SUPPORTING TRIBAL PUBLIC HEALTH 

INFRASTRUCTURE AND EFFORTS TO 

IMPROVE DATA ACCESS

CDC/ATSDR Tribal Advisory Committee

Leslie Ann Dauphin, PhD (she/her/hers)

Director

CDC’s Center for Surveillance, Epidemiology, and Laboratory Services (CSELS) 

August 4, 2022
Overview

• CSELS Mission

• Supporting Public Health Infrastructure 

in Indian Country

• Public Health Workforce

• Case Surveillance

• Data Modernization

• Tribal Public Health Data

• Addressing GAO Recommendations
CSELS

Data, Surveillance, and Analytics

Laboratory Systems

Public Health Workforce

Scientific Communication

What We Do

CSELS works to strengthen 

and modernize the public 

health infrastructure of the 

United States through science

and collaboration
Snapshot of Selected CSELS Programs
CSELS 

Strategic 

Priorities

Data, Surveillance, and Analytics

Modernize case surveillance and implement electronic 

case reporting

Expand syndromic surveillance capacity

Improve data science and informatics capacity

Laboratory Systems

Expand laboratory data exchange with public health and 

clinical laboratories

Strengthen laboratory training and workforce development

Public Health Workforce

• Build a diverse and capable pipeline of public health 

professionals

• Upskill the existing public health workforce 

•

•

•

•

•
How CSELS 

supports 

Public Health 

Infrastructure in 

Indian Country

1 Public Health Workforce

Case Surveillance

Data Modernization

2

3

4 Efforts to Improve Data Access
PUBLIC HEALTH 

WORKFORCE
Public Health Workforce

The Foundation of Every Public Health Effort

What

CDC builds the 

workforce necessary to 

protect public health 

through recruitment 

and training

CDC delivers 

learning opportunities 

for health professionals on 

many topics, 

including COVID-19

Why

A competent, sustainable, 

and empowered public 

health workforce is better 

prepared to meet 

emerging and future 

challenges

CDC fellowships are 

pipeline programs to 

CDC Leadership

How

CDC uses an 

evidence-based approach to

the public 

workforce, with 

an emphasis on 

diversity and 

data science 

Improving the diversity of 

the public health 

workforce pipeline 

through recruitment, 

selection, and training 

curriculum
Developing the Public Health Workforce 

in Tribal Jurisdictions

CDC TRAIN: A national system used by affiliate member organizations to 

manage and share public health trainings

• In FY21, more than 9,800 CDC TRAIN learners identified their work 

setting as either Indian Health Service (6,270) or Tribal Health Sites 

(3,614) 

• In FY21, more than 2,700 new CDC TRAIN learner accounts were created that 

identified their work setting as either Indian Health Service (1,845) or Tribal 

Health Sites (915). 

Training & Continuing Education Online (TCEO)

• In FY21, more than 15,900 TCEO learners identified their work setting 

as either Indian Health Service (12,661) or Tribal Health Sites (3,288).
Developing the Public Health Workforce 

in Tribal Jurisdictions

2022 American Indian, Alaska Native, & Native Hawaiian Career Expo

November 3, 2022

• CDC will host a virtual recruitment event to provide Tribal students and 

alumni an opportunity to learn about CDC career opportunities. 

• The event will also provide an opportunity to interact with CDC 

leaders and staff. 

For questions or general inquires: recruiter@cdc.gov
CASE SURVEILLANCE
Case Surveillance and Electronic Case Reporting (eCR)

Data from Healthcare to Public Health Agencies

What

CSELS runs NNDSS, 

the nation’s case 

surveillance 

infrastructure 

eCR automatically 

sends case reports 

to public health 

agencies from an 

EHR in healthcare

eCR enables 

real-time case 

reporting to public 

health agencies

Why

Automating the case 

reporting process

replaces timeconsuming reporting

eCR provides a seamless, realtime, bidirectional transfer 

of case 

report data

eCR improves

data completeness

How

Scaled up eCR for COVID-19

by aligning efforts of:

1. Public Health Agencies

2. Health IT and EHR Vendors

3. Healthcare Organizations

• All 50 states, DC, PR, and 13 

large local jurisdictions have 

received eCR data

• 14,000+ healthcare facilities 

in 49 states in production for 

eCR
Expanding eCR with Tribal Partners

CDC is working with Urban Indian Organization healthcare providers to connect them to the eCR infrastructure, reducing their public health reporting burden.

• The National Council of Urban Indian Health selected three Urban Indian 

Organizations as subawardees for the Expanding Electronic Case 

Reporting To Benefit Urban Tribal Populations project. 

CDC is working with Tribes to connect to the eCR infrastructure 

to receive better and faster data. 

• The National Indian Health Board selected two Tribal nations as 

subawardees for the Improving Electronic Data Access For 

Reportable Conditions For Tribal Governments project. 
Field Work in Action

The CDC Epi InfoTM Team conducted individual Tribal 

technical assistance sessions that ranged from general 

orientations to technical screen sharing collaborations.

• The Epi InfoTM team worked with the Albuquerque Area Southwest 

Tribal Epidemiology Center with a COVID-19 database used to 

actively collect health data of COVID-19 patients.

• Tribal members reached out seeking a way to use Epi Info web 

products while maintaining the sovereignty of their data on their 

dedicated servers.
DATA 

MODERNIZATION
Ver

16

DMI is a once-in-a-generation opportunity to strengthen the data and 

surveillance infrastructure of the United States. 

Priority CSELS DMI Efforts

• Electronic Case Reporting

• Laboratory Data Exchange

• Case Surveillance Modernization

• Syndromic Surveillance Enhancement

• Data Science Workforce and Upskilling 
Accelerating Public Health Data Modernization in Tribal 

Jurisdictions 

Alaska Native Tribal •

Health Consortium

•

Automating integration of immunization registry data into 

population health data feeds, creating dashboards, and 

providing training to users on newly created analysis tools

Northwest Portland Area 

Indian Health Board

•

Conducted internal DMI needs assessment; implementing action 

plans & increasing staff upskilling opportunities

Rocky Mountain Tribal 

Leaders Council

•

Staff upskilling in data management and visualization to improve 

data use

Wabanaki Public Health 

and Wellness

Process of creating, initiating, and maintaining surveillance 

structure
Spotlight on Alaska Native Tribal Health Consortium Efforts

Collaborated with the 

Alaska DHSS 

and VacTrAK Vendor

Established a Data Sharing Agreement 

to share vaccination data for patients 

served by ANTHC and 15 other Tribal 

Health Facilities

Combined vaccination data with data 

about patients, to ID patients in each 

region that met CDC's criteria for high 

risk of COVID-19

Reps from Tribal Health Organizations 

have access to data and tools used and 

can apply them in ways that work best for 

their own regions
DMI Technical Assistance

Informatics & IT Technical Assistance

Systems 

Architecture/Data 

Exchange & 

Interoperability 

Projects

SME in 

Processing, 

Validating, and 

Routing E-data

Data Reporting 

Between Health 

Department 

Levels

Data Analytics & 

Creating Data 

Visualizations

Creating Data 

Extract Scripts & 

Automated 

Programming 

Interfaces

Developing SOPs

Quality Training 

or Other Learning 

Materials

Maintenance Plan 

When New 

Solution/System is 

Created

Business Analyst Support

Requests for DMI TA can be sent to csels_dmi@cdc.gov

Assess Health 

Information 

Systems 

Capacities & 

Needs

Business Analyst

Consultant 

Hours to Prioritize 

Activities w/ 

External Partner

Project Management 

Support for Systems 

Replacement 

Implementation

Planning
EFFORTS TO IMPROVE

DATA ACCESS
EFFORTS TO IMPROVE DATA ACCESS

Lesliann Helmus, MS, CHTS-CP (she/her/hers)

Associate Director for Surveillance

CSELS, Division of Health Informatics and Surveillance

Georgia Moore, MS (she/her/hers)

Associate Director for Policy

Center for State, Tribal, Local and Territorial Support
Example Data System: Notifiable Diseases

Jurisdiction Surveillance Process

Other PH Systems Used in Investigation

Immunization Outbreak & 

Registry Vital Contact 

Records Tracing

Laboratory

CDC National Notifiable 

Diseases Surveillance 

System Program STLT Surveillance System

Public Health 

Investigation

Health Care

Electronic Case Reporting (eCR)

(identifiable data)

Case Notification

(de-identified data)

CDC Surveillance Programs

National Center for HIV, 

Viral Hepatitis, STD, and 

TB Prevention 

(NCHHSTP)

National Center for 

Emerging and Zoonotic 

Infectious Diseases 

(NCEZID)

National Center for 

Immunization and 

Respiratory Diseases 

(NCIRD)

Center for Global 

Health (CGH)

National Center for 

Environmental Health 

(NCEH)

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Addressing Data and Systems Challenges

Limitations

• Public health systems have not 

met tribal data needs

• CDC data are not centralized 

and standardized

• Native American indicators are 

often unavailable

Improvements

• Reworking systems to expand 

data availability and access

• Centralizing and standardizing 

through Data Modernization

• Increasing data completeness of 

tribal affiliation and race
GAO Recommendations

Agency Affected Recommendation

Department of Health and Human Services 

(HHS)

The Secretary of HHS should develop a policy clarifying the HHS data 

(including monitoring systems, delivery systems, and other protected health 

information) that are to be made available to TECs as required by federal law. 

CDC 

The Director of CDC should develop written guidance for TECs on how to 

request data. Such guidance should include information on data potentially 

available to TECs, how to request data, agency contacts, criteria the agency 

will use to review such requests, and time frames for receiving an agency 

response to data requests. 

CDC

The Director of CDC should develop and document agency procedures on 

reviewing TEC requests for and making data available to TECs. These 

procedures should include a description of data potentially available to TECs, 

agency contacts, criteria for reviewing TEC data requests, and time frames for 

responding to TEC requests. 

U.S. Government Accountability Office, March 4, 2022, www.gao.gov/products/gao-22-104698
GAO Recommendations

Agency Affected Recommendation

Indian Health Service

(IHS)

The Director of IHS should develop written guidance for TECs on how to 

request data. Such guidance should include information on the data available 

to TECs, how to request data, agency contacts, criteria the agency will use to 

review such requests, and time frames for receiving an agency response to 

data requests.

IHS

The Director of IHS should develop and document agency procedures on 

reviewing TEC requests for and making data available to TECs. These 

procedures should include a description of the data available to TECs, agency 

contacts, criteria for reviewing TEC data requests, and time frames for 

responding to TEC requests.

U.S. Government Accountability Office, March 4, 2022, www.gao.gov/products/gao-22-104698
Thank you!

For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily 

represent the official position of the Centers for Disease Control and Prevention.

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