Co-operative Public Health Infrastructure, COVID 19 and Monkey Pox
Minakshi Tikoo, PhD MBI MSc MS
Minakshi Tikoo, PhD MBI MSc MS
Chief Problem Solver
Published Aug 17, 2022
The abysmal performance of the National Public Health Infrastructure was blamed on lack of investment over the last several decades. But after pouring billions into the public health service system, we remain unprepared for the next pandemic, which has been evident by the spread of Monkey Pox and our inability to report on the spread accurately. Why is it that a country as rich as USA with the highest spent on health care is unable to create and maintain an infrastructure that can support real time reporting within its public health delivery system. Lack of investment in public health infrastructures over the years as the core reason for the failure is unacceptable now. It is an easy explanation and passes the blame on to others and does not lead to self-reflection, which is the basis for continuous quality improvement. What can you do with the budgets that you have, and then what more can we do with the new investment being made by the government.
Partly, the abysmal performance of our public health system is due to the lack of leadership, inability to accurately evaluate and procure IT cost-effective systems and supporting technologies (hardware and software) to operate functional public health systems, which can surveil, test, track, trace, and report on many disease conditions including COVID 19 and Monkey Pox. This inability to accurately count in real time, is in part due to under-skilled staff in health departments. This leads health departments toward staff augmentation, which can help, if the goal is to train and hire staff eventually that can support and maintain the public infrastructure being built. What usually happens is the dependence of the vendor increases and the in-house staff get further behind in their skills. Lastly, when too much money is thrown at any problem, it brings bad actors into play, those that have no domain knowledge or experience come in and confuse the space with additional noise.
So how can we together work to improve and build a connected public health infrastructure. This is possible if we take a strategic and planful approach with prioritization and collectively vow to take the public dollar as far as it can go and do an honest accounting by acknowledging our mistakes as well as our successes.
First, we need to make sure that our procurement and contracting staff defer to in-house subject matter experts with domain expertise to write the statement of work with justification. This write-up needs to come from the staff and not the vendor. Also, write contracts in a way that allow small, innovative, and niche health IT companies to compete with the usual big-name vendors that are mostly successful based on the market that they captured decades ago based on technologies that are old but packaged as being new, and cloud native (this discussion is for another time).
Second, states need to clearly write out the problems they are solving for, yes just a clear list of questions. When done well this can lead to amazing results. This is not a technical task. Do not let the vendors frame your questions because they each will frame it to demonstrate that they are the only one that can solve your problems. Remember there are many ways to solve a problem. Then prioritize your questions in order of importance. Work out a budget and stick to it. Ensure that the cost of purchase is cheaper year after year if you are purchasing technology. Never sign a contract for more than two-years or evaluate the pros and cons of getting into a long-term agreement.
Third, make sure that you and the systems you use/choose follow best practices in their domains, be it: IT standards, cloud implementations, disaster recovery, code development, ability to manage and clean data through transparent algorithms, and use of standard terminologies and ontologies. Do not be mesmerized by the loose use of terms such as Artificial Intelligence, Machine Learning, application native to the cloud, managed services in the cloud… Ask them to clearly define what their operational definition is for these terms and how does this impact the outcomes that you are pursuing why are these tools critical to your success. Put the onus of justification on the vendor and get everything in writing.
Fourth, when vendors offer partnership in development, take them on if you have the staff. But make sure you have good intellectual property lawyers so that the jointly developed product is in the public domain, so that it can be used/reused, leveraged, and improved upon by the collective of public health departments. This is a way we can help increase the capacity of the public health infrastructure without spending billions.
Collective cooperation will help us build infrastructure that is stable, scalable, flexible, equitable, efficient, cost-effective, person-centered, and standards-based that can support small and large public health departments alike.