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Examining the Barriers of the Current Public Health Surveillance System


        As the public health community looks to modernize public health surveillance, CSTE conducted a review
        of key challenges currently faced by the United States public health surveillance system for this report.
        Two focus groups of public health subject matter experts—including state and local epidemiologists, state
        and local public health laboratorians, state vital record registrars, and health care providers—convened in
        April 2019 to discuss the current landscape of data sharing through the public health surveillance system,
        and identify barriers to integrated, interoperable data exchange on the public health data superhighway.

        To frame the discussion, participants in the focus groups were asked to describe how data is shared
        and moved through today’s public health surveillance system for four public health threat case studies.
        Discussion questions can be found in Appendix B. While all public health threats rely to varying
        degrees on the five core pillars of public health surveillance—and would benefit from enterprise-wide
        improvements—experts discussed specific pillars in each case study to highlight principle functionality
        in monitoring the specific health threat. Thus, the case studies are illustrative, and not exhaustive, of the
        challenges of the current system and the opportunities to build a public health data superhighway.

        While an effort was made to capture a diverse set of experiences and locations when selecting the subject
        matter experts, this report provides a snapshot of the difficulties and barriers experienced by public health
        departments, public health laboratories, and health care providers from predetermined jurisdictions
        and geographical areas, and is thus not generalizable to every jurisdiction. Indeed, each jurisdiction’s
        experience is unique given the fragmented, uneven approach to systems modernization nationwide.


        That said, the common themes that emerged across the diverse representations of subject matter
        experts highlight mutual challenges that can be addressed by improving the core public health data
        infrastructure at an enterprise level. This report summarizes the barriers that obstruct the timely and
        efficient transfer of public health data, and demonstrates the need to establish an interoperable, secure,
        and automated public health data superhighway that protects the health of all Americans.






































        The Public Health Enterprise                                                                           16
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