Health Organizations Implore Congress to Fund Public Health Surveillance Systems

Noam ArztHLN Consulting joined more than eighty organizations, institutions, and companies in imploring Congress to fund public health surveillance systems. The appropriations request letters – one to the House and one to the Senate – seek one billion in funding over ten years (and $100 million in FY 2020) for the Centers for Disease Control and Prevention (CDC).

This funding would allow CDC, state, local, tribal, and territorial health departments to move from sluggish, manual, paper-based data collection to seamless, automated, interoperable IT systems and to recruit and retain skilled data scientists to use them.

HLN has been at the forefront of systems development in public health and has long advocated for the modernization of public health registries and other systems. This initiative is focused on public health surveillance systems, and HLN’s work on the Reportable Condition Knowledge Management System (RCKMS) supports the electronic case reporting (eCR) initiative described in a flyer describing the details of this initiative published by a set of leading public health organizations.

HLN encourages everyone to advocate for these needed funds at every opportunity.


Full text of the letter to the House and the Senate below, together with the list of organizations, institutions, and companies that endorsed the letter.

As you develop appropriations legislation for fiscal year (FY) 2020, the 80 undersigned organizations representing patients and consumers, public health professionals, health information technology (IT) developers, health care providers, and scientists urge you to appropriate $1 billion over 10 years—$100 million in FY 2020—to the Centers for Disease Control and Prevention (CDC) for a new initiative that will transform the public health surveillance enterprise and save lives. Specifically, this funding would allow CDC, state, local, tribal, and territorial health departments to move from sluggish, manual, paper-based data collection to seamless, automated IT systems and to recruit and retain skilled data scientists to use them. More, better, faster data yielded by secure, interoperable, integrated systems will allow public health professionals and policymakers to make better decisions and get ahead of chronic, emerging, and urgent threats.

“Public health surveillance” is the interactive system of government public health agencies at the federal, state, local, tribal, and territorial levels working with health care providers and the public at large to detect, report, respond to, and prevent illness and death. Every day—often unbeknownst to most Americans—public health surveillance is saving lives by detecting and facilitating the response to health threats including E. coli contaminated lettuce, measles, antibiotic resistance, lead poisoning, influenza, health care associated infections, opioid overdoses, Zika, and many more.

Unfortunately, the nation’s public health data systems are antiquated, rely on obsolete surveillance methods, and are in dire need of security upgrades. Sluggish, manual processes—paper records, spreadsheets, faxes, and phone calls— are still in widespread use. Lack of interoperability, reporting consistency, and data standards leads to errors in quality, timeliness, and communication. In addition, public health professionals are faced with rapid advances in data science and evolving cybersecurity threats, and many do not yet have the necessary 21st century skills to understand and securely integrate health data.

There are five core data systems of the U.S. public health surveillance enterprise that require modernization now to protect the health security of all Americans:

  1. The National Notifiable Disease Surveillance System (NNDSS) collects vital individual case investigation data at state, local, tribal, and territorial public health agencies from hospitals, physicians, and labs, then sends this data to CDC to create a national understanding of disease burden. This information is used to respond to public health outbreaks and is the first line of health security defense.
  2. Electronic case reporting (eCR) is the automatic, seamless submission of disease reports directly from electronic health records at clinical care organizations to state, local, tribal, and territorial public health departments. eCR dramatically improves disease/condition reporting and reduces physician burden in fulfilling their legal responsibility to report, which leads to early implementation of public health interventions and limits further spread of infectious agents.
  3. Syndromic surveillance provides near real-time data on every hospital emergency department visit for hourly detection and continuous monitoring of community health incidents such as the impact of natural disasters (including hurricanes), flu pandemics, and opioid overdoses. It gives public health professionals the ability to monitor the pulse of the community and identify health threats as they emerge.
  4. Electronic Vital Records System is a national system of 57 vital records jurisdictions that provide secure electronic collection of birth and death data from hospitals, funeral homes, physicians, and medical examiners. It allows for timely and accurate reporting of birth outcomes and causes of death, which serve to monitor and respond to public health crises as they arise in communities, including reducing preventable deaths and infant and maternal mortality rates.
  5. Laboratory Information Systems are the backbone of how laboratory data is collected, managed, and shared to inform public health decision-making. The Laboratory Response Network (LRN) is comprised of specialized laboratories that can respond to biological/chemical threats and other public health emergencies with advanced testing capabilities. Electronic Laboratory Reporting (ELR) is the electronic reporting of laboratory results from private and public labs to disease detectives and investigators in state, local, tribal, and territorial public health departments.

To varying degrees, these systems lack the proper electronic automation, data security infrastructure, interoperability, and integration. Investment in these systems will facilitate accelerated, secure, and seamless detection to improve prevention and response efforts.

Additionally, the public health workforce of today and tomorrow must acquire new skills to understand and securely integrate health data and bolster and maintain cybersecurity. Developing a new generation of skilled public health data scientists will require new curricula, professional development, postgraduate fellowships, and on-the-job training.

The development of 21st century data systems and the public health workforce needed to operate and maintain these systems have been woefully underfunded to date. A robust, sustained commitment to transform today’s public health surveillance will ultimately improve Americans’ health.

If you have questions, please contact Emily Holubowich at [email protected].


  • Academy of Nutrition and Dietetics
  • AcademyHealth
  • Advocates for Better Children's Diets
  • American Association on Health and Disability
  • American Brain Coalition
  • American College of Obstetricians and Gynecologists
  • American Medical Informatics Association (AMIA)
  • American Medical Women's Association
  • American Organization of Nurse Executives
  • American Public Health Association
  • American Society for Reproductive Medicine
  • American Society of Tropical Medicine & Hygiene
  • America's Blood Centers
  • APIC – Association for Professionals in Infection Control and Epidemiology
  • Association for Prevention Teaching and Research
  • Association of Clinicians for the Underserved
  • Association of Maternal & Child Health Programs
  • Association of Public Data Users
  • Association of Public Health Laboratories
  • Association of Schools and Programs of Public Health
  • Association of State and Territorial Health Officials
  • Association of University Centers on Disabilities
  • Caring Ambassadors Program, Inc.
  • Center for Science in the Public Interest
  • College of Healthcare Information Management Executives
  • Commissioned Officers Association of the U.S. Public Health Service, Inc. (COA)
  • Consortium of Social Science Associations
  • Council of State and Territorial Epidemiologists
  • Edifecs, Inc.
  • EHR Association
  • Epilepsy Foundation
  • Florida Environmental Health Association
  • Friends of NCBDDD
  • Friends of the National Center for Health Statistics
  • Green & Healthy Homes Initiative
  • Healthcare Information and Management Systems Society (HIMSS)
  • Hep B United
  • Hepatitis B Foundation
  • Hepatitis Education Project
  • HLN Consulting, LLC
  • Infectious Diseases Society of America
  • Intermountain Healthcare
  • International Society for Disease Surveillance
  • Inter-university Consortium for Political and Social Research
  • ISF, Inc.
  • Lakeshore Foundation
  • Liver Health Connection
  • March of Dimes
  • MQ Foundation
  • NAPHSIS - National Association for Public Health Statistics and Information Systems
  • National Association of County and City Health Officials
  • National Association of School Nurses
  • National Association of State Emergency Medical Services Officials
  • National Birth Defects Prevention Network
  • National Blood Clot Alliance
  • National Coalition of STD Directors
  • National Environmental Health Association
  • National Healthy Start Association
  • National Multiple Sclerosis Society
  • National Network of Public Health Institutes
  • National Safety Council
  • National Viral Hepatitis Roundtable
  • NTT DATA Services Federal
  • Philadelphia Department of Public Health
  • Prevent Blindness
  • Public Health Institute
  • Research!America
  • Ruvos
  • SAP
  • SAP Public Services
  • SAS Institute
  • Spina Bifida Association
  • Teratology Society
  • Testability, Inc.
  • The Academy for Radiology & Biomedical Imaging Research
  • The Immunization Partnership
  • The Joint Commission
  • The Michael J. Fox Foundation for Parkinson’s Research
  • The Society for Healthcare Epidemiology of America
  • Trisomy 18 Foundation
  • Trust for America's Health
  • United Spinal Association
  • Washington State Department of Health