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Learn how to build a business case for data modernization efforts to translate technical needs into impact-driven narratives.

This page features ASTHO’s legal mapping work to plot the legal landscape for public health priorities.

ASTHO Legislative Prospectus | Previewing 2023 state legislative actions on data modernization and privacy.

Public Health TechXpo and Futures Forum Come to the Public Health TechXpo and Futures Forum! TechXpo, tech expo, public health, data modernization, public health event, astho, association of state and territorial health officials, public health officials, territorial health officials, state health officials, public health workforce, public health workers, data solutions, nation health features, data management, data platforms, virtual event exploring challenges, data architecture, technology solutions, data lakes, health of all people, monitoring health threats, real time, health care, healthcare ASTHO Public Health TechXpo and Futures Forum 2023 website

Data-Sharing Strategies to Support Access to Care Interventions Anna Bartels, Chikamso Chukwu Learn how primary care offices improve community access to health care in this Health Policy Update. Every state public health agency houses a Primary Care Office (PCO), which monitors the effectiveness of that jurisdiction’s health system. HRSA funds PCOs to identify communities with health professional shortages, and PCOs may also administer workforce programs to place providers in those communities. To identify which communities are experiencing shortages, PCOs collect state-level data on where health care providers work, what services they offer, and how many hours they spend on patient care. PCOs also track data on community needs, such as household income levels and community transportation options, to create a holistic picture of whether health care is truly accessible. PCOs across the country have explored different policy pathways to access reliable, accurate data, including laws that support PCO access to certain data sets, cross-sectoral relationships, and data-sharing agreements. According to ASTHO’s national PCO workforce assessment, over 85% of PCOs are part of a formal data-sharing arrangement, with licensing boards and Medicaid agencies serving as two of the most common data sources. This health policy update describes several types of actions jurisdictions have taken to support PCO data access. New Hampshire Law Allows the PCO to Survey Providers During License Renewals The New Hampshire PCO’s Health Professions Data Center administers a survey tied to health care providers’ medical license renewals that gathers self-reported provider and practice data, such as where providers work, how many hours per week are spent delivering direct patient care, and anticipated changes in capacity over the next five years. New Hampshire law outlines the scope of the survey and authorizes the PCO to collect, store, analyze, and report on health care workforce supply and capacity through surveying during license renewal. Although survey responses are the primary source of data on the health care workforce, data from the state’s all payer claims database housed within the Medicaid division provides supplemental information. Given the type of data involved, legal agreements are required between the PCO, licensing agencies, and relevant parties to maintain privacy for providers. These data are critical for the PCO to evaluate current and future capacity — especially in regions with limited providers — and proactively focus recruitment efforts on those communities. Colorado Braids Data Collection Strategies Across Multiple Sources While the Colorado PCO has relied on a similar law that authorizes collecting licensure data for more than 10 years, its data collection efforts have since expanded. The state now collects and integrates data across 16 different sources, each requiring a different procurement strategy. While some data sources are simple to access because they are public use files (e.g., Medicare provider data), other sources — namely state agencies — require the PCO to submit an application or enter into a memorandum of understanding or contract for access. Pursuing multiple data sources in this way takes significant effort and staff time, necessitating the health department to supplement HRSA’s PCO cooperative agreement funding with other sources, including state appropriations and private funding. A commitment to collaboration and investment and a willingness to build new relationships and processes from scratch support the Colorado PCO’s wide-ranging data collection strategy. Iowa Builds on Existing Relationships to Access Provider Data Iowa’s PCO has a long-standing relationship with the University of Iowa and a joint interest in health care workforce data. Currently, the PCO purchases provider phone survey information from the University of Iowa’s existing program and receives data on a biannual basis. The university’s data collection is part of its own research efforts and not collected on behalf of the PCO, so while the data are broader than what the PCO needs, it is still a valuable source of provider information. Because of this existing arrangement, the PCO could pursue a more expansive agreement (that would likely require additional funding) and expand the scope of the data, such as by adding data collection on provider residence or sliding fee scales. Other PCOs may consider approaching partners that have pieces of the data they need so there is an established relationship in place that may be expanded as new resources become available. PCOs Secure Access to Medicaid Claims Data State Medicaid agencies are another frequent data partner for PCOs, with at least 16 receiving provider data from their state Medicaid agency in various formats. In some states the Medicaid agency shares a point-in-time file with the PCO, who may manually recode the data before submission to HRSA. In other states, the PCO has direct access to the Medicaid claims processing system to independently extract the necessary data points. The nature of the partnership between the PCO and Medicaid agency may vary based on the state’s organizational structure (e.g., whether the PCO and Medicaid agency sit within the same department). However, a PCO seeking access to Medicaid claims data should be prepared to justify the need for the data, articulate how it can support the Medicaid agency, and develop the necessary relationships to support a workable solution for both parties. Conclusion Each PCO and state health agency has its own unique structure, and there is no “right” way to collect health care provider practice or access data. However, exploring how different jurisdictions approach these processes can help PCOs think strategically about new initiatives and relationships. ASTHO will continue tracking PCO success stories and remains available to facilitate connections among health agency staff. 2 UD3OA22890-13-00 article yes

Discover resources that can help your health agency unlock the power of internal policymaking in data modernization efforts.

Immunization Information Systems: One Foundational Data Source, Endless Health Insights Immunization Information Systems - Endless Health Insights Kim Martin, Mary Beth Kurilo Learn how public health agencies can better share critical data across jurisdictions in this blog post. A Bold Vision Back in 2014, a state health official from the Midwest recognized a problem: immunization information systems (IIS) were jurisdictionally based — mostly at the state level — resulting in data gaps when people moved or received care across state lines. In talking with his ASTHO colleagues, he shared a bold vision: what if ASTHO led a coordinated effort to unite key stakeholders and make widespread, seamless interjurisdictional immunization data exchange a reality? Momentum built quickly, and by the end of the year, ASTHO had convened a broad coalition of stakeholders and meaningful progress followed: A draft memorandum of understanding (MOU) to enable data exchange across jurisdictions. A community of practice that fostered peer-to-peer learning and problem-solving. Stronger support for the development and implementation of the Immunization (IZ) Gateway, a federally sponsored technology solution and infrastructure that facilitates immunization data exchange. As these efforts advanced, organizations like the American Immunization Registry Association (AIRA), a national nonprofit dedicated to supporting and strengthening IIS, played a growing role in supporting IIS interstate data exchange while continuing to advance data standards, improve data quality, and promote IIS modernization across the country. Results: Connections Continue to Expand Today, 57 IIS jurisdictions have signed interjurisdictional exchange MOUs, and 44 jurisdictions are participating in IIS-to-IIS data exchange through the IZ Gateway. Those 44 jurisdictions have connections with their peer IISs for a total of 361 live connections that create pathways for data to securely flow across state lines. Have we completely solved the interjurisdictional data challenge? Not entirely, but we are well on our way to a collaborative solution that addresses a significant proportion of the data gap. As this state health official pointed out, broad collaboration is not only essential to this work — it’s a defining strength of ASTHO, AIRA, and the wider immunization community. Unprecedented Times We often hear that we are operating in unpredictable and evolving times. During recent discussions, immunization program staff highlighted potential risks to immunization infrastructure, particularly IIS, due to cuts in federal funding. With funding winding down, jurisdictions are anticipating impacts such as staffing reductions, the loss of contracted support, and the slowing or halting of ongoing data modernization work. These systems are important not just for supporting routine immunization efforts, but also for readiness in future outbreak or emergency responses. As the funding landscape continues to evolve, it's important to highlight the central role IIS play in providing timely, high-quality data to a wide range of stakeholders, including: State, tribal, local, and territorial health departments, which use IIS data to monitor coverage rates, manage vaccine ordering and inventory, and support reminder/recall efforts. Health care providers, who access IIS through bidirectional connections with Electronic Health Records or pharmacy systems to deliver informed care at the point of service. Long-term care and skilled nursing facilities, which serve vulnerable populations and depend on complete immunization histories for residents. Educational institutions — including colleges, secondary schools, and childcare centers — that verify student immunization status during enrollment. Health payers, who enhance claims data with IIS records to improve Healthcare Effectiveness Data and Information Set reporting and member outreach. Federal partners, who use IIS data to support nationwide surveillance and response efforts. Individuals and families who are increasingly empowered to access their own immunization records for health care, school, travel, and personal use. Immunization data is undeniably a vital resource that supports and strengthens both public and private health systems, helping keep communities healthy and ensuring we are better prepared for the next outbreak or pandemic. Where Do We Go Next? Broad interjurisdictional exchange of immunization data started with a vision from a single state health official. What can we tackle together next? Advocate for sustained IIS funding through public/private partnerships — We need to consider new funding models for IIS. With so many partners valuing and benefiting from IIS data, we have a rich resource to protect and support together. We could look to key partners (CMS and private payers, large health systems, EHR vendors, pharmacies) to support the systems and programs that ensure the secure exchange of immunization data. Support ubiquitous consumer access — All individuals can benefit from convenient and efficient access to their own and their family members’ immunization records to manage their health, inform their health care decisions, or supply documentation for work, travel, or school/childcare requirements. Today, only about half of the United States has direct consumer access to their immunization record in the IIS. Encourage broad IIS participation — We can all actively promote policies or incentives that encourage authorized health care providers and partners to exchange data with their IIS. However, not everything needs to be a formal law or policy. Sometimes, simply fostering a culture of routine reporting to or querying the IIS as the standard of care can make a meaningful difference. It’s also important to ensure onboarding processes are efficient and that providers and partners receive the necessary technical support. Ensure legal and policy support for your IIS — Advocate for laws and regulations that support provider reporting, data sharing, and patient access while safeguarding privacy. Address barriers such as consent requirements that may add burden to providers and limit comprehensive data collection. Together, we can ensure that IIS are robust, reliable, and an integral part of immunization programs and the broader public health infrastructure. By strengthening these systems, we help ensure individuals receive high-quality, personalized care — wherever they are. article yes

A Difficult Week for Public Health: The Cost of Incomplete Efforts The Cost of Incomplete Public Health Efforts Due to Funding Cuts Susan Kansagra Hear from ASTHO's chief medical officer who discusses the implications of funding cuts on public health. Last week state, territory, and local public health departments received abrupt notices terminating several CDC funding streams that covered a range of public health activities. While the rationale given was that these funds supported COVID-19 (no longer a declared public health emergency), the reality is that the funds supported public health response infrastructure as a whole — both for COVID-19 and for other health threats. While some jurisdictions may be able to absorb or reprioritize activities, most are reporting detrimental impacts on their ability to deliver public health services. Here are just a few of the impacts we’re hearing from states/territories, locals, and partners. A House Without a Roof First, the funding cuts will halt technology improvements and data systems modernization that would have made sharing information with health care facilities and the public timelier and more efficient. In addition to impacting future work, cutting funding early for these public health technology improvements results in waste of past work. Why? It’s like building four walls of a house and then abruptly stopping construction before the roof is in place. The usefulness of the whole house goes to waste. This is the quandary that many health departments are facing as funding terminates for updates already underway to immunization, surveillance, and case reporting systems as well as laboratories themselves. The First Line of Defense Against Health Threats When you walk into an emergency room you expect a health care provider to treat you. Likewise, when an outbreak occurs, public health expects it will step in to contain disease spread and protect the community. For some states, these funding cuts disrupt the very core duties of what health departments do to detect and respond to health threats like measles, H5N1, and mpox. And that’s to say nothing of diseases we don’t know about yet. For example, these funds were allocated by Congress to support lab capacity including specialized lab personnel and equipment. So, if there is a suspected or known measles or foodborne outbreak, many health departments will have less capacity to quickly test and use that knowledge to prevent people from getting sick. They will also have limited capacity to deliver treatments and vaccinations directly to people. For some communities, that will mean fewer clinic hours, longer waits, and delays in accessing care. Timing and Communication Matter In addition to the impact of the cuts themselves, public health departments report struggling with how abruptly they learned about them. Many public health workers found out about funding termination the same day the funding ended. The suddenness felt akin to shutting off the lights to the operating room while the surgeon is still in the middle of a procedure. In short, while the cuts themselves had a health impact, so did the lack of notice. For some funding streams, health departments were already preparing to close out the funds, but for many it created unnecessary disruption for people still depending on the services from these funds today. Overall, most jurisdictions report that the loss of these activities leaves an immediate hole in public health infrastructure that will impact their ability to respond to health threats both now and into the future. article yes

ASTHO’s 2024 resource roundup highlights essential public health tools, policy guides, and best practices for state and territorial health agencies.

How Massachusetts is Advancing Public Health Data Standards How Massachusetts is Advancing Public Health Data Standards Saisha Adhikari Learn how Massachusetts is leveraging funding from the Public Health Infrastructure Grant to improve how it handles and shares public health data. The Massachusetts Department of Public Health (DPH) has long understood that strong public health systems rely on strong data. But with thousands of staff, dozens of programs, and dozens of data sources, achieving consistency across the department is no small task. Rather than treating data modernization, performance management/quality improvement (PM/QI), and data standards as separate efforts, Massachusetts is intentionally bringing them together. Through Public Health Infrastructure Grant (PHIG) funding, the department is accelerating progress toward common data standards by strengthening internal capacity, improving coordination, and laying the groundwork for meaningful impact. Massachusetts is turning standards into shared practice, using measurements to connect teams, strengthening communication and change management, and tracking early wins that signal meaningful progress. Building a Strong Foundation Data standards are not new to Massachusetts. For more than a decade, DPH has collaboratively developed standards with voluntary work groups composed of subject matter experts from across the department to improve how data are collected and used. Today, the department maintains eight approved data standards. PHIG funding enabled DPH to develop training modules for three approved data standards (disability, housing and homelessness, and employment) and to create a new module on a data standard related to adults with disabilities. With leadership support, PHIG funding has allowed the department to move forward quickly and strategically, including aligning training content with updated federal guidance such as the 2024 Office of Management and Budget revisions. “These standards have existed for a while,” shared Emily Neumann, Coordinator of Data Standards, “but PHIG allowed us to invest in training and communication so that more people across the department understand not just what the standards are, but why they matter.” Turning Standards into Shared Practice A key focus of the PHIG-supported work has been accessibility. DPH developed short, digestible training videos and housed them on the state’s internal learning platform, making them available not only to DPH staff but also to the broader Executive Office of Health and Human Services, vendors, and partners across the Commonwealth. “It’s hard to expect adoption if people don’t even know the standards exist,” said Brett Turner, Director of Data Strategy & Transformation. “The trainings are our first step toward building that awareness across a department of more than 3,000 people.” With this increased awareness through training, staff can begin to meaningfully connect systems and improve reporting. Measurement as a Bridge Between Data Modernization and PM/QI This is where PM/QI plays a critical role. By tracking participation in training modules and aligning efforts with the department’s strategic plan, PM/QI teams help translate awareness into measurable progress. Rather than setting overly broad or unrealistic goals, DPH is taking a targeted approach. For example, one performance measure focuses on data stewards (staff responsible for managing datasets) completing trainings related to race, ethnicity, and language data standards. This allows the department to set concrete, achievable goals while still moving toward broader adoption. PM/QI teams are also using data inventories and surveys to understand what datasets exist, who manages them, and where programs are already using standards. This shared visibility helps identify opportunities to connect previously siloed data and ensures that modernization efforts are grounded in real operational knowledge. Navigating Challenges Through Communication and Change Management Like many large public health agencies, DPH data systems work within a complex system that include state and federal requirements, governmental and non-governmental partners, and legacy technologies. To address this complexity, the department has leaned into advocacy and documentation. Teams are creating clear guidance for partners, engaging early in conversations with organizations that collect key datasets, and using every opportunity to promote alignment. In some cases, this has led to near-complete adoption of Massachusetts’ standards by external partners. Internally, change management remains essential. Many staff have stepped forward to contribute to data standards work beyond their primary roles, acting as champions across bureaus and offices. At the same time, the department is working to embed these processes into routine operations so that standards become part of core practice rather than a separate initiative. To support sustainability, the department is investing in knowledge management to document lessons learned, track implementation challenges, and reduce the burden on individual staff to repeatedly explain standards. “It comes back to communication,” said Kate Saunders, Director of Quality Improvement, Bureau of Health Care Safety & Quality. “When people understand the why, compliance improves. This isn’t just about technical definitions, it’s about improving health outcomes. Early Signals of Progress While the work is ongoing, Massachusetts is already seeing encouraging signs: Increased Awareness and Engagement: Training modules have expanded reach across the department and partner organizations. Stronger Measurement Practices: PM/QI teams can now track participation and link progress to strategic goals. Improved Coordination: Data inventories and shared workflows help identify where standards are being used and where support is needed. More Inclusive Data: Aligning standards makes it easier to incorporate smaller, specialized datasets, such as those related to long-term care or pediatric populations, that might otherwise be lost. Together, these efforts are helping leadership better understand the value of data modernization not as just a funded initiative, but as a driver of equity, efficiency, and prevention. A Model Grounded in Collaboration What stands out most about Massachusetts’ approach is how collaborative it has been. Staff from across bureaus and offices have helped shape the work, creating shared ownership and stronger connections across the department. “This was a ground-up effort,” Neumann reflected. “It was eye-opening to see how many people wanted to be involved once they understood the bigger goal.” That goal remains clear: improving health outcomes for everyone in Massachusetts. Common data standards provide the shared language needed to identify inequities, track progress over time, and understand the full experience of individuals and communities. As PHIG funding continues to support this work, Massachusetts is focused on next steps: refining communication strategies, engaging leadership and management, and embedding data standards into everyday practice. For other PHIG recipients navigating similar alignment challenges, the lesson is simple but powerful: start with the “why,” build collaboratively, and don’t let perfection stand in the way of progress. Reviewed by - Lindsey Myers OE22-2203 PHIG article yes

How Palau is Advancing Its Data Modernization Infrastructure and Capacity Through Partnership How Palau is Advancing Its Data Modernization Infrastructure and Capacity Through Partnership Saisha Adhikari Discover how Palau is improving public health data by leveraging private-sector partnership in this blog post. The Republic of Palau is navigating a rapidly shifting public health landscape with an approach rooted in creativity, clarity, and community. Rather than slowing down in the face of limited staffing and competing priorities, the Ministry of Health and Human Services (MoHSS) has chosen to use this moment to build systems that will last. Through Public Health Infrastructure Grant (PHIG) funding, Palau hired HealthEfficient, a health care consulting organization, to support data modernization (DM) initiatives, including a new national electronic health record (EHR). Palau previously collaborated with HealthEfficient through the Pacific Islands Primary Care Association (PIPCA), which introduced HealthEfficient to the region through a multi-year initiative to support regional EHR planning, readiness, and adoption. During that time, HealthEfficient developed a strong understanding of Palau’s priorities, needs, and operating context. Palau subsequently joined HealthEfficient's Health Center Controlled Network. This multi-phased, ongoing partnership has helped Palau bring structure to complex work, expand internal capacity, and make progress on long-standing priorities. Laying the Groundwork for Meaningful Progress As part of its PHIG workplan, MoHSS is committed to adopting modern, flexible technologies and standards, reducing data silos, and strengthening its workforce. Given the need for external support to implement the EHR, Palau also considered how to leverage its partnerships to advance broader DM efforts. MoHSS collaborated with ASTHO to clarify needs and what success should look like. This preparation, combined with HealthEfficient’s familiarity with Palau’s health system and cultural context, created a strong foundation for their partnership. HealthEfficient has been instrumental as Palau transitions from a largely manual system to a modern, comprehensive EHR. The consultant’s ability to understand local realities of how staff work, how communities engage with health services, and what modernization means in Palau’s context has helped decisions remain grounded in what the country truly needs. Project Management as a Capacity-Building Strategy HealthEfficient serves as an extension of the MoHSS team, managing day-to-day coordination and creating structure around the DM work. They lead agendas, capture meeting notes, track progress, and manage overall project flow. This allows Palau MoHSS staff to stay focused on vision, strategy, and local leadership. Palau MoHSS and HealthEfficient meet on a consistent cadence: twice weekly on EHR implementation and twice monthly on broader DM activities. As demand has increased, additional meetings and hours are scheduled as needed throughout the week. This rhythm keeps the work aligned while giving each workstream to move at its own pace. Due to capacity, MoHSS moved the EHR launch from December 2025 to the first half of 2026. Rather than treating this as a setback, they used the new timeline as an opportunity to refine workflows and better support staff. Together, MoHSS and HealthEfficient updated their approach and kept the work moving. Although the workload is still considerable, the partnership has made it manageable. Clear roles, shared communication, and reliable structure have allowed the team to maintain momentum without overwhelming MoHSS staff. This progress is also driven by a strong internal MoHSS team of five staff members, several of whom are featured in this blog, who are working closely with HealthEfficient and the EHR vendor to move implementation forward. Sherilynn Madraisau, Director of the Bureau of Public Health Services at MOHSS, explained: “Even with limited staffing, leadership recognized how critical this project was for Palau and contracted HealthEfficient not only to manage much of the day-to-day work but also to help build our internal capacity, ultimately strengthening overall systems and creating long-term impact.” Navigating Challenges with Cultural Awareness Like many small jurisdictions, Palau MoHSS faces: Limited staffing and competing priorities. Navigating technical jargon. The need to coordinate across multiple external partners. These challenges show up in real ways: teams are stretched across responsibilities, vendors may not understand local context, and cross-agency communication requires ongoing attention. Edolem Ikerdeu, Executive Director of the Palau Community Health Center, noted the importance of cultural mediation in this work: “Our consultants bring valuable expertise and guidance, but it’s equally important that the work reflects our culture and our priorities.” Her role includes working with staff members to help partners understand context, smoothing miscommunication, and ensuring all stakeholders stay aligned around the mission of serving Palau’s people. That spirit of shared learning and adaptation is echoed across the team. Tmong Udui, Acting Chief of Division of Health Informatics and Intelligence at MoHSS, added, “A lot has been new for [staff], but learning together and building skills in this new area has been a good experience.” Partner engagement remains personal and intentional. The MoHSS team keeps partners engaged by having real conversations, naming the shared purpose, and showing exactly how the EHR will help the whole country, not just the health sector. Early Wins and Emerging Strengths Even just a few months into the EHR migration, MoHSS is already seeing measurable progress: Accelerated EHR Implementation: After years of anticipation, MoHSS now has a clear structure, dedicated support, and renewed momentum behind the EHR work. Informed Technology Decisions: With HealthEfficient at the table for external stakeholder discussions, MoHSS has had a trusted advisor to help evaluate system options and advocate for what best fits the country’s needs. Growing Internal Capacity: Through trainings and ongoing collaboration with subject-matter experts, staff are strengthening their skills in cybersecurity, systems upgrades, and process improvement. Stronger Organizational Coordination: Clear oversight and consistent communication have helped reduce the burden on staff and increased alignment across the ministry. These wins reflect progress beyond just technology, but in confidence, communication, and long-term planning. The work is strengthening the system as a whole and not just a single project. A Foundation for the Future With HealthEfficient managing much of the operational load for DM, Palau can focus on guiding strategy and determining long-term direction. HealthEfficient advances the work; MoHSS shapes the vision. Edolem Ikerdeu shared, “If you hire people and the funding goes away, then what is this for? We want a stronger system that includes the people who are already here.” Palau’s approach offers a compelling model for other resource-limited jurisdictions: Start with clarity. Build the right partnerships. Protect space for local leadership. Design systems that will outlast short-term funding. By centering community, embracing thoughtful project management, and working with culturally aligned partners, Palau MoHSS is building public health infrastructure that will serve its people well into the future. Reviewed by - Lindsey Myers OE22-2203 PHIG article yes

Likely Public Health Legislative Trends for 2025 Prospective Public Health Legislative Trends for 2025 Maggie Davis Get an inside look at prospective public health legislative trends for 2025, based on ASTHO's legislative tracking efforts and member feedback. Drawing from member feedback and ASTHO’s legislative tracking efforts, ASTHO identified five key issues state and island legislatures are likely to work on for the upcoming legislative sessions for the annual 2025 Legislative Prospectus Series. Each brief provides public health leaders and policymakers with a synopsis of the topics, recent legislative trends, and anticipated legislation in upcoming sessions. Public Health and Health Care Workforce States are continuing to address workforce shortages within public health and the health care systems. ASTHO’s prospectus outlines strategies that legislatures are considering, from bolstering state public health funding to legislative efforts addressing nationwide workforce shortages through recruitment incentives, workforce commissions, and pipeline programs. Containing Spread of Infectious Disease State and territorial public health agencies are responsible for protecting the health and safety of their residents and have legal authorities to fulfill those responsibilities. In recent years, many legislatures have revisited the scope of these legal authorities, with states like Washington (SB 6095) expanding the health official’s authority to issue standing orders for a range of disease interventions. Similarly, legislatures may continue considering vaccine-related legislation. While many bills in recent years aim to weaken vaccine policy, state leaders have listened to medical leaders within their state who advocate for strong vaccine policies. In 2024, West Virginia’s governor vetoed HB 5105 that would have weakened school enrollment requirements, informed by strong opposition from the state’s medical community and evidence that the existing vaccine policy had prevented disease outbreaks. Data Modernization and Privacy Modernizing public health and health care data systems have taken big steps forward, including federal initiatives like the Trusted Exchange Framework and Common Agreement (TEFCA), which establishes guiding interoperability principles and standards for health data exchange. Nevada enacted AB 7 in 2023 requiring new regulations governing health information exchanges (HIEs) and granting certain liability protections to providers using them. In the proposed rules published in August 2024, the Nevada Department of Health and Human Services intends to require that participating HIEs are TEFCA members. ASTHO anticipates more jurisdictions will allow public health agencies access to a wider range of privacy-protected health data through secure platforms like HIEs. Maternal and Child Health Public health supports mothers and children throughout their development. There are three emerging issues that legislatures are likely to work on in the next year: maternal morbidity and mortality, fetal and infant mortality, and youth mental health. One strategy to address youth mental health is using laws to regulate social media companies, requiring them to implement safeguards for minors who use their services. For example, California enacted SB 976 in 2024, which requires “addictive internet-based” services to gain parental consent before minors could use the service and limit the hours in which minors could use an application. Technology industry groups are challenging these efforts in court, with one suit asserting that California’s measure is unlawful governmental interference with First Amendment rights of minors. Substance Misuse and Overdose Prevention Although there was a significant decrease in overdose deaths in 2023, there are still legislative actions to help reduce substance misuse and prevent overdose likely to be considered in 2025. During the 2024 sessions at least 24 state legislatures considered bills to regulate products like kratom and hemp derived products (e.g., Delta-8). Additionally, at least 18 legislatures considered bills to decriminalize drug checking equipment like fentanyl and xylazine testing streps. ASTHO anticipates states legislators will continue implementing harm reduction efforts, policies to connect people with substance use disorders to care, and efforts to regulate products with potential for abuse or misuse in the next session. What We Know So Far The majority of states will convene their legislative sessions in January 2025, with at least 15 states scheduled to conclude their session by the end of April; there will likely be a flurry of legislative activity in the first quarter of the year. Already the Texas legislature has prefiled more than 1,200 bills for their 2025 session, covering topics including a health commissioner’s authority to establish routine childhood immunization requirements (HB 468) and making changes to the state’s maternal mortality and morbidity review committee reporting requirements (HB 713). Additionally, Virginia’s General Assembly convened its two year session in January 2024 and has a number of bills carrying forward into 2025 including bills related to suicide prevention (HB 80) and improving maternal health data quality (HB 286). ASTHO will monitor legislation related to these topics and more during the 2025 sessions and will provide relevant updates. 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ASTHO Requests $1 Billion in Emergency Supplemental Funding for Opioid Epidemic ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) is requesting that the Administration and Congress provide $1 billion in emergency supplemental funding for the Centers for Disease Control and Prevention (CDC) and state and territorial health departments to address the opioid epidemic. This emergency supplemental funding will allow state and territorial health agencies to allocate additional resources for their top priorities, including: Strengthening public health surveillance to improve our understanding of the epidemic. Expanding opioid misuse and addiction prevention campaigns. Linking electronic health records and prescription drug monitoring programs (PDMPs). Expanding partnerships and collaboration with law enforcement. Expanding access to naloxone and linking patients to medication assisted treatment and other services. “While the Administration has made major federal investments in treatment and recovery, health officials need funding for prevention,” says Michael Fraser, executive director of ASTHO. “We strongly encourage Congress to provide this emergency supplemental funding and address this deadly crisis like any other emergency where the Administration proposes and Congress provides the resources necessary to defeat it.” More needs to be done to provide CDC, states, and territories with investments in prevention to turn the tide on this epidemic. There is an urgent need to prevent opioid misuse through population-based and community-wide public health programs including connecting PDMPs with electronic health records, surveillance, implementation of prescribing guidelines, and prescription drug public awareness campaigns. ASTHO’s request aligns with many recommendations included in the President’s Opioid Commission report and Gov. Chris Christie’s recent call for additional resources to address the opioid crisis. To view ASTHO’s $1 billion opioid emergency supplemental request, click here. Visit my.astho.org/opioids to view ASTHO’s opioid framework, access resources, and learn about promising practices that state and territorial health agencies are undertaking to end the opioid epidemic. ASTHO Press Release Boilerplate website yes

New platform will provide forum for data exchange, analysis, and visualization to support public health work

ASTHO Partners with Veritas Data Research and HealthVerity to Launch the First-of-its-Kind Public Health Data Consortium ARLINGTON, VA — The Association of State and Territorial Health Officials (ASTHO) announced today a partnership with Veritas Data Research and HealthVerity that establishes a first-of-its-kind public health data consortium. This novel consortium brings together ASTHO, jurisdictional health departments and private partners united in a shared mission to improve public health outcomes through enhanced data access and quality, and to address long-standing challenges that hinder our nation’s public health data infrastructure. “There is tremendous opportunity when we connect the strengths of private industry with the mission of public health,” said Joseph Kanter, MD, MPH, ASTHO CEO. “By working together in a structured way, we can close long-standing data gaps and build a stronger, more responsive system for the future.” The consortium’s central mission is to improve the quality of and access to real-world data and public health data relied upon by a broad range of stakeholders to drive public and population health decisions and understand longitudinal outcomes. State health agencies, providers, payers, researchers, and others rely on this data, which is often difficult to obtain. Through this public-private partnership, members aim to expand access in ways that strengthen communities and support health care and public health systems. “Our nation and communities need a robust, sustainable model that leverages the capabilities and expertise across both private industry and public health. For too long, there have been challenges in bringing private and public entities together to address the gaps that plague our nation’s public health data and technology infrastructure,” said Jen Layden, MD, PhD, ASTHO senior vice president of population and innovation, and former CDC and state public health leader. “This consortium, by uniting on a common mission and placing governance in the hands of public health, is primed to be a game changer.” Jurisdictional health departments will gain access to real-world data and technical capabilities and will play a key role in strengthening the quality and availability of critical data. The consortium will initially focus on mortality data, a foundational asset for a variety of use cases. "This consortium represents an excellent example of public-private partnerships in healthcare," said Jason LaBonte, CEO at Veritas Data Research. "Under the governance of ASTHO, all state and territorial health agencies can securely pool their data to improve clinical practice and innovation. In return, the agencies can combine their data with national real-world data to power better public health. Veritas is pleased to facilitate these data exchanges using our robust ingestion and delivery platform, and to make appropriate data available to a wider group of stakeholders with use cases pre-approved by the state and territorial health agencies.” “We are proud to serve as a founding operating partner, applying our expertise in identity resolution and data privacy to solve the 'linkage' problem that has long plagued public health,” said Andrew Kress, CEO of HealthVerity. “Through this consortium, we are enabling a standard of data exchange that respects patient privacy while providing a level of clinical truth that will accelerate research and improve the speed of public health interventions.” To support the consortium, ASTHO is creating an advisory network to provide organizations with opportunities to stay informed and offer guidance as the initiative evolves. To learn more about the consortium or advisory network, please contact phdc@astho.org. ASTHO Press Release Boilerplate   Veritas Boilerplate   HealthVerity Boilerplate website yes

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COVID-19 revealed the dire straits of public health; now, with renewed funding, public health leaders discuss how to use COVID funding to build and maintain sustainable infrastructure.

In the United States, three main types of fungi—coccidioidomycosis, histoplasmosis, and blastomycosis—can cause lung infections like pneumonia when people breathe in fungal spores from the air. In honor of Fungal Disease Awareness Week, this episode is focused on the risks of endemic fungal diseases.

Disease Forecasting Learning Series, Part 2: Disease Forecasting Basics disease forecasting, outbreak analytics, Center for Forecasting and Outbreak Analytics, CFA website yes

Join ASTHO for the first in a four-part series designed to provide health department staff with foundational knowledge and best practices for disease forecasting. The session will provide an overview of the process, including a brief history of public health’s utilization of forecasting, inclusion in preparedness and response activities, how health departments can use forecasting in decision-making activities, and what forecasting does not tell us. Featured Speakers: - Anne Zink, MD, FACEP, (SHO-AK), ASTHO past president - Dylan Morris, PhD, Team Lead, Inform Division, Center for Forecasting and Outbreak Analytics (CFA), CDC - Matthew Biggerstaff, ScD, MPH, Team Lead, Applied Research and Modeling Team, Influenza Division, CDC