The Promise of the North Star Architecture Initiative

 

The historical record shows that public health policies are the most effective way to address and prevent the kinds of population-wide health crises we are currently living through. But policies can only work if they bear the fingerprints of collaborating government bodies while also reflecting the needs and voices of people with lived experiences.

 

The Role of Public Policy

Public policy can affect communities and public health in tangible ways. Namely, regulations built on data and research can directly address public health issues and improve the health of people and their communities. When it comes to authoring those policies, several different bodies come into play. Think of states. Or think of federal government bodies, such as the Center for Disease Control and Prevention (CDC) and the Office of the National Coordinator (ONC), that create administrative policy and deploy legislation.

Cross-sector collaboration and partnerships also play a crucial role in policymaking. These have ebbed and flowed throughout the years depending on a variety of factors, some of which include political will and bipartisanship. But with the ongoing pandemic, there has been a flood of funding directed to public health investments and healthcare. The pandemic also opened people’s eyes to the health disparities that have existed for generations in our communities along the lines of race, age, income level, and more.

The need to improve both public policy and cross-sector collaboration has led major agencies and legislative bodies, such as the CDC, the ONC, and Congress, along with others, to come together under the North Star Architecture in an effort to improve data and public health modernization and address the inequities communities experience.

The North Star Architecture

In 2020, the CDC launched an initiative called Data Modernization Initiative (DMI). Its goal has been to move away from “siloed and brittle public health data systems” toward a more “connected, resilient, adaptable, and sustainable system”. The CDC collaborates with the ONC on the initiative and attempts to align with the ONC’s “pursuit of creating an open architecture, an ecosystem based on open industry standards”. To achieve that, the initiative includes five priorities: building the right foundation, accelerating data into action, developing a state-of-the-art workforce, supporting and extending partnerships, and managing change and governance.

However, the DMI has faced criticism for its slow and vague start. The US Government Accountability Office, for instance, explained in a recent report that the CDC has not yet announced action steps, allocated funding, or set deadlines.

With its slow start and the persistence of the COVID pandemic, it is imperative that the DMI increases interoperability and data-sharing with the public health sector – especially considering that the public health sector has been rarely included in discussions regarding data-sharing or health information exchange partnerships.

For these reasons, the DMI is designing a cloud-based data ecosystem called the North Star Architecture. The goal is to connect federal, state, and local health department information systems and make them interoperable. The CDC will govern the cloud environment to protect the state and local governments’ control of data, while the ONC’s Trusted Exchange Framework and Common Agreement will help promote information exchange.

As of late, the CDC has allocated $1.1 billion toward the initiative. Meanwhile, healthcare technology trade organizations, such as the Healthcare Information and Management Systems Society, are pushing for an increase in funding to $35 billion over 10 years.

The North Star Architecture is meant to increase and support state government and public health agency efforts to accurately report and access public health reporting data in a timely fashion. They should also help to simplify bidirectional information exchange with healthcare and other sectors (including social services).

The initiative sounds promising, but a decrease in confidence in recent years in federal initiatives and the CDC is worth bearing in mind. Nevertheless, if done successfully, the DMI would allow for the modernization of public health systems and data systems, with the opportunity to improve both public and community health across the country.

Impact on DASH

For over half a decade, Data Across Sectors for Health (DASH) has worked to cultivate cross-sector and agency partnerships to advance equitable data-sharing and encourage community data ecosystems.

In DASH’s view, the collaboration between major organizations, such as the CDC and the ONC, on public health and data modernization, backed by significant funding, is a step in the right direction. DASH’s work with communities in its Learning and Action in Policy and Partnerships (LAPP) funding program has highlighted how data-sharing between community-based organizations (CBOs), state governments, and other stakeholders can effectively enact change and improve health and equity. See, for example, the recently published brief titled A Community-Centered Approach to Data Sharing and Policy Change: Lessons for Advancing Health Equity.

However, it is crucial that initiatives such as the North Star Architecture incorporate the input of communities and people with lived experiences. The involvement of community voices and people with lived experience allows for a better understanding of the issues in our communities and opens opportunities to tackle systemic issues of inequity in our communities.

If the North Star Architecture Initiative is effective, it will modernize public health and data infrastructure, allowing for real-time health and syndromic reporting between agencies along with better cross-sector communication.