Brief State Public Health Data Reporting Policies and Practices

Public health data is used for anticipating, identifying and analyzing public health threats and ultimately informing policymaking. Although public health crises can evolve quickly, public health data is often lagging. 

Public Health Data Challenges 

Public health agencies rely on data to drive decisions around emerging public health risks, preventing the spread of diseases and identifying communities disproportionately threatened by illness or injury. The pandemic was a huge test of both national and state level capacity to collect and share data to provide actionable information. 

State epidemiologists reported that such processes were slowed due to wading through phone calls, faxes and paper to piece together information needed in a rapidly changing environment. A sizable portion of data is still reported using manual processes which can create administrative work, introduce human errors and slow the analysis and use of information.  

A 2022 report from the U.S. Government Accountability Office includes recommendations on three items that can support the country’s ability to share data and respond to public health emergencies:    

• Common data standards: Requirements that data elements are collected in a standardized manner so data can be compared and trends can be identified. 

• Interoperability: The ability of systems to exchange information such as data from labs or hospitals to public health agencies. 

• Public health IT infrastructure: Computer software, hardware, networks, policies and staff that enable public health agencies to collect and analyze information electronically. 

State Policies and Practices

A new report from The Pew Charitable Trusts provides an analysis of state policies and practices that govern how data flows to state public health agencies. The research was informed by examination of each states' public health statutes and regulations as well as interviews with 266 public health officials in 47 states and the District of Columbia.

Key findings from the statute and regulation search, conducted between May and August 2021, include:

• No state or District of Columbia statutes require case reports to be submitted using automated electronic technology; three jurisdictions require it for lab reports and four require it for syndromic surveillance.
• All 50 states and the District of Columbia require labs to report data.
• Forty-five jurisdictions require immunization data to be reported, including 34 that require reporting for all ages and 11 that require reporting of children's vaccinations only.
• Ten jurisdictions require emergency departments to report syndromic surveillance data.
• Forty-six jurisdictions allow case reports to be submitted by phone and 25 allow case reports to be faxed.
• Thirty-eight jurisdictions allow lab reports to be submitted by phone and 20 allow lab reports to be faxed.
• No state or District of Columbia statutes require case reports to be submitted using automated electronic technology; three jurisdictions require it for lab reports.

Key findings from interviews with public health officials include:

• Each state has unique needs, capacities and resources. No single approach to modernizing public health data will work for every state, but states can learn from each other and adopt common approaches.
• Staffing shortages, outdated IT infrastructure and inadequate funding were cited as reasons public health agencies have not invested in modern IT systems to collect and analyze electronic data.
• Certain providers, including some smaller and rural providers, lack the resources to invest in automated electronic reporting systems and some public health officials fear requiring them to do so may discourage reporting altogether. Some jurisdictions have created alternative methods for smaller providers to report electronically without adopting expensive technologies.
• Most public health agencies use lab data as a primary source of information about emerging diseases since most lab reports are now transmitted electronically.
• More reports could be automated and shared electronically, as opposed to manual transmission via fax and phone, which would improve the timeliness and accuracy of the data.
• Automated data does not necessarily equate to better data so states must work with data reporters to evaluate and improve data quality.

State Considerations and Actions

Based on the research conducted, The Pew Charitable Trusts suggests that states develop processes to examine and study the performance of their public health data reporting systems including:

• Measuring baseline performance of public health data reporting.
• Prioritizing areas for improvement.
• Determining needed strategies and policies.
• Tracking progress as strategies are implemented.

Some states have already taken actions. For example, Indiana budgeted an additional $225 million, from $7 million, to expand the state's public health programs. The legislation was based on a commission report that noted: "The Governor's Public Health Commission believes Indiana must take action to transform the state's public health system by modernizing our public health services, administrative and data supports, and delivery systems … to ensure that the state is prepared for future public health emergencies."

Maryland passed legislation establishing a Commission on Public Health to recommend improvements for delivering foundational public health services in the state including recommendations to reform the areas of information technology, information exchange and data and analytics.

Utah recently enacted legislation to review and define the health data authority duties of its Department of Health and Human Services, which includes the state's public health services, to include:

• Identifying key health issues amenable to improvement through better data or improved dissemination of data.
• Documenting existing health data activities in the state to encourage improvements in data collection, interpretation and reporting.
• Detailing types of data needed for the department's work and intended suppliers.
• Explaining the intended uses and expected benefits derived from specified data.

For more information on the use of public health data to inform policy decisions, see the following NCSL resources.

• Workforce and Data System Strategies to Improve Public Health Policy Decisions, brief, June 2023
• The Critical Role of Public Health Data, podcast, August 2022
• Using Data Exchange to Improve Public Health, article, June 2022