Good afternoon, Mr. Chairman and members of the committee. My name is Stephen Thacker, and I am the Director of the Epidemiology Program Office at the Centers for Disease Control and Prevention. With me are Verla Neslund, who is the Deputy Legal Advisor to CDC/ATSDR, and Dr. Joseph Reid, who is the Associate Director For Science in CDC's Information Resources Management Office. We welcome this opportunity to appear before this subcommittee of the National Committee on Vital and Health Statistics to provide the federal perspective on the functions of public health and their relationship to certain issues of privacy and confidentiality.
The mission of CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. We accomplish this mission by engaging in a number of activities, including monitoring the health of the population, detecting and investigating health problems, developing sound public health policies, and implementing prevention strategies. In these activities we work closely with state and local health departments and other partners. CDC and its public health partners are concerned with a wide spectrum of health issues including infectious diseases, chronic conditions, reproductive outcomes, environmental health, occupationally related health events, and injuries.
There are several different types of public health data that we use routinely. For example, there are reports of cases of specific infectious diseases, that are sent from state health departments to CDC each week. Other types of data include vital statistics; information on health status, risk factors, and experiences of populations; and information on potential exposure to environmental agents.
Health information collected by CDC does not generally include the personal identification of individuals. However, to protect the public's health, the agency, under certain circumstances, must access confidential health information. With few exceptions, state health departments and other providers remove identifying information and assign case report numbers before they forward information to CDC. When CDC assists health departments with investigations, agency staff may act under the authority of local health officials whom they assist. CDC policy mandates that its staff retain individually identifying information only when absolutely necessary after leaving the health department setting.
Today, powerful social and technological trends will create new opportunities and challenges for strengthening the nation's health information infrastructure. The first trend is the shift in the health care industry from one dominated by a large spectrum of small offices to one characterized by a smaller number of large managed care organizations with electronic patient record systems. A second major trend is a greatly increased capacity to take advantage of hardware, software, and spatial aspects of the transfer of electronic data, currently characterized by the explosive growth of the Internet. We anticipate that new technologies, new partners, and new data sources will provide health information systems that will enhance our capacity to safeguard the public health.
At the same time, there are barriers to be overcome. Public health information exists in thousands of places; in the record systems of public health agencies and grantees, in the information systems of health care institutions, and in individual case reports, to name a few. Fragmented and compartmentalized, this information often cannot be aggregated to describe populations, communities, or issues. To address this, CDC is committed to implementing the highest priority objective of its strategic plan--the creation of integrated public health information and surveillance systems.
CDC has convened a Health Information and Surveillance System Policy Board, which is chaired by the agency's Associate Director for Science. The board has representatives from the Council of State and Territorial Epidemiologists, the Association of State and Territorial Laboratory Directors, and the National Association for Public Health Statistics and Information Systems. In addition to addressing policies and standards within the agency, Board members are actively interacting with a number of outside groups, such as the American National Standards Institute and the Computerized Patient Record Institute. Board members also participate on Implementation Teams convened by the HHS Data Council to develop recommendations for enacting certain provisions of the Health Insurance Portability and Accountability Act of 1996. We believe that these efforts will create efficient and valuable sources of information about health strategy, status, and quality and cost of health services--information needed to create and evaluate effective public health policies and practices.
In summary, CDC programs use health information to monitor health trends, respond to urgent threats to public health, identify the causes of preventable disease and injuries, develop and evaluate prevention strategies. The execution of these essential public health functions depends upon CDC's continuing access to confidential health information. The agency recognizes the importance of individual privacy and data confidentiality and has successfully protected information in the past. We are unaware of any breaches in confidentiality that have occurred at the federal level. CDC will continue to use state-of-the-art methods to protect data and data systems and to maintain the confidentiality of health information. Thank you.