National Public Health Informatics, United States

Abstract

Informaticians looking at national public health information management in the US may ask, "Who designed it this way?" Most systems are not straightforward or easy to understand, in part due to their historical evolution in a decentralized federal structure that located most public health authority at the state level. Thus, many national systems have been built from the bottom-up in a heterogeneous fashion based on voluntary cooperation, sometimes induced through federal funding. In other cases, federal powers related to interstate commerce or national defense gave rise to centralized systems. More recently, federal agencies have played an important role in convening stakeholders, coordinating practice and information standards, and using funding to support implementation and induce conformance to standards. This chapter describes local, state and federal public health roles in the United States, points to collaborative products defining information requirements for various public health activities, outlines the evolution toward national information exchange standards, and describes health informatics roles (highlighting several important regulations) played by several federal and national agencies.