This transcript is auto-generated and may contain inaccuracies.

Abigail Viall:
All right, I want to welcome you all back from the break. I want to welcome the virtual participants, who I know can see us, even though I can’t see them. So thank you all for joining us for the second plenary session, aligning efforts for modernization, jurisdictional perspectives on Wave One of the Implementation Center program. There are a couple of objectives that we will have for today’s session. You will learn about the Data Modernization Implementation Center Program and how it aligns with other CDC programs advancing data modernization. You will hear real-world examples of how health departments are leveraging efforts through the IC program to advance jurisdictional data priorities, and we will explore challenges and strategies for aligning multiple funding streams and technical assistance offerings to advance data modernization objectives.

And I will be your host through it all. My name is Abigail Viall. I am the Acting Lead of the Technology Implementation Office, which is situated within the Office of Public Health, Data Surveillance, and Technology at CDC, because we like nested offices. They are very fun. So, in terms of how we will walk through the program, I’m going to very quickly reorient you to the IC program. I say very quickly, because one, I get super nervous when I’m up here in front of a group like this. And two, I think that while I loved the idea that you all came to hear me pontificate and recapitulate history, what I think you’re really here for are the jurisdictional perspectives. What does it actually feel like to be part of the implementation center program? How’s it working for our wave one jurisdictions? What are they learning? And what does that mean for all of you who may be thinking about Wave Two for the IC program?

So after we walk through our orientation to the program, we’ll have a moderated discussion with all of my fabulous panelists up here, and one who is virtual and will appear shortly, and then we will have time for audience Q and A. So we’re hoping to make this a little bit more dynamic, not make this feel extraordinarily static, like we’re spending the entire time talking at you, not with you, but we’ll see how that goes. And so with that, let’s walk through history, a very short, short jaunt through history and the Implementation Center program, just so everyone has a baseline. I know Jen mentioned it in her talk. You guys are probably all familiar with it, but it hurts to never assume and to actually just make sure everyone has a baseline for understanding.

So in 2024, CDC, along with three national partners, ASTHO, or the Association of State and Territorial Health Officials, and then PHI, or the National Network of Public Health Institutes, and PHAB, the Public Health Accreditation Board, launched the data modernization implementation and Implementation Center program with 255 million of what were essentially COVID surplus or supplemental dollars. And we launched it through PHIG, as what’s called before the program, which is funded through 2027, builds on previous data modernization investments and a long History of technical assistance provision and funding by CDC, but it also sort of looked to additional models outside of CDCs, past experience, and in particular, about a decade ago. There was once upon a time something called regional extension centers. This was something that ASTP or OMC had stood up that really focused on providing practical, customized support to address the needs of local healthcare providers, and did so in a way that was sort of technology agnostic, so building capacity to leverage nimble technologies without vendor capture.

That program, the rec program, became a model for the CDC Implementation Center program. It was not just another technical assistance investment. It was an investment meant to establish an infrastructure that could provide that kind of customized TA that jurisdictions were really hungry for, and that sometimes wasn’t fully met by some of our other technical assistance offerings. So the Implementation Center Program is both a continuation of the kinds of funding and technical assistance CDC has done in the past, but it is also marks, you know, a something of right turn to really look at, how do we build technical assistance capacity in a sustainable manner. How do we create that infrastructure?

So, like those RECs that had previously been funded by ONC, the four ICSs funded by CDC provide targeted technical support to public health agencies as they seek to adopt the latest health IT standards and participate in data exchange networks. As I noted, there are four implementation centers, three of which support state, local, and territorial health departments, and those include crisp shared services, Guidehouse, and Mathematica. A fourth Implementation Center, which we will talk about very briefly shortly, is Chickasaw Health Consulting, which provides support for tribes and tribal serving organizations, and you’ll hear a little bit about the launch of our tribal IC program at the end of my talk.

So the goal of the program, the Implementation Center program as a whole, is to improve the timely prevention and detection of public health threats by reducing the burden of data exchange between public health and health care agencies, as well as the communities they serve. To achieve that goal, we defined three outcomes for the Implementation Center program. One focuses on helping PHAs’ public health agencies use the latest health IT standards to exchange data with the entire ecosystem that Jen mentioned in her talk. So, health care providers, labs, and other data providers, and we set the stage for being able to do that for at least one priority use case. But I want to be clear when we say one, at least one priority use case, that doesn’t mean that we are recapitulating the typical we’re going to build capacity in silos. So everyone’s going to focus on ECR, and we’re going to do these things, and it’s going to work for ECR, but only for electronic case reporting.

One of the foci for this program is really thinking about investing in use cases to create capacities that are flexible enough to enable multiple use cases. So we’re not just building for silos. We’re really helping jurisdictions adopt systems thinking, streamlining how they approach data exchange, so that one use case is a building block towards generalized capabilities. The second outcome that we target in the Implementation Center Program is that, wherever possible, jurisdictions are leveraging intermediaries to exchange data for at least one priority use case. And when I say intermediaries, those can take a lot of forms. I think many people at the start of the program heard about QHENS, which are qualified health information networks established under TEFCA, which is the trusted exchange framework and common agreement, which was set up by ASTP as part and parcel to the 21st Century Cures Act. And if you’re sitting here thinking, My God, she just said a ton of acronyms, that’s true; it’s a complex space. But I think what we’re really sort of emphasizing more broadly is that there are a lot of different networks out there.

There are state-level health information exchange networks. There are now these things that are emerging called Health Data utilities, which are health information exchanges that are acquiring additional capacities and capabilities and offering additional services. So, whether it’s a state-based network, a regional network, or a national network, the key for outcome two is to plug in and to tap those existing data flows in a more seamless fashion. And finally, outcome three under the program is making sure that what we’re learning under the program doesn’t stay within a jurisdiction. You know, ultimately, the IC program is not just about the funded projects themselves, but about how we as a community use the lessons we’ve learned from our investments to continue to what I’m going to say is leveling up and building a public health ecosystem is that is not just modern now, but capable of remaining so as part of a learning health system.

So those are the outcomes for the program, and how do we achieve those? Again, as I noted, implementation centers provide direct technical implementation services to participating agencies that support can take a variety of forms, whether it be financial assistance, capacity building, or technical guidance, and it’s necessarily customized based on the jurisdiction-specific project goals. But just a few examples that I literally plucked out of a lovely dashboard that we have with everyone’s projects in it include jurisdiction specific readiness assessments, helping PHAs adopt new standards like FIRE, developing scalable processes, tools and resources, especially so that jurisdictions can help onboard healthcare providers more quickly and more seamlessly, and even investigating and testing new technologies that can improve public health response and decision making.

For example, generative AI for electronic case reporting. And I just pulled again, I pulled this out of a program thing. I don’t actually know entirely what that means, because Sarah, I’m not much above you in terms of AI savviness, but hopefully. We’re going to get into a little bit of that today, but it’s cool to know that we can support the implementation centers that are providing, which can really span the gamut from basic capabilities building to helping jurisdictions really press the needle in terms of what they can, what they can sort of step towards in terms of using new technologies.

So in January, Wave One of the Implementation Center program launched with 34 state, local and territorial public health agencies, six of which, well, okay, five, and then there’s a six somewhere up in the ether around me, are going to talk a little bit very soon about their projects and what they’re hoping to accomplish, but just so a couple of statistics for everyone here. 21 of the projects under wave one are focused on outcome one, so that’s again, that’s adopting those modern standards. Five are focused on outcome two solely, so that’s data exchange. And eight are focused on outcomes one and two. So there’s a blend of both standards adoption and thinking about data exchange frameworks in different ways.

In addition to those, 34 projects, 25 of which are focused on electronic case reporting. You’re going to see that’s been a big theme, and that makes sense. It’s one of the bread-and-butter systems and capabilities for public health. Three are focused on immunizations. Five are focused on both, and one project is focused on syndromic surveillance. But again, I urge folks to think about these as the use cases that people are building on top of, thinking about how we take the capabilities established for a single use case, and think about what they mean in terms of scalability and extensibility to address additional data needs by our public health agencies. So again, a use case is just a way of being specific and focused in implementation. It doesn’t mean that we are building updated, siloed systems.

And then finally, also earlier this year, in February, the community support program opened up for public health agencies not selected in the first cohort through webinars and shared resources. It’s focused on that third outcome, which is again, knowledge transfer. Because this is an Implementation Center Program, fundamentally about building a learning public health ecosystem, and that means sharing what we’re learning, making sure that people can take advantage of those lessons and the challenges encountered, so that we can build up as a community. So, where is the Implementation Center program going?

As you can see from the timeline, Wave One projects are scheduled to be completed by approximately next summer, so the summer of 2026. Meanwhile, the tribal IC application process will be formally launched next month at the National Indian Health Board’s Tribal Public Health Conference. So that’s September 8, the tribal IC will provide hands-on support and expertise to federally recognized tribes, Tribal Epidemiology centers, and tribal consortia for public health data infrastructure projects. We are also planning to launch a second application, a second wave of applications for state, local, and territorial agencies, frankly, next week. And in fact, I believe I have a slide to give you additional details about the webinar, but we are opening up for that second wave. And really encourage all of you to join both the tribal IC launch and the second wave launch for states, locals, and territorial public health agencies. And I’m actually going to look, there we go.

So there’s the tribal I see slide. I will note we do have one more, what we are calling Office Hours webinar on the 25th, so these were just open times for people to come and learn a bit more about the tribal IC as we ramp up into its formal launch on September 8 at NIHB’s National Tribal Health Conference. And as noted, similar to the offerings for state, local, and territorial public health agencies. The tribal IC program will have both a project support component and a community support component. And there’s a lovely QR code I will give everyone a moment, in case they want to just hold up their phones and scan it. All right, no, I was too fast. Sorry.

I thought it was too, all right, I’m gonna go to the next slide. All right. And as noted, there is also a Wave Two. I believe some of you, frankly, most of you, I hope, have seen the announcement. For the webinar. If not, we will make sure that it circulates more widely. But this will be Wave Two. It is a little bit different from wave one in that it will be focusing entirely on ECR capabilities, so there won’t be the option of immunizations or syndromic or ECR. We are really going to double down on strengthening electronic case reporting capabilities. It will be the final wave of the Implementation Center program, and the goal is to support up to 60 public health agencies between the fall of 2025 and the end of the program, which will be approximately the fall of 2027. There are three tracks under the wave two. One is focused on processing electronic or initial case reports into surveillance systems. Track two is focused on using intermediaries and other modern approaches to optimize ECR exchange and usability. And then there is a track three, which is a more limited track of pilot projects focused on electronic case report data exchange via health data utilities.

And I’m happy to answer questions about all of those later in the program, if time permits. With that. Oh, wait, here’s another QR code. I do not want to go through this too quickly, but this is for Wave Two. I will give you all a moment. I believe these are probably also located somewhere else, and we will find that information for you, all right, but we are now going to move on to what I really think is probably the more exciting part of this panel, which is me not talking and instead asking questions of others; those are my favorite part of any panel. Also, let’s face it again, you guys are not here to hear me talk. At least I hope not. You are here to hear about your peers’ experiences with the implementation centers, and we have a fantastic lineup for you all right now.

So first, I am told that I am supposed to ask Reid Potter to join us. He is our virtual six-panelist. Reed, if you can come, there we go, Hi. Reed, I’m leaning over to see you. Can you test? Can we hear you say, Hi. Can you hear me? All right. Reasonable, yeah, so welcome. So we are going to go into our moderated discussion now. I’m going to introduce the six panelists, and then each of them has prepared remarks in response to three questions. We will let each go through their responses to those three questions. We’re going to try to create a little bit of interaction here, and then remember, there will be time for Q and A towards the end of the panel discussion.

But first, in terms of introducing our panelists, I’m going to start with Aparna Priyadarshi. I’m really hoping I said that reasonably well. All right, perfect. Aparna is the deputy commissioner and chief public health informaticist at the Chicago Department of Public Health. She has 27 years of experience advancing data interoperability and is spearheading the agency’s informatics strategy to drive operational efficiencies, and she oversees the design, development, and management of mission-critical infrastructure. Welcome. Next, we have, sorry, I’m trying to go by the actual order that they’re sitting, not that order that their bios were handed to me. So Edgardo Borja Padlan is reasonable. Did I get that sort of reason? All right, Edgardo, sorry, we didn’t practice this ahead of time. Edgardo is a data modernization specialist at the Pacific Island Health Officers Association with over 30 years of experience developing, managing and analyzing data and IT systems. Since 2023, Edgardo has been supporting data efforts in the Republic of Marshall Islands to strengthen their information systems, improve interoperability, and ensure data are accurate, secure, and useful for guiding public health decisions. Welcome.

Next, we have Marcia Pearlowitz, all right, the data modernization director of Maryland’s Department of Health. Marcia has been with the Maryland Department of Health for over 19 years, and previously served as the chief of Maryland’s contact tracing unit. So welcome. Seated to her right, we have Evan Mobley. Evan is the research manager for the vital statistics team at the Missouri Department of Health and Senior Services. So he had the shortest distance to travel here, I think, in this role. He oversees the team that conducts analysis on information collected through vital records, including birth, death, and fetal death certificates. He has worked at the Maryland and the Missouri Department of Health and Senior Services in various capacities since 2013, so we have folks here. We have a really well-established long-time panel here.

Next, we have John Ray Taitano II, who is a program director from the Guam Department of Public Health and Social Services. John has been with the Guam Department of Public Health and Social Services for over 20 years, and he believes that a patient-centered philosophy will always point us in the right direction. He is also a fan of flip-flops. We addressed this in our preparations for this panel, and so we will have a party afterwards, and we’ll all put our flip-flops on. It’ll be great and shorts, and finally, last but not least, we have Reid Potter, who is the director of data modernization at the state of Maine Center for Disease Control and Prevention, where he leads enterprise-wide efforts to modernize data systems and infrastructure. He brings over 15 years of experience in management and delivery, including over eight years driving data transformation initiatives in complex and matrix environments.

Marcia Pearlowitz:
So please give our entire panel a round of applause, and we are going to get into the really exciting part of this panel with these discussion questions. So the three questions that each panelist will respond to are: where is your jurisdiction and its public health data modernization journey, and what are the priorities you’re addressing? How does your IC project fit into your jurisdiction’s broader modernization priorities? And last but not least, how is the ISEE program acting as a catalyst for driving data modernization progress within your jurisdiction? And with that, I’m going to join the panelists here, and I’m randomly going to call on one to start, because they all agreed that they didn’t actually want to know the order that they would go in. And I found that very daring. I am one of those control freaks who has to know which number I am. But with that, Marcia, I just looked at you. And so Marcia, all right, yeah, mine works.

Okay, good afternoon. So Maryland’s data modernization strategy aims to be strategic, and our approach to modernizing our public health systems upskills our workforce and strengthens our agency’s ability to visualize our data to ensure that we are able to use it for public health action. So we are about to begin the second phase of our public health systems assessment with a large focus on a roadmap for improving our cloud infrastructure and migrating systems to the cloud that most need it, so that we can prioritize the needs of our large portfolio of public health systems, Maryland’s NBS, or what we refer to as Ned’s system, and our vital record systems are two of the core systems at the top of the list for these efforts.

In terms of how our IC project fits into our broader data modernization goals and priorities, we decided to select an immunization use case in Maryland. Previously, we felt there had been a lot of opportunities for ECR and ELR enhancements, and so this really felt like an opportunity to devote some additional effort to our immunization program. Particularly coming out of COVID, where we have a lot more folks in our immunization registry that were new to the system, and we had a lot of data coming in quickly, so there’s a lot of work to be done in terms of data improvements and clean-up.

So we plan to expand and accelerate some of our current work with our HIE, which is crisp, and specifically, the goals of our IC project are to enrich our vaccine data with demographic and location information from the crisp master patient index. This is something we did during COVID, and so we’re continuing to sort of refine those workflows, to enrich our data with information from our HIE. Additionally, once we’ve sort of cleaned and enriched that data, our goal is to automate the deduplication efforts for our immunization system so that we can really get that data much cleaner, both for our own purposes at the state and local level, but also for our residents through their consumer Portal.

Additionally, we plan to improve our bulk query functionality that’s used by our healthcare systems for decision making and for their patients, and make sure they’re able to identify who needs vaccinations, to target those as well. And then ultimately, all of the enhanced data will be used for reporting and dashboards, both at the state level and the local level, to target resources and additional efforts to improve vaccination rates in our communities. So, thinking about how the IC program is a catalyst for our overall data modernization efforts.

The IC project actually wound up being very well timed, and us choosing immunization because of the PHIG immunization supplement that came out sort of right on the heels of this. So conveniently, we are using the IC project to, again, really clean up our immunization registry data, and then we will be moving into a modernized immunization solution using the additional PHIG supplemental funds. And again, the timing is great, because right now we’re working to improve the quality of the data while we are working to procure the new immunization system, which we all know is going to take a minute. So this is working out quite nicely for us in Maryland. All right, who are you going to pick next?

Abigail Viall:
It’s a mystery. First, though, I’m going to ask you a follow-up question. Okay, see, I’m taking that moderator’s already one of the things that you noted, and I think it’s a theme that we might build on here throughout the discussion, is you mentioned that you had, there had been a lot of work for ECR and ELR, and you saw this as an opportunity for immunizations. But again, getting to that concept of, you know, thinking about how investments in different sort of source data, different pieces can build on one another, I’m wondering if there were any lessons learned from that earlier investment and work around ECR and ELR, that better position you to think about how do we want to approach immunizations differently or strengthen our systems and capabilities there,

Marcia Pearlowitz:
Sure, absolutely, as I mentioned, the data enrichment work that we did during COVID and the workflows that we built during that time for our COVID contact tracing system, we have absolutely reused and continue to refine. We’re also simultaneously doing an ELR project to do that same sort of data enrichment for actually, I think we’re starting with Lyme disease, gonorrhea, and chlamydia data. So we absolutely are looking to reuse what we’re building here, and chose this work partially based on previous work. Yeah.

Abigail Viall:
All right, thank you for my next victim. So to speak. I actually hope it’s not that bad, but I think we’re going to call on Reed, whom I wish I could see. But, Hello, Reid, do you want to take a stab at answering the three questions?

Reid Potter:
Sure? I hope you can hear me okay. Can I get a confirmation on that?

Abigail Viall:
It is a little light. Is there any way to turn it up at all?

Reid Potter:
Oh, I can on my side, okay. Apologies for that.

Abigail Viall:
I think we can hear it. Yes. Go ahead, yeah.

Reid Potter:
So, on question one, where is your jurisdiction in the public health data modernization journey? So I’ve just come into the data modernization director role. Prior to this, I was a data Modernization Initiative coordinator for just under a year, focused on the infectious disease and informatics programs. So I’ve been catching up on where the state is, and I’d say we’re kind of in the beginner to intermediate stage. We’ve we have multiple parallel efforts underway, and we’re kind of wrapping our heads around that. We’re continuing to improve our systems, replacing outdated systems with the funds, enhancing existing systems we’re conducting, cataloging our systems, their use, identifying and assigning data stewards to the systems, documenting the system’s functionality and standards, their terminology, structure, transmission processes, and trying to facilitate the interoperability once that data is needed. Along, we’re coordinated with a department-wide effort to standardize some core data elements, such as demographic data, also to facilitate. The use of this data.

How does it fit? How does the IC project fit our jurisdictions’ broader modernization priorities? One of our focuses is really to help transition from manual and fragmented processes within our surveillance systems to an automated and complete process by leveraging the software and tools that we already have. So this has allowed us to conduct a review of our NBS, which we use our net-based system for surveillance. I did identify where we want to transform, make the transformation logic changes, and where we can automate it, so that it aligns because we’re staying within the software that we have procured and approved. We know we can, are better luck at or better chance of sustaining.

And then, how has the IC program been a catalyst for driving modernization? It’s really helped create the time so it’s provided a focused opportunity where we can target the ECR automation we chose to do further ECR automations than we have existing. We’re really focusing on program matching and the deduplication process to free up some of the epidemiologist time on the case reporting, so they’ve done a good job at connecting us with MBs and ECR pipeline experts, identifying existing tools that we might not have dove in as deep on because not having that dedicated development time and focus time around the problem. So I’d say the big benefit has been the resources and then being able to focus on the improvements over the day-to-day jobs, and that’s what I’ve got. Thank you.

Abigail Viall:
Thanks, Reid, next I am going to, I’m going to call on John. John.

John Ray Taitano II:
I guess because I was just right next to her, I was trying to stay out of her line of sight, also just to manage everybody’s expectations. Okay, 20 years in healthcare, management, or administration, all right, with public health, this is my third month, okay, that’s why, when she said 20 years, I said, Whoa, we need to, I need to set the record straight. And also, and for, I think they shortened it or something, and then for PHIG IC, this is my first month, okay, so I guess, and I’m not also a technical person, all right, so I’m glad that there’s, you know, there’s not too much technical that I heard so far. So I’m glad I’m going next.

All right, so currently, Guam is working with the CDC Foundation to do the assessment for our modernization, and then once we have that, we’re also looking at trying to create solutions that will streamline our data security, as well as make it quick. We do have our data modernization Advisory Council done as well as our governance council. So one of the, I mean, I don’t know if this is the challenges part, but one of the challenges that we’ve had is, is that we had a DMI vacancy. The director position was vacant for about a year. So, of course, you have all the rest of the team on PHIG and others in the department trying to pick up some of that slack. Doing that, we were able to, if things just became a little bit slower on what we’re trying to accomplish. But you know, of course, the way, you know, government and public health, right, we can’t stop just because something is not working. We just have to keep pushing forward. So that became a little bit of a hindrance for us.

Some of the goals that we have are to identify short-term and long-term solutions to the gaps, prioritize data modernization projects, and then, of course, fill that DMI position. There are some solutions that we’re talking to, some of the team here, as well as our Guam team, to try to move forward from, from that with the PHIG IC, I’m sorry, with, yeah, with the PHIG IC, Guam is currently, or, and I don’t know how many other states, I mean, the other states are doing this, but, or have this issue. So one of the things that. We have is, is we have a lot of smaller clinics. Even our largest clinic is probably one of your smaller clinics, right? So because of that, we have the EHRs. It’s a few and far between, right? There are many types of EHRs, and all we all know some are better than others, but a lot of the EHRs that we do have, a majority of them don’t have an ECR that will transmit to our disease surveillance system.

We also have quite a few clinics that are still using the paper method, right? So they’re still either faxing. I know some are anybody still fax here? No, oh yes. Oh, nice. Those are my friends over there. Now I’m gonna come check you guys. We can, we can relate. Oh, really. Oh, okay, okay, who? Okay, that that makes me feel a lot better than makes me feel a lot better. See, I’m starting to warm up here. Thank you. So that’s where we’re at with that. So I Okay, I guess we’re not too far behind. But because of that, we’re trying to work with the IC. What we’re trying to do is to create a portal so that all of those who do not have the EC already embedded are able to still transmit to the data surveillance system quickly. So you know, for all the different reasons that we mentioned right, for surveillance, so that we can catch things a lot quicker.

I mentioned interoperability. So, how the IC has helped is when the IC came about, it actually started making us look at the gaps in data modernization, which was a lot. So there were many things that we weren’t doing. And then with the IC project and with the team, we’re able to, they were able to give them consultants and, you know, kind of show them a roadmap, like, Hey, these are the tools that you guys can use. So giving us that helped us see that, okay, we can change all of these things. So we had a plan. We started looking at that plan and how we can get these things done. When I came on, my project was for interoperability. But one of the things that, when I was looking at trying to coordinate with our hospital, as well as behavioral health with public health, I started realizing that we’re not even talking inside our own house.

So public health is not communicating with public health. We are still very siloed. So with the IC project, it was there to eliminate that, so that we can all kind of talk the same language. And if once we’re able to do that, then I think it makes everything a lot easier for interoperability, because now we can all talk the same language. And of course, in the future, what we want to do is not just make it public, but also to keep it, or to make it public and private. At the end of the day, we need the private sector there, because they’ve got lots of money right for sustainability, and that’s what we’re going to talk about maybe tomorrow. So we need that type of relationship. So having that would definitely make things a lot better for us.

Abigail Viall:
And I’m just curious. So we’ve talked a lot about interoperability, the ability of systems to speak together, but John mentioned something, and it came up in Jen’s talk as well. Maybe it’s engagement or internal engagement. So I’m just wondering for the rest of the panel, you know, how has either as part of the IC project or otherwise, you know, what are you finding in terms of, you know, what’s it take to actually engage all the parts within your health department that need to be part of data modernization, like, what are the solutions or the ways that you guys have sought to bring your broader agencies together? Is that something that has come up as part of your IC work so far? Aparna, do you want to say a little bit more, and then we’ll just go right into you answering your questions, like how I did that?

Aparna Priyadarshi:
Yeah, thank you. Interoperability is what I’ve done for 27 years. I’m just two years in the public health field, just like John, a little more than you, but I’ve been doing clinical data interoperability all my life, literally. So when I came in and took up the job, I saw there was a cloud and, you know, it’s being used for the right purposes, but not being applied correctly. That’s when I worked on. We are going to launch our interoperability version 2.0, as of September 15, again, procurement being the issue.

So, where are we going with this? We did go into a lot of understanding of how the Bureau’s work the clinical departments worked, like John mentioned, the same thing, trying to get everybody on the same page, explaining how centralization of information is like the way to go, how we see value in one data set coming in for one program and being used for another program’s enablement. So things like that are what we are working with. And like, for example. Example, ECR, which is our IC program. We had only 20 conditions. Initially, we are working on 93, so that’s how we have our collaboration, our talking to everybody, and trying to explain to them the benefits. And that’s what we did.

Abigail Viall:
Anyone else want to talk about that? If not, Aparna will just stay with you and ask you to answer the three questions. But any of you guys, or read on the phone, anything that you want to share about how you’ve addressed the sort of internal change management part of modernization?

Reid Potter:
So that’s a big focus for us coming up. That’s why I gave us a beginner to intermediate stage. I think once we get that opposite, operationalize that change management to be able to get it, you know, agency, wide understanding, kind of change the culture, or bring it part, make it part of the culture, right, having that loop and being able to talk to all the different services and programs, understanding what data they need and how best to get it to them, that’s when I’ll be confident, or I’ll be excited that we’re mature with our data modernization efforts, so big steps.

Abigail Viall:
Anyone else want to mention anything? John.

John Ray Taitano II:
I think it’s also a paradigm shift, right? Things have been so siloed, and people do things the way that they want to do it. This is how we’ve done it traditionally. This is how we’re going to do it. But I think that now, because of the dwindling of funds, it’s forcing people to say, hey, you know what you’re doing. The same thing in some respects, and I think we have some overlap. And you know what? Why don’t we see if we can cost cut that over cut, and then what we can do is, once that’s done, then we can actually go and to see now what will be the next step after that, trying to understand, maybe also how that part will relate to all the other parts, I think, makes things a lot easier, A lot better. So that management, when they’re looking at and trying to make decisions, they have a better picture, rather than just segmented and fragmented sets of information that at that point in time might not be correct.

Abigail Viall:
Makes sense. Aparna, I’m going to come back to you now and ask you to tell me a little bit more about your journey writ large, and how the Implementation Center is playing a part.

Aparna Priyadarshi:
So I have a pin-up in my office which says the most expensive words are. This is how we’ve always been doing it. So whenever somebody comes and tells me that, I’ll tell them to turn around and see my pin-up. It’s right behind. So I came in with a commercial experience, and there was a lot of talking. I did step on a lot of toes, trying to say no and stuff like that. But eventually, I think leadership has listened, and so we’re able to make a change. So IIC happened just when we were doing our data hub 2.0, so we started off on our journey. We wanted a data model. Reached out to CDC, and OMC built one, got it validated by OMC. So to understand interoperability, one needs to know how the data management behaves. And there is going to be redundancy, because we have duas that do not let us merge data together. So there’s going to be redundancies. But then, you know, also, to make sure that each group is enabled, even through the duas blocks. And you know, whatever the other issues are with respect to change programs, we are now enabled by grants very specifically, which was new to me, to understand that a particular grant has only particular features that we have to deliver.

So we have to look at many aspects to develop this data model as such, which we did. Finally took us a year and a half, but we did it. And so we were in a place where we’re going to enable the centralized interoperability platform for CDPH. And that’s when IC happened as such. So it was an extension to see the state of Illinois; my colleague is right here. And as we didn’t, we don’t have an HIE, so we work together to get, you know, where we can manage that. And you know, through the TEFCA and the IC platform, we both have both collaborated on many aspects, though his technology and my technology are different. We worked very strongly to ensure that we are enabled. They are very kind to involve me in their data modernization committee meetings and stuff like that.

So it’s like a collaboration with the state, which really helped us to, kind of, you know, help us, put us in our place. So the data hub was there. It’s not only for the clinical data. We had to bring a lot of optimization. We have something called the 311 service requests and all that. So it’s where the citizens would actually raise requests towards the department, and we have to respond to those requests. So that was going through different places. So we are organizing a lot. Our commissioner has its healthcare healthy, Chicago 2025, where we are going to bring in AI ML, I’m more of an ML person than an AI person to make sure that we manage life expectancy as well. So these are the different programs that were there. And like I said, ECR, when we did our analysis, we were doing 20 conditions, and we realized we had to do 2093 conditions. Being in Chicago, being the big city, we have a lot of, you know, special events. We have a lot of things to take care of. So it really worked for us in a way. So it was, it was great to get IC at the right time for us.

Abigail Viall:
And how would you say it’s anything specific about how the support has helped you catalyze in those areas?

Aparna Priyadarshi:
They listened to us, especially because I know every jurisdiction has its own requirement; they heard us out, and we were back and forth. We designed the solution together. So they gave us some suggestions, we told them, we showed them our platform, and they worked with us. Even today, they’re working with us to see how we can do the integrations and how to set up the pipelines, and to that extent, they are helping us procure some aspects or some products that we need to ensure that this is working. So it’s like listening is very important. And then, you know, we collaborate on that front.

Abigail Viall:
It’s truly that customized aspect that has really stood out for you as a little bit different than the typical, like, here’s some tools and figure out how to use them more like solving together.

Aparna Priyadarshi:
Even the dips platform, for example, we have a dips ECR viewer, so we are integrating that into our Tableau dashboard, so the viewer is there, and we can run analytics with the data at the back. So there are lots of things like, you know, all these things happened at the same time. And very helpful that, you know, we built one on top of the other. So it was the right way, actually; it just happened, but it was the right path to go.

Abigail Viall:
All right, Evan, I’m going to turn to you next, because I know that you guys are taking a slightly different approach, like, yes, it’s ECR, but thinking about how ECR can help with other kinds of problems. So I’m wondering if you can say a little bit about sort of the journey within Missouri, and then how you’ve been using the IC support.

Evan Mobley:
Hi everyone. Hopefully, everyone can hear me. Okay, all right, great. So within our state, the state of Missouri, our department is modernizing a lot of different systems, just a couple that are most directly related to this project. We recently adopted a Show Me World Care for case management of reportable diseases and automatic ingestion of electronic case reporting. We’re also in the process of adopting a new vital record system for electronic registration of vital events that systems and have a lot of new enhancements, particularly fire capability, so that we can share data with federal and other state partners through fire, some of our priorities that kind of been guiding all of our decision making so far, ensuring citizen and stakeholder access to up to date data that’s a big priority to program and leadership staff.

Recent priorities also include more dashboards and enhancements to data systems that display various data elements. One is our public health data query tool, MOPHIMS. That’s M, O, P, H, I, M, S, it’s another system I work on. Go check it out. It’s pretty cool. So improving our systems for data collection, automation, and interoperability is our top priority. We’re also prioritizing a modern workforce through staff training, revising job specifications when needed, and hiring staff that will support digital and data needs. Our long-term data modernization strategy must include a governance structure to ensure long-term success, and an advisory structure has recently been established to ensure data modernization efforts are consistent across the department and decisions can be made without delay.

So how does our IC project fit within these broader priorities? So our project intends to leverage the tools and systems created for reportable diseases to improve our data surveillance of birth defects through the use of the RCKMS, reportable conditions, knowledge management system, and ECRs. We could collect information on many different conditions, including over 40 different conditions relating to birth defects and infant disorders. Our traditional method of birth defect surveillance has relied upon kind of a traditional passive surveillance system where we’ve linked our vital records data with our hospital discharge billing data system, which we call patient abstract system, and that we use that to try to identify any birth defects, kind of found on all the variety of data that’s collected through all of those systems, and we try to identify any defect through one year of age.

It’s this process is conducted through a complex linking system that we’ve developed through SAS. The biggest limitation with this process is that it relies on data that has a pretty significant lag. Our vital records data typically isn’t finalized until about nine months following the end of the calendar year. Our PAS data, though, is not finalized until much later, usually about 18 months after the end of the calendar year. And since our system is trying to identify any defects through one year of age, we kind of need the current year of interest and the next year to really do the full linkage. So that means we aren’t really able to conduct birth defect surveillance on, say, 2023 data, for example, until around June or July of 2025.

The ECRs have the potential to report birth defects near real time. So if healthcare providers, you know, have their systems set up to report on those specific conditions. You know, we can get that data much, much faster. Our pilot project is focusing on five defects, but we plan to expand to other defects as we learn and grow from this pilot. We’re focusing on one or two large healthcare providers in our system to partner with in the pilot. However, it’s possible. We’re hoping that other providers have already kind of set their EHRs up to automatically report on these birth defects through our CTMS. So basically, when we flip the switch, and all the data starts flowing in, you know, we’re going to look at everything, not just the two big health care providers, but you know, whatever might show up.

With this data, the five defects that we’re including are our Spina Bifida NAS, which is national neonatal abstinence syndrome, so it’s not really a defect, but more issues with infants that have been exposed to opioids during pregnancy, Down syndrome, gastroescheesis and Tetralogy of Fallot. We chose these five different conditions as they kind of represent a fair mix of different things, different types of defects. Some things are collected on birth certificates. Some aren’t, some are a little more common. Some are rarer. But we kind of picked all of these because we knew they all existed, and we were consistently finding data on those, particularly with those health care systems that we’re interested in partnering with. So hopefully, the data, you know, comes in.

One issue with some of these defects is they’re so rare, you know, you might not get anything because they’re just, they’re not present. They’re not showing up that year. So, how is the IC program? How has it been a catalyst for, you know, our data modernization in our jurisdiction? So this project’s been very helpful, learning more about how ECRs can be used to enhance our surveillance of conditions not traditionally thought of as reportable conditions. At least in Missouri, none of our birth defects are reportable. I think about a quote from Michael Scott from The Office. You know, we knew exactly what to do, but in a more real sense, we had no idea what to do.

So with that, our implementation center, partner Guidehouse, has really helped us out a lot along the way. They brought in a lot of expertise to assist us in this project. They’ve helped us create a roadmap to successfully integrate ECRs into our birth defect surveillance, our process flows to accurately show how processes are going to kind of be before and after this implementation, and they’ve also brought in many subject matter experts to assist us in the project. So many of the steps we are taking, I think, will kind of be generalized into a framework of necessary steps to onboard other conditions. Maybe things that are, you know, completely not related to birth defects.

Our CKMS collects a whole bunch of conditions, so leveraging our existing system is very important to our department to maximize efficiency and reduce costs. And you know, we have limited funding, especially when it comes to birth defects surveillance, so being able to utilize this untapped resource will allow us to hopefully get more information about defects on a much faster timeline and potentially gain access to birth defects we normally wouldn’t have access to. Our PAS data only contains hospital and ER data. So if we can get birth defects through, say, a pediatrician’s office, you know, that would be something we would have never collected before.

Abigail Viall:
So that’s fantastic. And I know there are at least a couple of other jurisdictions that are also thinking about, like, how do we take this infrastructure and use it for, say, a chronic condition? So I want to come back to that with the audience, because I think there are a couple out here, but I know that we’re running out of time a little bit. So Edgardo, I’m going to ask you to just respond to those first three questions. You know, what’s the data modernization sort of situation look like in the Marshall Islands? How is the IC? How is the IC program helping you address this?

Edgardo Borja Padlan:
The Marshall Islands is advancing its data modernization through the unified Health Data Hub and exchange initiative. Our goal is to strengthen the Ministry of Health and Human Services capacity for disease surveillance, case reporting, and integration of other hospital components. We are a nation with 29 atolls and five islands, many places, with limited internet, paper-based reporting, and a fragmented system. With the support from the IC program, we are focusing on two main priorities: piloting of the electronic case reporting and Second. Second is the building, the foundation for the Health Information Exchange.

The IC program complements several outgoing efforts in the Marshall Islands. We are expanding the Starlink internet in outer island health center clinics. We are also scaling up telehealth in remote communities, and we are also keeping our current Marshall Island health information system running while waiting for wider integration. Through ECR, we are also connecting three critical components: standardizing electronic case reporting, identifying resolution to the master patient index, and structured data capture from outer island remote facilities. The project also pushed us to formalize our DMI Advisory Committee, the data commerce, data governance, and systems architecture, making sure that what we build today will be the system we need tomorrow.

While ECR is our technical focus, it is also linking to adjacent areas, from telehealth to program data, laying a strong foundation for future interoperability. The IC program has helped us move from planning to action, from a fragmented environment to standardize approach. It has built local capacity in data, governance, security, and cross-platform collaboration. It has given us a platform to engage stakeholders, the ministry leadership team and the ministry executive team, align programs, and think long-term for the front-line workers. Especially those in the outer islands, it means their data is no longer disconnected. It will directly contribute to the national insights and decision-making. Thank you.

Abigail Viall:
In one response, you hit so many important themes. So I just want to call out, as Jen showed, that picture of what the ecosystem looks like and how public health is part of it. You mentioned telehealth, you mentioned Starlink, getting internet access. And this is, it’s a great picture of how that public health journey is part of an ecosystem journey. So it’s, you know, and I love that you went, you said we’re going from planning to action, because that’s really the goal here. Planning is important. Planning makes sure that the action is very well targeted. But being able to have that ability to actually move to that action, to implement things, and implement things so that, for example, you mentioned, people in the outer islands can now see their data as part of the picture for their Marshall Islands as a whole. That is so powerful and so important. So I’m actually going to stay with you now because we do have one final question for our panel before we go to the audience Q&A: as you think about other jurisdictions applying for Wave Two, what would you say? What advice would you give to other jurisdictions thinking about participating in the Implementation Center Program? Are there any other things that you want to say to your peers about what they should think about to make the most out of this program?

Edgardo Borja Padlan:
First, design for your geography, let your environment guide your solution, and plan for your local realities. Second poster, shared ownership data modernization is about people as much as systems; engage IT, clinical, and surveillance teams early and align them around the same goal. In the Marshall Islands, we learned that data modernization is not about size; it’s about strategy and determination.

Abigail Viall:
We have both in public health strategy and determination. Evan, I’m going to come to you next.

Evan Mobley:
Okay, yeah, I would recommend, you know, I’m sure coming from, like, if you’re like, the data modernization team within your organization, I’m sure communicating with somebody in your group. Someone has a system that could be updated, that, you know, they have some ideas on, but maybe another source is so like for birth defects. We were just recently at a conference, the National Birth Defect Prevention Network Conference. And conferences are a great way to network and get ideas, and to like tech, the state of Texas has done a lot of work with ECRs and defects, so it was great, you know, communicating with them, learning more about their lessons learned. So I guess maybe one idea is, you know, steal an idea from one of the posters or one of the sessions here. You know, if you see some idea and say, Oh, I wish we could be doing that, you know, maybe bring that back to your organization, and try to come up with some ideas on what you need to do something similar.

Abigail Viall:
I love that steal an idea, that is, that is great advice, because that is also part of that community element. This is lifting everyone up, or at least that’s the goal. And the easiest way to do that is to say, hey, that worked for you, and it solves a problem I have. Let me learn more. Let me figure out how to do it and use the implementation centers to support that. Next, Reid, I’m going to invite you. What advice would you give to jurisdictions that are thinking about applying for Wave Two based on your experience so far, right?

Reid Potter:
So, my experience, I had written down, you know, kind of try to be as specific as possible, however, and as I’m listening to everyone, I feel like the implementation centers have done a really good job from people’s stories of identifying the problems, understanding them, and giving, giving them the strategy to act on it. So part of my experience was that when we started this, I had just started in my role as the DMI coordinator. So I’ve been learning kind of, as we’ve been explaining to guide house our ECR needs, you know, our what, what the duplication means for us, what the program matching requirements are, and really understanding our pipelines. So I guess go in with, I like the idea of, you know, ownership, so everyone, everyone has some skin in the game, and you’re able to describe your problem. And you know, these consultants, these firms, have really helped, certainly guide house has helped lay out what we do, existing currently, and then where we can, where we can improve it. And so we’re just starting to get into the action side right now. So I guess, yeah, the patience and making sure that you’re confident that everybody’s understanding what the problem is, so that’s where my focus has been. Thanks.

Abigail Viall:
And that gets back to Edgardo. Is a determination. Aparna, maybe I’ll come to you next.

Aparna Priyadarshi:
They listen. So what we did was we went and put out our problem statement, and we slowly worked on where we wanted to work with them. So I think that’s where we all need support, and I highly recommend it, because it doesn’t have to be that you’re solving an ECR problem or immunization problem. It just could be something that could come out through discussion, also, and say what’s best for your jurisdiction. So I think they bring in a lot of knowledge of what’s happening across the country.

They collaborate a lot, and so they give us a lot of solutions in a way that, you know, somebody did something, and so we can incorporate it. And, like, we had a complex requirement we were running, we were doing a dips pilot, and then we were working on our data hub, and then we wanted to go into, like, you know, the Q in space, because we don’t have an HIE, so all looking at all of this they, you know, they take give you a path to move forward. And I think that’s something we all need, because sometimes we sit in our own jurisdictions and we try to ponder and solve problems, but we need to get out and understand, and the ICS have really been helpful for us.

Abigail Viall:
Let’s see, John, you’re next.

John Ray Taitano II:
Okay, I’m gonna quote Evan, and I’m just gonna steal what everybody else has been saying. But I learned a new I learned a word phrase when I first started. It’s called leverage and reuse. So I think, for you guys, maybe instead of steal the idea, you’re going to leverage and reuse others’ ideas, right? Yeah. And then he was mentioning ownership, and Edgardo mentioned people without the right people in those positions, and without those people or your teams feeling that ownership, or giving them that ownership, then things are going to be very rough trying to accomplish this task, because it’s, it’s not a sprint. I mean, this thing is a dang marathon. And think of a marathon also with obstacles that you can’t foresee, and you’re going to have to, and it’s also a relay, because maybe that person that’s initially running is not going to be there, right, so you’ve got to tag somebody else in. But I would say having the key people to have the vision so that you can always, you know, stay right, you can figure out where you’re at and keep that, that line to the goal where you’re trying to get. And then I really just feel ownership, so that everybody understands, and everybody can keep it so that the next person, or you can start trying to get more allies to join your cause and keep fighting forward.

Abigail Viall:
All right, and Marcia, last but not least.

Marcia Pearlowitz:
So I think we have all sort of gotten familiar with always thinking about the broader funding landscape and things that are going on in that area. And I think with this particular project, that’s definitely something to keep in mind. I think trying to figure out how to leverage these funds to do something that is specific and achievable but also sustainable is really important. It’s a short-term project, so trying to identify things that are realistic and that are quite concrete and reusable is probably your best bet. And also, like, best bang for the buck as usual. Like, I think it’s an opportunity to be creative, but you also need to make sure you’re realistic about it. And so that would be my suggestion.

Abigail Viall:
So what I’ve heard here is both be specific and focused, but situate it within your larger picture, because you need to do both in order to achieve what you said, Marcia, which is to actually ensure that it’s sustainable, that you’re moving towards that larger end game. We have reached the end of our prepared questions and statements, and now we get to the fun unknown, which is all of you. So at this point, we are going to open the floor to questions from the audience, as I understand it. There are microphones floating about here. There’s, well, there’s one, and we can always toss one of these to you if need be, but we’re really just opening up now; you’ve got six really dynamic folks here. I also want to note that there are virtual participants, and you can send questions in via chat. Those will go to ASTHO. ASTHO is monitoring those. So this is the opportunity to ask those burning questions, or to even ask our panelists to dig into one of the themes that they addressed in their remarks. So, virtual or in the room, open up to opening up to questions. Don’t be shy.

Audience Member #1:
Thank you for a great session. I wanted to ask you about data quality, data security, and the models that you guys are using. There are always pros and cons with one or the other approach. So that’s the biggest ask right now, where AI machine learning is coming out, how are you normalizing the data across different agencies? And how are you working all together to make it like you normalize that data?

Abigail Viall:
All right, we’ve got a question about how we’re addressing data quality, data normalization, and building the foundation to allow for more advanced technologies, like AI, like ML. Aparna, I remember you said you liked ML, so I’m thinking maybe you want to jump on this one first.

Aparna Priyadarshi:
I’m audible. Yes, this is exactly what I was discussing last week before I came in here, the interoperability solution that we’ve built is building the data quality features in it. We were talking to one of our program teams working in the MIS space we’re talking about, they have a criterion to kind of address data quality and go back to providers and, you know, advise how data capture has to happen. So we are trying to automate that process, and we’re going to throw the error reports to them so we can go and have the conversations with providers with data capture, interoperability, as such does talk about, you know, normalization, standardization, but it’s every jurisdiction’s prerogative how we would like to manage the data. So we get data in code sets, ICD, snow, meds, and everything.

But the point is, what do you want to maintain? Is the jurisdiction big enough to handle all the code sets, you know, real-time, or do you know, have a smaller code set and stuff like that? So everything is standardized. MPI. Many of my colleagues here have talked about MPI. MPI is big because we consume data. So we get all kinds of data from across CDC and state and everywhere, and we also collaborate with the state about MPI and see how we can duplicate and remove erroneous data at that level itself. In the consumption stage, we have conversations with the APHL team as well as the Illinois team, so it’s something that we’re working on. And building AI ML models without doing that will be very advisable. So everybody’s working that route when you talk about interoperability.

So that’s why I started saying the data model is very critical. So we work with ONC to make sure that it’s accurate. And they match that with an HIE. And they said, We are quite there. They gave us some pointers. How do we identify data issues? A very good example they brought about is that there was a report coming in, a lab report, but every time it was a CBC report. So the point is, is that what we were supposed to acquire? It was a question that came up. So we need to put the tags and ensure that when we do data acquisition as well, we identify what’s the data that we’re expecting. It. And sometimes, you know it is normal, but you know, identify, even at the data level, abnormalities.

Les Pap (Audience Member):
A couple of you had mentioned about utilizing the NBS with the IC grant, and we are from Rhode Island, and we’re looking at creating a parser for the ECRs through our HIE, because one of the greatest complaints that we have from our surveillance teams is the lack of the NED system being able to give them good information when looking for data in the NED system. So, a couple of you had mentioned utilizing your IC grant in conjunction with the NBS system. So kind of curious to see what you’re doing about helping your surveillance team get better data and more relevant data out of the NBS system, because we’ve had such a great complaint, we’re looking at creating a parser to help alleviate the nurses, the EPIS, and the DIS team from having to deal with the limitations within the NED system.

Abigail Viall:
Anyone. Let’s, Reid, anything you want to share?

Reid Potter:
This is where I would, I believe that I recognize the voice, Les, from Rhode Island. This is where I would offer our ECR coordinator time with her to really understand, you know, what we’re doing with the routes, our raps, the routes, before we bring it into MBs, and how that’s facilitating the epidemiologists within MBS to get all the data that they need if they’re going outside of that. We do get some information from an HIE; we’re a very central, centralized agency within Maine, so maybe we don’t have the same information gathering issues, but yeah, sorry to be a bit vague on that, but I’m happy to facilitate more communication. So yeah, please reach out.

Abigail Viall:
All right, I’m coming back. Edgardo.

Edgardo Borja Padlan:
To answer your question, sir. In the Marshall Islands, we’ll be developing a lightweight, web-based tool for providers without electronic health records, so that they can still send a structured case report. So this lightweight tools is can be described as a health tracking information system.

Abigail Viall:
Other questions in the room or online, don’t be so shy. It’s only the first day of this meeting. There we go.

Audience Member #2:
I’m really curious about the internal work, the internal communication, what it took for you to help describe in a way that somebody like me, who is not a DMI expert, who knows maybe just enough to get myself in trouble, but could. What are you doing to help communicate about what you’re doing and the success? Because I hear a lot of success in what you’ve said today, and I kind of understand it. So, who are you working with? How’s that working?

Abigail Viall:
Great, John, you said this to me earlier that you were not a data guy, and you’ve had to talk to a lot of folks. So, how about you talk about how you’re handling the internal communication?

John Ray Taitano II:
Well, thank you for putting me on the spot. How we’re handling the internal communication is, we’re going to the departments and basically asking, Well, what are you looking for? What are you doing? What do you want out of the information? Right? And then, what information do you give? And then we just kind of go down the lines for the next step and say, you know, how do you receive this? Why are you receiving this? So this is something new, because they’ve never been asked these questions before, as we discussed. This is the way we’ve done it. So I’m going to keep continuing to do this. And there are some things that we started realizing we’re like. Wait a second, but you’re doing this, but technology took over that. So why are you still doing this and that? I don’t know. It’s just we’ve done it, and I think I want to take that snapshot of what you did and put it on my wall so I can tell people to turn around and read that as well.

But I think that’s what it is, starting that conversation about what you need, what you want? And then what are you sending? And then why are you sending that? Then, going up the chain, you keep doing that, and then you’ll start to get a better picture. And the reason why I say you need to do that is that you don’t want to take somebody else’s word for it, because maybe they’re not doing it the way you would think that it should be done. And I kind of want to hear it, because sometimes when people are saying things, they’re not saying it, or they’re saying something else by trying to explain something, or you pick up certain things, or then you ask leading questions. Well, how about this? They’re like, Oh, yeah, yeah, that too. That too. So I think it’s, it’s a longer discussion, it is a longer process, so just be careful what you get into, because this is kind of how I landed in this role. I started just with interoperability, and then I went down a rabbit hole, and now I’m here. So, so, yeah, just be careful with the answers. Okay, yeah, but thanks.

Abigail Viall:
Does anyone else want to weigh in on the change management process in their agency?

Aparna Priyadarshi:
It’s a process, so it’s the where it goes is you have to sit down and explain sometimes cloud architecture, to people who do not understand cloud architecture. So what we’ve done is draw those arrows and show them. This is where it comes. Is where your raw data sets are, this is where your curated data sets are, and this is how you view your data. So it’s like, it’s a process, which I learned initially. I was like, you know, it’s a cloud architecture. It’s fine, but the point is, I’ve been coached by my commissioner and my colleagues to go and speak English, basically. So that’s what I do. So it’s a process, and every program who’s having an IT application, I’m sitting down with myself or my team members, explaining the architecture design and explaining how it’s enabling their solutions. So it’s a process.

Abigail Viall:
I’ve got one right here.

Audience Member #3:
Thank you all. Many of you mentioned challenges with interoperability, which brings to mind the need to have the right standards. We’ve been doing standards for this kind of interoperability for a long time, probably all of my career and then some, and I’m still hearing interoperability woes. How are we missing the mark? What is the secret ingredient that needs to happen through something like PHIG to get beyond the standards to real interoperability?

John Ray Taitano II:
This you’re talking about. It is more like an operational question, so standards are one thing, right, and governments are notorious for planning to plan to plan to meet, to plan, right? Very little action. For me, one of the things is, especially with the space of technology, everything you know today will be, I guess, out of technology tomorrow, right? It’ll be, it’ll be wrong, right? There are new things that are happening tomorrow. So for me, the best thing is to have the best plan today, move on that, and then tomorrow, reassess, look at it again, and if you need to adjust that plan. But remember when I said having a goal? So if you have the goal and the vision, you know where you’re trying to go.

But as in the technology space, everything is consistently changing. People are changing. The environment is changing. So you need to be able to be flexible and help navigate standards, which is one thing. But I think if you just keep looking at that standard, you’re too focused on this. You need to be more broad-minded up here. So it’s great to have the people that are doing the standard here, and they’re the ones that are going to kind of, they’re like the tech to keep you in line to do this. But you need that visionary and that goal person to make sure that you’re still heading over there and you’re still being pulled because it’s very easy to be bogged down here. It’s very easy. And I think with the government, this is normally the case; everybody gets bogged down here. And with private, sometimes they just go way too fast, that’s where I’m at, and normally we were doing that. So coming from private to here, it’s very different, very different. So that would be my recommendation.

Abigail Viall:
Say no, we’re about at time, I think this, what your question really gets to is, how do we continue to move the ecosystem along, too? Because public health can only be where we’re part of it, but we don’t own the entire ecosystem. So that’s it, an important question with still challenging answers, but I think the IC program is one of the ways that we are at least trying to make sure that we’re part of pushing that broader ecosystem approach forward. I know that we are at the time for this panel, so I want to thank all of my panelists for their thoughts, and then I’m going to hand it over to Tabitha for a couple of announcements.

Tabitha (Host):
Okay, just a couple of announcements for this afternoon. We are going into a 15-minute break, and from there, you’ll have two concurrent sessions to choose from. We have one on leveraging AI, which will, if you’re interested in that one, please come back to this room, and another one that is working on a governance framework. So if you’re interested in that one, please go to the room right next door to us. I also wanted to remind everybody about our breakfast tomorrow morning at 8:30. We have a networking breakfast, so that’ll be down here as well. And just again, as you’re heading out this evening after your concurrent sessions, please come back to the fourth floor in the park view room, that’s where we will have a data modernization reception. So we’d like to join you all there.

I wanted to share a couple of the highlights about Metopio, which is sponsoring that reception. They are a nationally recognized Community Health intelligence platform that equips public health agencies with fast, user-friendly tools for community health assessments and plans. They work; their work aligns with building the data modernization work that you all are doing in terms of infrastructure. And they share a public health commitment to innovation and collaboration, and share a community. So we’re really excited that they’re sponsoring the reception for us, and if we have our members from Metopio here, just to kind of stand up so everybody knows who you all are at the session this evening. So please join us at five o’clock, and we will see you all there. Thank you so much, everyone.