Public Health Data Strategy

April 2023

Public Health Data Goals and

2-Year Milestones

Public Health

Data Strategy

Executive

summary

1. Ensure Core Data Sources are more complete, timely, rapidly exchanged, and available to support the integrated ability to detect, monitor, investigate, and

respond to public health threats

The Public Health Data

Strategy (PHDS) outlines the

data, technology, policy,

and administrative actions

essential to exchange

critical core data efficiently

and securely across

healthcare and public health.

The strategy is designed to

describe a path to address

gaps in public health data,

helping the nation become

response-ready, promote

health equity, and improve

health outcomes for all.

To advance core public health missions (Detect and Monitor, Investigate and Respond, Inform

and Disseminate, and Be Response-Ready), the PHDS addresses the CDC Moving Forward

imperative to consistently deliver public health information and guidance to Americans in near

real-time.

Through the PHDS, public health decision-makers (e.g., the public; labs; providers; other

healthcare partners; state, tribal, local, and territorial health departments; CDC programs; federal

agencies) will have a clear, streamlined vision of near-term priorities.

The Public Health Data Strategy outlines four Public Health Data Goals:

1. Strengthen the core of public health data

2. Accelerate access to analytic and automated solutions to support public health investigations

and advance health equity

3. Visualize and share insights to inform public health action

4. Advance more open and interoperable public health data

Accomplishing 2-year milestones associated with these goals requires collaboration and

partnership with state, tribal, local, and territorial health departments; healthcare partners; and

other federal agencies.

CDC will create accountability for these Public Health Data Goals and 2-year milestones

through the new Office of Public Health Data, Surveillance, and Technology (OPHDST),

which will lead and strengthen engagement and collaboration with jurisdictions, CDC programs,

and private partners, and focus the execution of data modernization activities.

What the Public Health Data Strategy (PHDS) is and why it

matters

Public Health Data Goals and 2-year milestones

How CDC will help achieve these goals and milestones

What the Public Health Data Strategy is

The Public Health Data Strategy (PHDS) outlines the data,

technology, policy, and administrative actions essential to

exchange critical core data efficiently and securely

across healthcare and public health.

The strategy is designed to describe a path to address gaps in

public health data, helping the nation become response-ready,

promote health equity, and improve health outcomes for all.

Why the Public Health Data Strategy matters

To advance core missions of robust public

health data aimed at improving health

outcomes equitably…

Detect and

monitor

Investigate

and respond

Inform and

disseminate

Be response-

ready

…the Public Health Data Strategy …

Addresses the imperative of the CDC Moving Forward effort

to consistently deliver public health information and guidance to

Americans in near real-time

Measures success with specific 2-year milestones

Aligns data modernization efforts at all levels of public health

and across partners, focusing on near-term priorities

Creates accountability for public health data with CDC's

newly established Office of Public Health Data, Surveillance, and

Technology

Builds on lessons learned from the COVID-19 pandemic and

other recent public health threats to be more response-ready

Source: CDC Moving Forward website

The Public Health Data Strategy aims to address challenges currently experienced

across healthcare and public health

ILLUSTRATIVE

Healthcare

(labs, providers)

National public health

(CDC, Federal partners)

Public

States, tribes, localities, and territories

(STLTs)

12+ months for data on some reportable conditions

to become available in national datasets or be

disseminated in accessible and interoperable

formats

~3 months between first reported domestic

mpox case and CDC data access

agreements with STLTs

6+ months often needed to develop

and potentially rework Data Use

Agreements

30%+ of COVID-19 cases missing data on

race and ethnicity early in the pandemic

~70% of healthcare organizations using fax to

send or receive care records

Up to 80% of epidemiologists’ time spent

cleaning data

because of non-interoperable

systems

! ! !

Example challenge

High-level data flow

1. ONC Data Brief No. 54 (2021), 2. ‘A Prototype of Modernized Public Health Infrastructure for All: Findings from a Virginia Pilot’ – CDC (2022), 3. CDC case surveillance data (as of Sept 9, 2022), 4. Average estimates by CDC staff, 5. ‘Very

Harmful’ lack of data blunts U.S. response to outbreaks’ – New York Times 2022

Source: New York Times, NEJM Jan 2022, GAO, ONC, CDC + USDS Virginia prototype findings, CDC estimates

Successfully achieving the Public Health Data Goals and 2-year milestones

addresses critical public health challenges by 2025

Public health data goal supported

Healthcare

(labs, providers)

National public health

(CDC, Federal partners)

Public

States, tribes, localities, and territories

(STLTs)

Increased ability for STLTs to automatically

exchange data with CDC creates a reliable

national common operating picture

Data on demand enables health

disparities analysis across geographies,

conditions, and settings

Faster sharing of data through

language and terms for data

protection and use

<7 days needed to detect a suspected

disease outbreak and begin nationwide

monitoring

American public has near real-time awareness of

the status of high-consequence diseases

through a centralized data dissemination

platform

4 1

Time saved on data cleaning and

analytics, through reusable technologies,

enables epidemiologists to focus on core

public health missions

ILLUSTRATIVE

High-level data flow

The Public Health Data Strategy supports partners across the public health ecosystem

1. STLT: States, Tribes, Localities, and Territories

Federal agencies

Understand where and how to access richer public health

data on demand to inform decision-making

…To…

The Public Health Data

Strategy will help…

The Public

Have greater access to critical information on public health

emergencies, risks, trends, and resources

STLTs

Prioritize data and technology investments to enable the

most critical public health systems to be scalable, flexible,

interoperable, sustainable, reusable, and intuitive

Streamline ongoing and planned efforts to support

measurable and concrete 2-year milestones

CDC programs

Healthcare

(labs and providers)

Identify and adopt ready-to-use tools that enable easier

and faster sharing of critical core public health data

Enabling

greater

response

readiness

and

progress

toward

health

equity

Public Health Data Strategy strengthens the core of public health data

Core Data Sources

are essential to identify diseases and conditions, detect emerging public health threats, and understand

disease burden and severity across different populations. The PHDS decreases the burden to securely report these critical data,

and improves dissemination to ensure the right data are available at the right time.

Case

Emergency

dept.

Immun-

ization

Vital stats.

Healthcare

capacity

Lab

Core Data Sources…

Case data represent comprehensive disease and condition information used by public health to understand

disease burden, know who is at risk, and identify outbreaks

Laboratory data, including test results and test type, enable public health agencies to track disease trends and

identify outbreaks or exposures, and help frontline providers diagnose and treat health conditions

Emergency department data, including clinical diagnoses, signs, and symptoms, help identify near real-time

trends for new, emerging, and developing public health threats to inform faster detection and response

Vital statistics data include birth and death data and are essential to understand disease severity, mortality,

trauma, and toxicity that might signal a larger public health emergency

Immunization data capture vaccine doses administered (both routinely recommended and response-related)

to support calculating vaccination coverage levels and trends

Healthcare capacity and utilization data assess availability of healthcare resources, including staff, beds, and

equipment, aiding understanding of health system stresses and disease severity to inform resource allocation

1. Core Data Sources as defined in CDC Advisory Committee to the Director (ACD) Data and Surveillance Workgroup (DSW) Report; non-exhaustive of all data sources critical to public health

awareness and response (e.g., advanced molecular detection data)

1010

What the Public Health Data Strategy (PHDS) is and why it

matters

Public Health Data Goals and 2-year milestones

How CDC will help achieve these goals and milestones

Four major Public Health Data Goals enable the core public health missions

Detect and

monitor

Investigate

and respond

Inform and

disseminate

Be response-

ready

Make tools available so STLTs and other public health decision-makers can better use

public health data to address health disparities

Public Health Data Goals

Core public

health missions

1. Case (including electronic case reporting [eCR]), lab (including electronic lab reporting [ELR], Electronic Test Orders and Results [ETOR]), emergency department (including National Syndromic Surveillance Program [NSSP] emergency

department data), vital statistics, immunization, healthcare capacity (including National Healthcare Safety Network [NHSN] data)

Ensure Core Data Sources

are more complete, timely, rapidly exchanged, and available to

support the integrated ability to detect, monitor, investigate, and respond to public health threats

Serve as a trusted source for near real-time visualizations and offer situational awareness for

the public and decision-makers to understand risks, make decisions, and direct resources

Enable exchange of interoperable data so that healthcare, STLTs, federal agency partners,

and CDC programs can access and use data they need, when they need it

Strengthen the core of public health data

Accelerate access to analytic and automated solutions to support public health

investigations and advance health equity

Visualize and share insights to inform public health action

Advance more open and interoperable public health data

Public Health Data Goals drive key outcomes over the next 2 years

Goals

Accelerate access to analytic

and automated solutions to

support public health

investigations and advance

health equity

 STLTs and CDC can identify emerging threats in all parts of the nation in a timely way as more critical access hospitals in rural communities

send case data electronically

 STLTs can address gaps in the public health workflow such as linking case, lab, and immunization records to enrich data and inform public

health action through reusable technologies

 STLTs and communities can identify, prevent, and mitigate disproportionate impact on populations through use of automated reports

provided by CDC, using CDC public health databases

Visualize and share

insights to inform public

health action

 STLTs and CDC programs receive quicker access to data and insights from Core Data Sources

 Americans can access near real-time data and visualizations made available via a centralized data dissemination platform (e.g., a

Public Health Data Channel like the National Weather Service) to improve understanding and inform decisions about public health risks

Advance more open and

interoperable public

health data

 CDC establishes a strategic pathway of data exchange with providers’ electronic health records (EHRs) through at least 2 initial

Trusted Exchange Framework and Common Agreement (TEFCA) for public health use case pilots

 CDC and STLTs increase data exchange back to healthcare providers, helping to inform clinical decision-making

 Data use and access are easier through established, standardized agreements (e.g., for sharing emergency department data with CDC

programs, STLTs), enabling quicker access to minimal data necessary for response during a public health emergency

 CDC has measurably and securely increased the number of accessible open public health data sets for timely use and faster insights

Strengthen the core of

public health data

 States, tribes, localities, and territories (STLTs) have reduced reporting burden as case data are electronically reported in a consistent

format, using a CDC Front Door concept

 Public health labs can forecast needs better with integrated, electronic ability to see test orders before samples arrive and ensure faster

exchange of orders and test results with submitters

 STLTs can access lab reports more quickly and through multiple pathways, enabling faster public health action (e.g., case

investigation, contact tracing)

 CDC can access lab, case, and mortality data faster, enabling robust situational awareness that informs decision-making across the

nation

 STLTs and CDC programs have access to more early warning signals from emergency departments (EDs), with up to 80% participation

by US non-federal EDs in the National Syndromic Surveillance Program (NSSP)

1. Case (including electronic case reporting [eCR]), lab (including electronic lab reporting [ELR}, Electronic Test Orders and Results [ETOR]), emergency department (including National Syndromic Surveillance Program [NSSP] emergency department visit data), vital statistics,

immunization, healthcare capacity (including National Healthcare Safety Network [NHSN] data)

By the end of 2024, 2-year milestones strive to ensure…

Accomplishing the Public Health Data Goals requires collaboration and partnership with STLTs, healthcare partners, and other federal agencies

SPECIFIC MILESTONES BY YEAR ON FOLLOWING PAGES

ILLUSTRATIVE

13
Success is measured by 2-year milestones (for Goal 1)
Public Health Data 
Goal
Milestones within 2 years
1
Strengthen the 
core of public 
health data
Ensure Core Data 
Sources
2
are more 
complete, timely, 
rapidly exchanged, 
and available to 
support the 
integrated ability to 
detect, monitor, 
investigate, and 
respond to public 
health threats
1
End of 2024 End of 2023 
38 jurisdictions³ are ingesting eCRdata into disease surveillance systems32 jurisdictions³ are ingesting eCR data into disease surveillance 
systems
Almost 100%of ELC recipients are connected to multiple intermediaries (e.g., 
AIMS, ReportStream, HIEs) for lab data
90% of ELC recipients are connected to one or multiple intermediaries 
(e.g., AIMS, ReportStream, HIEs) for lab data
100% of State Public Health Labs have implemented ETOR (e.g., web portal, 
direct integration, or use of intermediary) with at least 1 healthcare partner for at 
least 1 lab program
90% of State Public Health Labs have implemented ETOR (e.g., web 
portal, direct integration, or use of intermediary) with at least 1 
healthcare partner for at least 1 lab program
Core case data for select nationally notifiable conditions are reported using a 
common format, using a CDC Front Doorconcept, and shared back in near 
real-time for CDC programs and STLT partners to access
STLTs enabled to submit a generic core case data feed that can be 
used for national disease notification
50% of lab test order requests received electronically at CDC infectious 
disease labs(e.g.,using ETOR, CSTOR, intermediary)
75% of CDC infectious disease labs send lab test results to external 
partners electronically (e.g., using ELR, CSTOR, intermediary)
Increased participation to 80% (from 73% today) of U.S. non-federal 
emergency departments to increase representativeness of NSSP data sources 
and users
Reduced time to send mortality data to and receive coded cause of 
death data from CDC for 30 additional jurisdictions (42–45 total)³
through use of FHIR messaging
Reduced time to send mortality data to and receive coded cause of 
death data from CDC for 12–15 jurisdictions³ through use of FHIR 
messaging
1. Accomplishing the Public Health Data Goals requires collaboration and partnership with STLTs, healthcare partners, and other federal agencies   2. Case (including electronic case reporting [eCR]), lab (including electronic lab reporting [ELR], Electronic Test Orders and Results [ETOR]), emergency department (including 
National Syndromic Surveillance Program [NSSP] emergency department data), vital statistics, immunization, healthcare capacity (including National Healthcare Safety Network [NHSN] data) 3. Out of the ~64 ELC- or PHI- funded jurisdictions
Potential impact: <7 days needed to detect a suspected disease outbreak and begin nation-wide monitoring, through using faster case, lab, emergency department, mortality data
CDC receives and ensures access to commercial lab data from at least 
3 major national and regional commercial labs to enable situational 
awareness across multiple conditions
CDC receives and ensures access to commercial lab data from at least 
2 major national commercial labs to enable situational awareness 
across multiple conditions

Success is measured by 2-year milestones (for Goal 2)

At least 2 automated reports using CDC’s

healthcare databases available within CDC

and across STLTs to identify and address

health disparities

Public Health Data

Goal

Accelerate access

to analytic and

automated

solutions to

support public

health

investigations and

advance health

equity

Make tools available

so STLTs and other

public health

decision-makers

can better use

public health data to

address health

disparities

End of 2024 End of 2023

Critical access hospitals in production with

eCR increased to 25%, up from 20% in 2022

Critical access hospitals in production with

eCR increased to 35%

Reusable technologies to link multiple data

streams (e.g., case, lab) made available to all

jurisdictions and deployed by at least 1 STLT

– saving time for epidemiologists who currently

spend up to 80% of their time on data cleaning

Reusable technologies to link multiple data

streams (e.g., case, lab) adopted by multiple

STLTs

Milestones within 2 years

1. Accomplishing the Public Health Data Goals requires collaboration and partnership with STLTs, healthcare partners, and other federal agencies

2. ‘A Prototype of Modernized Public health Infrastructure for all: Findings from a Virginia Pilot’ – CDC (2022)

Potential impact: Improved data available to epidemiologists (e.g., 2x critical access hospitals sending case data electronically), enabling faster health equity analyses

Success is measured by 2-year milestones (for Goal 3)

Minimum viable product for centralized

data dissemination platform developed in

partnership with CDC’s Office of Readiness

and Response to share timely and actionable

data publicly

Centralized data dissemination platform

launched to streamline insights from case,

emergency department, mortality data, and at

least 1 other data source

Data and visualizations available within 2–3

days (from 5–90+ days) for CDC programs

and STLTs since time of receiving case data

at CDC for at least 1 nationally notifiable

condition (i.e., viral hepatitis)

Public Health Data

Goal

Visualize and

share insights to

inform public

health action

Serve as a trusted

source for near real-

time visualizations

and offer situational

awareness for the

public and decision-

makers to

understand risks,

make decisions,

and direct

resources

End of 2024 End of 2023

Data and visualizations available within 2–3

days (from 5–90+ days) for CDC programs

and STLTs since time of receiving case data

at CDC for multiple nationally notifiable

conditions

Milestones within 2 years

1. Accomplishing the Public Health Data Goals requires collaboration and partnership with STLTs, healthcare partners, and other federal agencies

Potential impact: Faster, actionable insights available to the public in near real-time (2–3 days from 5–90+ days) through a centralized data dissemination platform

Success is measured by 2-year milestones (for Goal 4)

Public Health Data

Goal

Advance more

open and

interoperable

public health data

Enable exchange of

interoperable data

so that healthcare,

STLTs, federal

agency partners,

and CDC programs

can access and use

data they need,

when they need it

End of 2024 End of 2023

New data access agreement established to enable

easier sharing of emergency department data from

NSSP across STLTs and CDC programs

At least 50% of existing NSSP jurisdictions adopt new

data access agreement to enable easier sharing of

emergency department data across STLTs and CDC

programs

Number of public health data sets published by

CDC with metadata utilizing FAIR open data

principles increased by 10%

Milestones within 2 years

1. Accomplishing the Public Health Data Goals requires collaboration and partnership with STLTs, healthcare partners, and other federal agencies

Minimal data elements necessary for public health

response defined for at least case and lab data, in

collaboration with STLT partners and CDC programs

Minimal data elements necessary for public health

response defined for multiple data sources, in

collaboration with STLT partners and CDC programs

CDC launches pilots for at least 2 public health

use cases with TEFCA (e.g., query data from

healthcare settings for urgent public health

investigations)

CDC selects a QHIN and has identified at least 2

public health use cases for TEFCA, establishing

a pathway for data exchange with healthcare

systems and providers

Standard language and terms for data

protection and use agreed upon with public health

partners for Core Data Sources, consistent with

ACD DSW recommendations

Data access and use under established language

and terms across at least 15% of funded states

and territories for Core Data Sources, including

case data

Potential impact: Standardized language and terms for data use introduced across healthcare and public health, enabling greater data quality and easier data sharing

1717

What the Public Health Data Strategy (PHDS) is and why it

matters

Public Health Data Goals and 2-year milestones

How CDC will help achieve these goals and milestones

How CDC will help achieve the Public Health Data Strategy goals and

milestones

Increase engagement and collaboration with:

 STLTs: Collaborate on and continually provide feedback on progress towards key 2-year milestones (e.g., DUAs,

reusable technologies); engage directly with STLTs to understand priority needs

 Providers and labs: Gather feedback from the frontlines on how CDC can better support progress towards 2-year

milestones

 CDC: Establish internal steering committee to provide guidance on longer term PHDS, monitor and provide input on

progress; establish mechanisms to solicit programmatic input and identify priority needs

 Private partners: Organize Industry Days and promote data exchange pilots to work toward modernization together

 Federal agency partners: Collaborate with partners such as ONC and CMS to advance shared understanding of

activities needed to support 2-year milestones, including TEFCA for public health

Increase engagement, collaboration, and continual feedback

Ensure accountability for the Public Health Data Goals sits with CDC’s Office of Public Health Data, Surveillance, and

Technology (OPHDST):

 Structure the organization to support core public health missions

 Identify owners within OPHDST and across the agency to drive progress for specific 2-year milestones

 Update the agency regularly on Public Health Data Strategy goals and milestones

Establish accountable office within CDC

The Public Health Data Strategy is an ambitious but necessary plan

to improve the exchange of core data across healthcare and public

health.

Successful implementation of the strategy—and achievement of the

Public Health Data Goals over the next two years―will require

collaboration with STLTs, healthcare partners, and other federal

agencies, as well as sustained resources.

List of terms used in this document

State Public Health LaboratorySPHL

States, Tribes, Localities, and Territories STLT

TEFCA Trusted Exchange Framework and Common Agreement

Association of Public Health Laboratories (APHL) Informatics Messaging Services platform

AIMS

CDC Specimen Test Order and ReportingCSTOR

Data Use AgreementDUA

Electronic Case ReportingeCR

Electronic Health RecordsEHR

Epidemiology and Lab Capacity Cooperative AgreementELC

Electronic Laboratory ReportingELR

Electronic Test Orders and ResultsETOR

Findability, Accessibility, Interoperability, and Reuse (of digital assets)FAIR

Health Information Exchange HIE

NEDSS Base SystemNBS

National Healthcare Safety NetworkNHSN

National Syndromic Surveillance Program NSSP

Public Health Data StrategyPHDS

Qualified Health Information NetworkQHIN

Fast Healthcare Interoperability ResourcesFHIR

Office of the Chief Information OfficerOCIO

Data Modernization InitiativeDMI

Objectives and Key ResultsOKR

Advisory Committee to the Director (ACD), Centers for Disease Control and Prevention

ACD

Data and Surveillance Workgroup (within the Advisory Committee to the Director)DSW