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Public Health IT (PHIT)
Sep 1, 2026
Beyond the EHR | Why Public Health IT Systems Play by Different Rules
Beyond the EHR | Why Public Health IT Systems Play by Different Rules
00:00
09:51
Transcript
0:00
So imagine trying to stop a wildfire, but you can't see where it started, you don't know how fast it's moving, and you have no idea how many fires are burning at once.
0:10
That's what public health would look like without information technology.
0:13
Work would still happen, people would still show up, and they would still work really hard to try to help, but it would be really slow, and it would reach fewer people, and it would be a lot more deadly.
0:24
That's why public health builds systems that let us see the fire, and there's a good chance that one of them already has your name in it. I'm Nancy Juma, and I've spent nearly two decades inside these systems.
0:35
In my public health career, I led the public immunization programs for the District of Columbia and the State of Texas, and I also oversaw the day-to-day infrastructure that keeps a community's health systems running at the county level.
0:48
Later in my career, I managed regional and local health operations at the state.
0:53
So when I talk about public health IT, I'm describing something that I lived for a pretty significant portion of my career, and I'm also talking about something that I am incredibly passionate about.
1:03
Today, I wanna start with the foundation because we're talking about the systems that make public health possible.
1:08
A public health IT system, or PHIT system, is any digital platform used to collect, manage, analyze, and store the data that supports population health.
1:19
So that's population health, meaning everybody, not just the person whose data was sent into the system. The most familiar example of a PHIT system is an immunization registry.
1:30
That's the database that holds your vaccination record, and it knows which vaccines you got, when you got them, and where you got them. It may also know which vaccines you're due to receive next.
1:40
But some of the most consequential PHIT systems are the ones most people have never thought about.
1:47
There's systems tracking outbreaks in real time, systems that are managing case reports for diseases that have to be reported by law, but there are also systems for documenting what we saw when the public health department inspected that restaurant down the street.
2:02
And there are others that are monitoring sewage systems to detect diseases that may be spreading in communities.
2:09
There's a specialized public health IT system in several countries that picks up early warning signals from emergency room data before anyone even knows something is wrong within the community.
2:21
Every single one of those systems exists for the exact same reason, and it's because somebody has to be able to see the fire while it's still small enough to be put out.
2:30
The thing that makes public health IT systems genuinely different from other health technology is the fact that most health software, like the EHR, the electronic health record that your doctor types into during your, you know, medical visit, all of those systems tend to be built around one patient seeking care.
2:48
Usually, the documentation in that case is focused on documenting one person, one visit, and one transaction at a time. But public health IT is built around everyone, whether they're seeking care or not.
3:00
And that one distinction actually shapes everything about how these systems get designed, who owns them, and what rules they have to actually follow.
3:09
So when talking about ownership, it's important to understand that these systems are almost always owned by a public entity. So that could be a city, a county, a state, a province, or even a national government.
3:21
PHIT systems are owned by government entities and are usually funded by taxpayer dollars.
3:27
One consequence of that is that they operate under the laws of the jurisdictions they serve, and the thing is that those laws can vary enormously.
3:36
So for example, if you look at immunization registries, I've led two of them in very different jurisdictions with very different appetites for data privacy, and I know firsthand how different these systems can be even within a single country.
3:51
In Texas, the state registry is opt-in. That means your immunization data only gets stored if you've actively given your consent. And that's not something that happens only once.
4:02
So a parent gives consent for their child, but then that child becomes an adult, and they have to actively submit an adult consent to keep their records in the system.
4:11
Texas prioritizes choice and privacy, and the Texas Immunization Registry is built around that. In Washington, DC, the system is opt-out. Your record is stored unless you specifically say otherwise.
4:25
When you go from a jurisdiction that has an appetite for big data to one that focuses on privacy first, it means that you have to rethink how you approach every workflow, every data feed, every decision about what the system can and can't do.
4:40
Policy differences affect how you monitor day cares and schools to make sure children are fully vaccinated because it shifts from central monitoring to a system of self-reporting that is then followed by audit.
4:54
It affects the conversations that happen with providers and families, and it affects pretty much everything about how the system is run.
5:02
Those two systems were built for the exact same purpose within the exact same country, but they run on completely opposite rules.
5:09
Multiply that across every state, every province, every country in the world, and you start to really understand why there's no such thing as a universal standard for public health IT.
5:20
It's because these systems are built around local laws, and they're operated under very strict rules decided by our elected officials. And in that way, they really are purpose-built for each individual community.
5:34
The challenge is that these systems have to balance three priorities that don't always point in the same direction. In each jurisdiction, they have to decide how they're going to strike that balance.
5:45
They have to figure out how they're going to manage individual privacy, public safety, and emergency response.
5:52
Sometimes protecting your privacy means slowing down a response, and then sometimes an emergency means moving faster than the privacy framework was ever designed for.
6:01
PHIT systems live inside of that tension every single day.
6:06
Now, there's another challenge worth understanding as we start going into these systems in detail, and it comes down to multiple versions of the same question: Are Mike Moore and Michael Moore the same person?
6:20
So the lab submits a test result for Michael Moore, and a hospital submits a case report for Mike Moore, and they have the same address and the same date of birth.
6:29
The system has to decide and has to figure out whether that's one person or two before it acts on either record.
6:36
Getting that wrong in either direction has real consequences because if it's the same person and the system treats them as two different people, you aren't getting the full picture, and you might actually miss something really important.
6:49
But if it's two different people and the system treats them as one, then you could think someone has gotten something that they actually still need, or you could be looking at the wrong person's data when you need to act fast in a response.
7:01
This problem is called entity resolution, and that's just a technical way of saying that the system has to decide whether two records belong to the same person or not.
7:10
And it is by far one of the hardest technical problems in public health IT, and it is one that will come up over and over again as we start walking through individual types of PHIT systems.
7:22
Then there's the coordination piece. A single outbreak investigation might draw on data from a local hospital, a regional lab, a national disease registry, and a customs database that's tracking international travel.
7:35
None of those systems were designed to talk to each other, and in most countries, public health isn't managed from one central point either.
7:44
So data collected at the national level still has to flow down to local health offices because that's where the actual follow-up work happens. It's where the phone calls happen.
7:53
It's where public health does contact tracing, and it's where the services that reach real people actually live. All of that has to happen much closer to home for most people.
8:03
So someone still has to sit in the middle of all of that and make it work.
8:07
And in most cases, that someone is a public health agency running a PHIT system which is often not quite built for the scale it's being asked to handle. Most people will never log into one of these systems.
8:20
You may never see your name in one, and you may not even know a record was matched or realize that an outbreak was caught early because the data arrived where it needed to be and when.
8:31
But for us in this field, that invisibility isn't a flaw. It's really the entire point. The best public health infrastructure works so quietly and so reliably that the people it protects never have to think about it.
8:46
So the next time you hear about an outbreak that was contained, a recall that reached the right people in time, or a disease that never became an epidemic, know that there was a system behind it and that there were probably several systems behind it.
9:00
They were built by governments, they're governed by law, and they're operated by people most of the public will never meet. That's public health IT.
9:08
It's unremarkable as long as the fires are caught early and everything is contained. If you want to learn more about PHIT systems, you can visit our website at publichealthit.com.
9:21
If you work in public health IT and you've got a story worth sharing, then we want to hear from you. These systems are built by real people solving real problems, and those stories really matter.
9:32
Our contact details are in the episode description as well. Here at Public Health IT, we believe that good data saves lives, but good design makes it possible.
9:41
I'm Nancy Yojuma, and I'm here to help you understand the technology that makes public health run. Subscribe for new episodes every week because we're here to help you get PHIT.
Public Health IT | Get PHIT
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