driving Public Health in the Fast Lane

to both the epidemiologists and health care providers. With the lack of infrastructure for bidirectional
electronic test ordering and reporting between health care providers and the public health laboratory,
manual faxes and emailed data are the burdensome means of communication. Test reports can stack up
on fax machines, delaying clinical interventions, and mailed test results can take several days to move
through the postal system. An example shared from our focus groups crystallizes the time-consuming
burden of manual methods: in a non-outbreak scenario, the public health laboratory prints and manually
faxes anywhere between 100 to 200 infectious disease test reports to health care providers daily. This
volume increases exponentially during an outbreak.

Finally, although NMI has made substantial improvements to NNDSS, gaps still remain. In non-outbreak
situations, data are sent to CDC through NNDSS on a weekly basis. However, this weekly frequency
becomes inadequate during a response to an outbreak when data are needed as quickly as possible. Due
to this limitation, CDC will often ask jurisdictions to call or manually provide spreadsheets of data to
expedite the data sharing process. This, however, does not supplant the need for jurisdictions to continue
to report data through NNDSS as the outbreak data sharing processes do not link with the regular, less
timely established processes; therefore, the same data is sent multiple times to CDC through different
systems. This itself is error prone and results in additional processes needed to complete reconciliation.

Highly contagious infectious diseases like measles move quickly and indiscriminately through
unimmunized communities, and an effective public health response requires public health data exchange
to outpace the spread of the disease. Better, faster, accurate data exchange through an interconnected
and interoperable public health data superhighway will help track and stop ongoing public health threats.

Natural Disasters

Recent natural disasters, such as Hurricane Florence in North Carolina, Hurricane Harvey in Houston,
tornadoes in Mississippi and Alabama, and the 2018 California wildfires, show the impact of natural
disasters on the public’s health. Damage to a community’s infrastructure, injuries, physical and mental
illness, and death during or after a natural disaster are important indicators to determine the need for
public health interventions, resource allocation, and prevention of further morbidity and mortality. Public
health surveillance and the real-time nature of syndromic surveillance help provide situational awareness
during the acute phase of a disaster response. This allows for rapid needs assessments that can determine
where people are at the highest risk for illness or injury and where limited medical resources should
be deployed. In the long term, public health data can be used to assess chronic health consequences
that result from a natural disaster and can help provide information for future planning, preparedness,
mitigation, and response activities.

Follow the Data

Death statistics are one key indicator of a natural disaster’s impact; however, due to the strain a natural
disaster puts on emergency systems and public health resources, registering deaths and issuing new birth
certificates to individuals that lost theirs during the disaster is a challenge. In the fall of 2017 as Puerto
Rico was in the immediate aftermath of Hurricane Maria, the country’s paper-based death registration
quickly hit the limits of its utility when funeral homes could not reach the deceased because parts of the
island were physically unreachable and isolated due to flooding. 17

17 National Association for Public Health Statistics and Information Systems. Hurricane Maria and Puerto Rico Vital Records – The Difficulties of Death Registration During a Natural Disaster. naphsis.
org. https://www.naphsis.org/single-post/2018/03/23/Hurricane-Maria-and-Puerto-Rico-Vital-Records-%E2%80%93-The-Difficulties-of-Death-Registration-During-a-Natural-Disaster. Published
March 23, 2018. Accessed April 30, 2019.

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