The Critical Role of Federal
Support in Public Health
Federal funding makes up the majority of support
for public health laboratories, mostly through
the Public Health Emergency Preparedness
and Epidemiology and Laboratory Capacity for
Infectious Diseases programs. But in recent
decades, funds for these programs have been
“limping along,” said Peter Kyriacopoulos, APHL’s
chief policy officer. Spikes of support generated by
public health emergencies, such as Zika, opioids
and vaping, quickly ebb once the immediate crisis
is over.
Without steady support, public health data
handling systems have become fragmented and
ineffective. In response, APHL has partnered
with the Council of State and Territorial
Epidemiologists, the National Association for
Public Health Statistics and Information Systems,
and the Health Information and Management
Systems Society to garner support on Capitol Hill
for a major health data modernization project.
With unflagging support from Rep. Rosa DeLauro
(D-CT), this Data Management Initiative received
$50 million in FY20, and the organizations were
pleasantly surprised by another $30 million in
President Trump’s budget request for FY21.
Then COVID-19 hit. Suddenly, all eyes were
on CDC, the nation’s network of public health
laboratories, and their roles in testing and data
handling. Pandemic response money began to
flow from Congress. The first three federal relief
packages totaled a little less than $12 billion,
including $500 million to support the Data
Management Initiative. A fourth bill, the HEROES
Act, included an additional $1 billion to CDC that
state and local governments could apply for
to support surveillance, laboratories and data
management.
Importantly, the response bills give state and local
governments the ability to build new facilities.
Currently, many public health laboratories
are housed in older buildings that limit their
instrumentation and testing capabilities. “When
all is said and done, our member laboratories will
be better equipped and better staffed to be more
nimble for whatever comes next,” Kyriacopoulos
said.
“I think people are finally coming to terms with
the importance of providing this level of funding
for governmental public health,” Kyriacopoulos
said. “Hopefully that will be a lesson that stays
with us after this response. I would love to
see a public health system that didn’t require
this massive infusion every time we had an
emergency.”
testing and results electronically that feed
directly into the laboratory information
management system at the state
laboratory.
Ensuring Critical Data Gets Its Due
APHL has also forged several informatics
partnerships that have helped support
the pandemic response on a national
level. Building on the network established
through the APHL Informatics Messaging
Services (AIMS) platform, APHL was
able to get up and running quickly. They
standardized vocabulary and coding for
COVID-19 and repurposed a feed in the
public health laboratory interoperability
project typically used for influenza,
adapting and scaling it up to handle
coronavirus test result data.
Within weeks, dozens of laboratories
were already using the feed to validate
their test messages. The volume has
been staggering, said Michelle Meigs,
APHL’s deputy director of Informatics.
In May 2020, this single feed handled
more than 625,000 messages—roughly
an 8,000 percent increase in volume over
last May. AIMS is also handling electronic
laboratory reporting information,
electronic test order and reporting data,
county-level testing data and more,
shunting millions of data messages
among testing facilities, public health
jurisdictions and federal agencies.
A COVID-19 module for electronic
test ordering and results within the
existing Lab Web Portal on AIMS was
built to facilitate communication among
laboratory staff, epidemiologists and
healthcare providers without requiring
local technical support. In addition,
APHL has been working with third-party
developers to host applications, such as
the Sara Alert™ symptom tracking app
created by the MITRE Foundation, and are
working with CDC to connect new point
of care testing sites—pharmacies, grocery
stores, clinics and others—to a centralized
test data routing portal on AIMS. “This
has just been a monumental effort,” Meigs
said. “We were able to not only reuse
existing infrastructure, but also leverage
our relationships and trust to play a large
role in the response efforts.”
The pandemic has also brought
heightened awareness of how data quality
affects decision making and response
management on both local and national
levels. Patient-specific information is
needed for case management, follow-up
and contact tracing for individuals,
while deidentified data is critical for
analyzing national trends and statistics.
8 LAB MATTERS Summer 2020
PublicHealthLabs
@APHL APHL.org