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We can prepare for the future of health equity and data by ensuring the equitable collection of data and building systems that are flexible enough to account for forward progress.

As AI adoption grows in public health, understanding its uses and ensuring responsible application are key to protecting privacy, minimizing bias, and improving outcomes.

Get insight into the successes and challenges of integrating race/ethnicity data in public health and future directions in this field.

Lessons from previous emergencies, like Zika, can help states create an effective response plan for future emergencies and protect maternal and child health.

Both the Pacific and Caribbean are on the front lines of the dengue health security threat. As a result, many island areas, especially in the USAPI and Puerto Rico, are doing great work to combat dengue.

As in any sector, there is often talk in the public health field of “working upstream,” or addressing problems at their source. If public health is going to be a changemaker in the world, its leaders must be equal parts nimble and innovative.

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: data privacy and modernization, reproductive health, health equity, strengthening public health agencies, and immunization.

This interview is part of ASTHO’s Leadership Trailblazers series, which shares outstanding public health leaders’ inspirations, motivations, and accomplishments. This post features Micky Tripathi, PhD, MPP, of the Office of the National Coordinator for Health Information Technology at HHS.

This blog explains ASTHO’s Islands Health Equity Framework, which outlines a culturally resonant approach to health equity in the island areas.

Project ECHO: Overdose Fatality Investigation Techniques (OD-FIT) Project ECHO: Overdose Fatality Investigation Techniques (OD-FIT) provides coroners, medical examiners, toxicologists, forensic pathologists, and public health personnel opportunities to learn and share their overdose investigation expertise with peers across the United States and territories. Coroners and medical examiners are called after a fatal overdose to investigate the cause and manner of death. Public health agencies and practitioners use this mortality data to better understand trends in fatal overdoses and to inform the allocation of resources, such as fentanyl test strips and naloxone in states with high rates of overdose deaths.  Project ECHO: Overdose Fatality Investigation Techniques (OD-FIT) is a collaboration between ASTHO and the Centers for Disease Control and Prevention (CDC) to provide coroners, medical examiners, toxicologists, forensic pathologists, and public health personnel with an opportunity to learn and share their overdose investigation expertise with peers across the United States and territories. By strengthening the medicolegal death investigation system, state and territorial health agencies can improve the accuracy and reliability of overdose death data to benefit public health and safety programs, law enforcement investigations, and upstream prevention strategies.  Project ECHO OD-FIT consists of live online sessions featuring didactic presentations followed by case study discussions. Didactic recordings and accompanying resources from the most recent series can be found below. website no False

Sustaining DMI: Leveraging Medicaid to Advance Public Health Data and Surveillance A primer for states: leveraging Medicaid to design and execute a sustainable DMI. This primer describes how to leverage Medicaid to design and execute a sustainable data modernization initiative (DMI). It provides guidance, resources, and practical tools for effective management, strategic planning, and skill development to strengthen sustainability planning. Get the Report (PDF) website yes

Policy Options to Improve Data Sharing Between State and Local Health Departments Organizational policies on data sharing between state and local public health agencies. This report explores organizational policies related to data sharing between state and local public health departments. ASTHO, in collaboration with the National Association of County and City Health Officials and the Network for Public Health Law developed this report, which aims to serve as a guide for state and local public health leaders as they consider organizational policy options to improve state and local data-sharing efforts. Get the Report (PDF) website yes

Investing in Indiana’s Public Health Infrastructure Through Community-Driven Policy Change public health infrastructure, community driven policy, indiana state health commissioner, public health system, indiana department of health, outpatient facilities, technical assistance, data and information integration, emergency preparedness, child and adolescent health, legislative action, state and local elected officials, health problems, health care, health system, health departments, federal agencies, essential public health services, centers for disease control, state and local levels, health outcomes, health organization, covid-19 pandemic, health infrastructure, promoting health, public health organizations, states public health, federal funding, astho, association of state and territorial health officials Maggie Davis, Keith Coleman Indiana enacts historic public health funding through community engagement and legislative support. In April 2023, Indiana passed bill SB 4, which was a historic investment in the state's public health funding and restructuring its public health system. This case study shares how the Governor's Public Health Commission and the Indiana Department of Health approached community listening sessions, formulated recommendations, and successfully built legislative support to reform the public health system in the state. Get the Report (PDF) website yes

This ASTHOReport highlights the public health importance of three harm reduction policies and practices to reduce overdoses: facilitating community distribution of naloxone, facilitating community distribution of fentanyl test strips, and overdose prevention centers.

Two reports explore opportunities for improved public health action through immunization data sharing with health information exchanges, in addition to the broader legal landscape of public health data.

This report analyzes the results from a survey of state and territorial health agency staff to collect information regarding health agency efforts to address climate change and extreme weather.

What Public Health Leaders Need to Know About HTI-2 Proposed Rule How Proposed HTI-2 Rule Will Benefit Public Health Data Exchange Lillian Colasurdo, Lana McKinney, Alexandra Woodward Read how the HTI-2 rule improves upon HTI-1 standards and criteria for data exchange among public health, health care, and data providers to benefit public health. On July 10, 2024 HHS’s Assistant Secretary for Technology Policy/Office of the National Coordinator of Health Information Technology (ASTP) published the proposed rule: Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2). This rule, which advances interoperability and supports access, exchange, and use of electronic health information (EHI), represents a significant step towards strengthening public health data infrastructure and promotes interoperability between health care and public health entities. It proposes significant changes impacting public health agencies (PHAs) and removing barriers to EHI exchange, while attempting to streamline health IT processes. Background Two of the most significant federal laws passed in the past fifteen years for health data exchange are the Health Information Technology for Economic and Clinical Health (HITECH) Act and the 21st Century Cures Act. Together, these laws provided ASTP with authority to set standards for and certify heath information technology. ASTP’s certification program mandates that electronic health records (EHR) comply with the new standards and eligible providers and hospitals must use certified technology to be fully reimbursed by the Centers for Medicare & Medicaid Services. Additionally, these laws grant ASTP rulemaking authority. Earlier this year, ASTP finalized the HTI-1 rule, taking substantial steps toward improving public health and health care data exchange. This rule requires EHR systems to support either HL7 Clinical Document Architecture (CDA) or Fast Healthcare Interoperability Resources (FHIR) standards for electronic case reporting, both of which enhance the data quality and timeliness for public health reporting. HTI-1 also directs EHR developers to track and report on the amount of data electronically submitted to Immunization Information Systems (IISs); that information helps improve vaccine product distribution and availability. While the rule sets the stage for a future transition to a FHIR-based approach for case reporting, there must be an adequate transition period for public health agencies. While HTI-1 took significant steps toward improving the way data is exchanged, primarily in the health care setting, the proposed rule HTI-2 aims to expand these standards to further benefit public health. The HTI-2 expands upon the interoperability standards established in HTI-1 and aims to improve interoperability by revising the ONC Health IT Certification Program. It specifically proposes two new sets of certification criteria for IT developers that will benefit public health entities and payers. Public health agencies face many barriers to efficiently exchanging data with health care providers and other entities including lack of common data standards, inconsistent reporting requirements, limited system interoperability, and inadequate public health data infrastructure. HTI-2 addresses these challenges by establishing certification criteria for public health technologies, creating a common floor to support data exchange. In addition, HTI-2 introduces changes to the Information Blocking Rule and provides transparency to Trusted Exchange Framework and Common Agreement (TEFCA) requirements. Micky Tripathi - What PH Leaders Must About HTI-2 Proposed Rule Key HTI-2 Provisions Certification Criteria, Standardizing Application Programming Interfaces (APIs) HTI-2 proposes four standards and certification criteria that may impact public health systems. Depending on the criteria, ASTP proposes that many of them be implemented by the beginning of 2027 and 2028. Updating naming conventions and standards for existing functional criteria. There are currently nine functional (or “f”) criteria EHRs must meet to exchange data with public health agencies. The updated naming conventions and standards point EHR vendors and public health systems to the latest standards for implementation. Additionally, these updates include two new criteria for birth reporting and bi-directional exchange with a prescription drug monitoring program. Establishing new certification “f” criteria for Health IT so Public Health certified systems can receive, validate, parse, and filter standardized data. These functions will apply to immunization, syndromic, laboratory, cancer pathology, case, birth, and prescription drug monitoring program data. Adopting the United States Core Data for Interoperability (USCDI) version 4, a standardized set of health data classes and elements for interoperable health information exchange. Version 4 includes several new data elements relevant to public health, such as health status assessments (e.g., alcohol and substance use). Standardizing HL7 FHIR-based API for public health data exchange by creating new certification criteria to support ongoing development and transition to FHIR for patient and population-level data exchange. CDC and ASTP have noted potential benefits of increasing public health access to critical data while reducing the reporting burden on both health care organizations and developers. HTI-2 proposes similar certification standards and alignment for reporting to payers that comply with existing CMS API requirements. Information Blocking Updates The Information Blocking Rule requires that patients have timely access to their own electronic health records and prohibits health care providers and networks, HIEs, and developers from interfering with said access. When a public health agency serves as a provider, it is crucial to ensure that patients can access records in compliance with the existing rule. HTI-2 clarifies what constitutes “interfering” with the access and exchange and provides a non-exhaustive list of examples. HTI-2 also proposes a new exception to information blocking—the Protected Care Access Exception—that would “apply to acts or omissions likely to interfere with access, exchange, or use of particular EHI that an actor believes could create a risk of exposing patients, care providers, and other persons who assist in access or delivery of health care to potential administrative, civil, or criminal investigations or other actions on certain bases.” This exception is particularly relevant for jurisdictions with more restrictive laws for sharing reproductive health data. TEFCA Governance Rules As ASTP and its Recognized Coordinating Entity (RCE), the Sequoia Project, seek to establish standards for implementing the Trusted Exchange Framework and Common Agreement (TEFCA), the proposed HTI-2 rule would codify one portion of the framework by establishing the qualifications for Qualified Health Information Networks (QHINs), onboarding and designation processes, the attestation process, termination and appeal rights, and ASTP’s formal authority to delegate responsibility to the RCE. Conclusion The HTI-2 proposed rule represents a significant step towards strengthening public health data infrastructure and promotes interoperability between health care and public health entities. It is specifically designed to “address gaps in public health data and help the nation become response-ready, promote health equity, and improve health outcomes for all.” The Joint Public Health Informatics Taskforce (JPHIT), coordinated by ASTHO and consisting of 14 member organizations including public health associations, gathered comments and input from constituent members and submitted consolidated feedback on the proposed rule in October and awaits responses and the final rule from ASTP. OE22-2203 PHIG article yes

Guam, Palau, and CNMI PHIG teams leverage diverse expertise to advance data modernization assessment, planning, and implementation strategies.

As the overdose epidemic continues, it is imperative for the medicolegal death investigative community to understand the importance of continuous training and the role that accurate death certification plays in protecting the nation’s health.

The adage “what gets measured, gets done” has had staying power for a reason. When we can accurately describe conditions, quantify impact, and elucidate connections, we have a better chance at taking collective (and effective) action to tackle even the most challenging problems facing our communities. The National Survey of Children’s Health is a powerful tool to provide this critical information to researchers, policymakers, and state-level decision makers.