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U.S. Department of Health and Human Services

Health Situational Awareness to Support Decision-Making

National Health Security Strategy Strategic Objective 3

Active and timely situational awareness (SA) provides the foundation for decisions and actions that may result in early detections and better resource utilization; successful prevention and mitigation of emerging threats; and improved security for the nation. Health situational awareness (HSA) provides data regarding health threats; population health; health system and human services resources; health-related response assets; and other considerations, such as power outages or emerging diseases in animals that can impact human health, to inform decision-making.

In order to achieve HSA, you need a way to identify, process, and analyze the incoming data and translate it into actionable information to inform decision-making. Effective decision-making requires coordinated sharing and analysis of information—human health, environmental, and zoonotic—to identify threats and mitigate their immediate, short- and long-term health effects, while ensuring that appropriate security measures are in place to protect public privacy and security. HSA has been supported through the use of tools such as social media, electronic health records (EHRs), and interactive mapping.  

The NHSS identifies five priorities for ensuring HSA to support decision-making. These priorities focus on improved data-sharing, use of innovative systems and tools for HSA, improved operational capabilities to meet the full range of HSA needs across stakeholders, development of a collaborative oversight body with representatives from key stakeholder groups and sectors, and addressing the technological and policy barriers to HSA. 


Actions to support these priorities

Human-Health, Environmental, Zoonotic, and Other Information

Federal partners will

  • Develop a prioritized list of top environmental and zoonotic threats 
  • Work with state agricultural agencies and industry to increase public reporting/alerts on the incidence and prevalence of disease in animals intended for human consumption 

Additional actions partners can take

  • State, local, tribal and territorial (SLTT) health, agriculture, and environment agencies can expand the integration and sharing of human and animal surveillance and outbreak information across states, counties, and other sectors 
  •  Scientific institutions can convene experts to identify leading indicators of environmental health warning signs for human, animal, and plant health
  • Higher education centers can develop partnerships, curricula, and cross-degree programs to aid in developing a workforce that understands human, animal, and environmental health 

Continuous Improvement Through Innovative Systems, Tools, and Partnerships

Federal partners will

  • Work with non-federal stakeholders to recruit local institutions (e.g., schools, hospitals, pharmacies) to participate in collecting and reporting HSA information to local health departments
  • Work with non-federal stakeholders, including private industry, to develop a framework and research agenda to guide efforts to build capacity to harness electronic health information for HSA 
  • Work with state health departments to identify opportunities for improvement in HSA through reviews of after action reports of recent national events and evaluation of HSA efforts across the spectrum from preparedness to recovery
  • Work with SLTT stakeholders to innovate and improve the functional compatibility of their systems across all sectors and among all levels of government
  • Conduct a comprehensive multi-agency review and evaluation of existing and planned data systems and sources to  build and maintain a shared inventory that could support HSA 
  •  Encourage and/or facilitate engagement with skilled experts across government, academia, and private industry who can analyze and interpret data vital to comprehensive HSA
  • Work with non-federal stakeholders to improve the resiliency of their cybersecurity systems by supporting and promoting the use of the National Institute of Standards and Technology (NIST) Framework for Improving Critical Infrastructure Cybersecurity where relevant to HSA
  • Conduct a comprehensive multi-agency/sector review and evaluation of existing modeling systems to identify gaps and improve coordination at it relates to HSA
  • Develop alternative protocols for patient triage that seek to identify higher levels of efficiency for electronic medical records and electronic health records during casualty surges

Additional actions partners can take

  • State health departments and professional associations can conduct an inventory of regional health information organizations and electronic health information exchanges and determine their potential role for inclusion in a national HSA capability 
  • Non-federal stakeholders can identify innovative approaches to address research priorities identified by the 2013 National Biosurveillance Science and Technology Roadmap
  • State health departments can work with professional associations to conduct an inventory of regional health information organizations and electronic health information exchanges and determine the potential for inclusion in a national HSA capability
  • SLTT health/emergency management departments can develop strategies for integrating new technologies and SA products, tools, and standards into routine practice

Operational Capabilities that Meet Needs of All Relevant Stakeholders

Federal partners will

  • Work with non-federal stakeholders to strengthen health security communications related to disease events, and, where appropriate, broaden key audiences to include large animal associations at national and SLTT levels
  • Work with SLTT health departments to determine information sharing needs across all levels of government and among all sectors
  • Work with non-federal stakeholders to improve health information exchange to support patient healthcare needs and population-oriented uses in near real-time
  • Develop secure pathways by which appropriate classified information, intelligence products, open-source information, and relevant health information can be shared across agencies 
  • Work with academic institutions to incorporate decision support, bio-informatics, modeling and simulation, information-sharing, GIS, and data visualization into undergraduate- and graduate-level emergency management curricula
  • Work with state health departments to encourage the establishment and participation of Regional Health Information Organizations (RHIOs) in providing public health departments with data access
  • Work with SLTT health departments to harmonize situational awareness preparedness performance metrics across programs
  • Work with SLTT governments and the private sector to develop the capability to house, share, and use information related to situational awareness while protecting privacy and confidentiality
  •  Work with SLTT partners to develop multi-sectoral policy frameworks and advance regulatory oversight for managing material to support diagnostic research and biosurveillance activities

Additional actions partners can take

  • State and local health, environment, law enforcement, and agriculture agencies can strengthen joint health, intelligence, agricultural, and law enforcement capabilities for prevention and mitigation of animal or human disease incidents 
  • State departments of health, environment, and agriculture can implement mechanisms for routine interdisciplinary and interagency health information sharing that leverage existing RHIO/Health Information Exchanges (HIE) and tie into hospitals, schools, and businesses
  • SLTT health departments and individuals and their caregivers to share health information and empower them to become more active participants in HSA

Voluntary, Collaborative Oversight Authority

Federal partners will

  • Work with academia to survey and evaluate successful and unsuccessful national, local, and regional models of governance to inform the development of a collaborative oversight body 
  • Solicit other federal agencies and recruit qualified subject matter experts to serve as members of a health situational awareness collaborative oversight authority 

The collaborative oversight authority will

  • Develop a charter with an actionable plan to align with and support the NHSS oversight structure
  • Work with state health departments to establish forums for the sharing of best practices, protocols, and lessons learned in situational awareness
  • Work with state health departments to establish systematic and ongoing methods and mechanisms for multi-stakeholder priority setting and decision-making

Technology and Policy Challenges to Ensure Functional Compatibility of Systems

Federal partners will

  • Work with non-federal stakeholders to develop and disseminate data-use and data-sharing agreement templates that address privacy, security, ethical constraints, data ownership and stewardship, and liability protections
  • Work with non-federal stakeholders, including private industry, to identify existing standards for maintaining the security and privacy of HSA data and information
  • Review and update information management plans to align with current strategies and policies, while coordinating with stakeholders to determine critical information exchange requirements and best practices 
  • Collaborate with SLTT health departments to examine and document the existing information sharing and reporting relationships
  • Identify existing policies and/or best practices to expand health information exchange usage by nontraditional providers, including Emergency Medical Services and public health and human services
  • Evaluate models for best practices and lessons learned on ensuring communications redundancy and coverage
  • Conduct cyber-security risk assessments of healthcare systems, with the goal of developing contingency plans for continuity of operations 
  • Promote policies that harmonize the implementation of the Health Insurance Portability and Accountability Act (HIPAA) privacy and security provisions and regulations
  • Work to implement and leverage standardization of data elements to promote interoperability among disparate healthcare information among public health and emergency management
  • Implement information sharing interoperability solutions across healthcare coalitions

Additional actions partners can take

  • The collaborative oversight authority will develop an action plan to encourage engagement among federal, non-federal, and international partners with regard to information sharing
  • State health departments can coordinate with local health department public information officers (PIOs) to develop guidelines for effective use of social media for public communications

  • This page last reviewed: February 13, 2015