This report describes how state health agencies(SHAs) and local health department(LHDs) use information technology systems to capture, manage, analyze, and report information. It assesses trends in use of information technology(IT) among SHAs and LHDs following the Health Information Technology for Economic and Clinical Health(HITECH) Act of 2009, the Patient Protection and Affordable Care Act(ACA) of 2010, recent work in public health informatics, and other factors. The study found public health departments making important advances in use of IT, but did not find a single "best practice" approach. Public health officials face common challenges, including variation and ongoing evolution of public health activities, lack of training on informatics and process re-design, shrinking funding and constraints that limit strategic investment and encourage data silos. Most respondents agreed that, in the future, public health practice will require and integrated approach to managing information and collaboration with health-care providers and other partners. The report describes essential qualities of an effective strategic framework to guide investments.