**GAO-11-99**                      Published: Dec 17, 2010. Publicly Released: Dec 17, 2010.                  

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## Highlights

A catastrophic public health event could threaten our national security and cause hundreds of thousands of casualties. Recognizing the need for efficient sharing of real-time information to help prevent devastating consequences of public health emergencies, Congress included in the Pandemic and All-Hazards Preparedness Act in December 2006 a mandate for the Secretary of the Department of Health and Human Services (HHS), in collaboration with state, local, and tribal public health officials, to develop and deliver to Congress a strategic plan for the establishment and evaluation of an electronic nationwide public health situational awareness capability. Pursuant to requirements of the act, GAO reviewed HHS's plans for and status of efforts to implement these capabilities, described collaborative efforts to establish a network, and determined grants authorized by the act and awarded to public health entities. GAO assessed relevant strategic planning documents and interviewed HHS officials and public health stakeholders.

HHS did not develop and deliver to congressional committees a strategic plan that demonstrated the steps to be taken toward the establishment and evaluation of an electronic public health situational awareness network, as required by PAHPA. While multiple offices within HHS have developed related strategies that could contribute to a comprehensive strategic plan for an electronic public health information network to enhance situational awareness, these strategies were not developed for this purpose. Instead, the offices developed the strategies to address their specific goals, objectives, and priorities and to meet requirements of executive and statutory authorities that mandated the development of strategies for nationwide health information exchange, coordinated biosurveillance, and health security. However, HHS has not defined a comprehensive strategic plan that identifies goals, objectives, activities, and priorities and that integrates related strategies to achieve the unified electronic nationwide situational awareness capability required by PAHPA. The department has developed and implemented information technology systems intended to enable electronic information sharing to support early detection of and response to public health emergencies; however, these systems were not developed as part of a comprehensive, coordinated strategic plan as required by PAHPA. Instead, they were developed to support ongoing public health activities over the past decade, such as disease and syndromic surveillance. Without the guidance and direction that would be provided by an overall strategic plan that defines requirements for establishing and evaluating the capabilities of existing and planned information systems, HHS cannot be assured that its resources are being effectively used to develop and implement systems that are able to collect, analyze, and share the information needed to fulfill requirements for an electronic nationwide public health situational awareness capability. HHS has engaged in collaborative efforts to improve information technology capabilities to share situational awareness information. For example, HHS has collaborated with public and private health care partners to establish standards, services, and policies that support the electronic exchange of interoperable health care and public health data to support electronic sharing of information for biosurveillance purposes. The department has also awarded funds through cooperative agreement programs to state and local public health entities intended to improve capabilities to detect public health emergencies and to identify emergency response resources. Although the act authorized the use of funds for the award of grants to states to establish statewide or regional public health situational awareness systems, to date, Congress has not appropriated funds pursuant to the authorization. GAO is recommending that HHS develop and implement a strategic plan to guide and integrate efforts to establish electronic situational awareness capabilities. In written comments on a draft of the report, HHS neither agreed nor disagreed with GAO's recommendation, but stated that a complete strategy would be developed.

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## Topics

Information Technology

Data collectionElectronic data interchangeElectronic health recordsEmergency preparednessEmergency responseGovernment information disseminationInformation disclosureInformation technologyMedical information systemsNeeds assessmentPerformance measuresPublic healthPublic health preparedness and response for bioterrorism programReporting requirementsRequirements definitionStandardsStrategic planningInformation sharing