GAO-11-99 December 17, 2010
A catastrophic public health event could threaten our national security and cause hundreds of thousands of casualties. Recognizing the need for efficient sharing of real-time information to help prevent devastating consequences of public health emergencies, Congress included in the Pandemic and All-Hazards Preparedness Act in December 2006 a mandate for the Secretary of the Department of Health and Human Services (HHS), in collaboration with state, local, and tribal public health officials, to develop and deliver to Congress a strategic plan for the establishment and evaluation of an electronic nationwide public health situational awareness capability. Pursuant to requirements of the act, GAO reviewed HHS's plans for and status of efforts to implement these capabilities, described collaborative efforts to establish a network, and determined grants authorized by the act and awarded to public health entities. GAO assessed relevant strategic planning documents and interviewed HHS officials and public health stakeholders.
HHS did not develop and deliver to congressional committees a strategic plan that demonstrated the steps to be taken toward the establishment and evaluation of an electronic public health situational awareness network, as required by PAHPA. While multiple offices within HHS have developed related strategies that could contribute to a comprehensive strategic plan for an electronic public health information network to enhance situational awareness, these strategies were not developed for this purpose. Instead, the offices developed the strategies to address their specific goals, objectives, and priorities and to meet requirements of executive and statutory authorities that mandated the development of strategies for nationwide health information exchange, coordinated biosurveillance, and health security. However, HHS has not defined a comprehensive strategic plan that identifies goals, objectives, activities, and priorities and that integrates related strategies to achieve the unified electronic nationwide situational awareness capability required by PAHPA. The department has developed and implemented information technology systems intended to enable electronic information sharing to support early detection of and response to public health emergencies; however, these systems were not developed as part of a comprehensive, coordinated strategic plan as required by PAHPA. Instead, they were developed to support ongoing public health activities over the past decade, such as disease and syndromic surveillance. Without the guidance and direction that would be provided by an overall strategic plan that defines requirements for establishing and evaluating the capabilities of existing and planned information systems, HHS cannot be assured that its resources are being effectively used to develop and implement systems that are able to collect, analyze, and share the information needed to fulfill requirements for an electronic nationwide public health situational awareness capability.
Long comment and recommended historical warnings and prescriptions below the line.
Phi Beta Iota: Office of Management and Budget (OMB) is not trained, equipped, nor organized to manage anything. Bruce McConnell did what he could in the information arena, Cass Sunstein does what he can, but at root OMB has no strategic analytic model, no comprehension of the fundamentals of Information Operations (IO), and is therefore unable to do what needs to be done: define and oversee to success a Whole of Government planning, programming, budgeting, and implementation process that brings the US Government, and the Republic, into the 21st Century. Particularly vital is the substitution of information of time, space, capital, and labor–we must do the right things cheaper and faster, not the wrong things righter and more expensively. General Accountability Office (GAO) does what it can, but lost most of its potential when Comptroller General David Walker accepted the Wall Street buy-out and then joined the No Labels show troupe. There is no leadership in the US Government capable of leading a break-out, the US Army being the one possible exception. Intelligence is about decision-support including early warning that incentivizes that General Al Gray called “peaceful preventive measures.” We knew this in 1988, 1992, 1994, 1996 and again in 1998. No one wanted to listen. Has anything changed? We doubt it–most (hopefully not all) flag officers and senior executives are content with going through the motions, realizing they will be long retired before they can be held accountable for failing to do all that could be done. Similarly, most vendors know all too well that they will not be held accountable over time because the government churns its acquisition leadership to the point of not having any. NEEDED: one responsible node able to do Advanced Information Operations. blending intelligence and integrity across ALL mission areas, across ALL elements of government, across ALL disciplines, across ALL domains, across ALL nations. This is called M4IS2 (multinational, multiagency, multidisciplinary, multidomain information-sharing and sense-making). It is achievable immediately with the first increment showing results within 90 days of inception.