Public health emergencies evolve rapidly, but public health entities lack the capacity to share new data and potentially life-saving information in near real time. To address this, the federal government must overcome 3 major challenges in the way it manages public health data. The GAO has made a number of recommendations to help address these challenges. However, many of these recommendations have not been implemented.

The big picture

Long-standing challenges in the federal government’s management of public health data undermine the country’s ability to quickly respond to public health emergencies like COVID-19 and monkeypox. These challenges include the lack of:

  • common data standards—public health requirements allow certain data elements to be collected, such as patient characteristics (e.g. name, gender and race) and clinical information (e.g. diagnosis and test results) d a specific way;
  • interoperability—the ability of data collection systems to exchange information with other systems and to process information from other systems; and
  • public health informatics infrastructure— IT software, hardware, networks and policies that enable public health entities to report and retrieve data and information.

More than 15 years ago, federal law required the Department of Health and Human Services (HHS) to establish a national public health awareness network with a standardized data format. This network aimed to provide secure, near real-time information to facilitate early detection and rapid response to infectious diseases.

However, the federal government still lacks this necessary network and has yet to overcome the challenges identified in previous GAO reviews. Near real-time access to this data could dramatically improve our nation’s preparedness for public health emergencies and potentially save lives.

Without the network, federal, state, and local health departments, hospitals, and laboratories lack the ability to easily share real-time health information to respond effectively to illnesses.

Illustration of a National Public Health Awareness Network

What the GAO’s work shows

Previous GAO work has identified three key challenges to public health data management and recommended actions for improvement.

1. Common data standards

To ensure that information can be reported, compared, and analyzed consistently across jurisdictions, public health entities need a standardized data format. Due to the lack of common data standards, information reported by states on the number of COVID-19 cases was inconsistent. This in turn has complicated the ability of the Centers for Disease Control and Prevention (CDC) to make comparisons. Public health officials also mentioned challenges in collecting comprehensive demographic data. This has made it difficult to identify trends in COVID-19 vaccinations and the number of doses administered. Although the CDC intended to implement data standards, its strategic plan did not articulate specific actions, roles, responsibilities, and timelines for doing so.

2. Interoperability between public health informatics systems

The inability to easily exchange information between data collection and other data systems creates barriers to data sharing and additional burdens for entities that collect and transmit data. During the early stages of COVID-19, the lack of interoperability of IT systems caused health officials and their key stakeholders (e.g. hospitals) to manually enter data into multiple systems. Additionally, some state health departments could not directly exchange information with the CDC through a computer system. This led to longer delays for the CDC to receive the data it needed to make decisions about the COVID-19 response.

3. Lack of public health IT infrastructure

The timeliness and completeness of information shared during public health emergencies can be hampered by the absence of a public health IT infrastructure. During the early stages of COVID-19, some states had to manually collect, process, and transfer data from one location to another. For example, one government official described having to fax documents, make copies, and physically transport relevant documents. The official noted that by establishing a public health IT infrastructure, such as the HHS Network was mandated to create, errors would be reduced. To help alleviate data management challenges for COVID-19, HHS launched the HHS Protect platform in April 2020. However, we have reported that public health and state agencies have raised questions about the completeness and accuracy of some of the data.

Learn more about GAO’s public health portfolio

Coronavirus surveillance reports

Previous reports related to the pandemic

Health care reports

For more information, contact Jennifer R. Franks at (404) 679-1831 or [email protected]