The low level of public health participation in broad-based NII grant programs is symptomatic of a lack of appreciation, both on the part of the NII and public health communities, of the benefits and applicability of NII technologies to population-based public health. This lack of understanding extends to the commercial information technology sector and works against creative thinking about how commercial products might be applied to the full range of public health information problems.
Multiple factors are probably at work here, including the excessively high visibility of clinical applications of the NII, a lack of information about NII grant programs among the public health community, a poor understanding of population-based public health among the NII and health care informatics communities, insufficient local investment to allow public health agencies to connect to the NII, and a lack of public appreciation of the importance of information in carrying out essential public health services. In addition, public health agencies have not been tied into the usual channels of distribution of information about NII programs. Because they have not received relevant training, many public health professionals lack the technical expertise to prepare competitive proposals for advanced information technology research or demonstration projects.
Collaboration of state and local health departments with university-based medical informatics or general computer science groups, advanced computing and telecommunications groups, the private sector, or other elements of state government is essential to apply for grants and implement applications. Some successful examples of these collaborations include the partnership of the Georgia INPHO project with the Georgia Center for Advanced Telecommunications Technology and the work of the California Health Department with Pacific Bell. To date, however, such collaboration has been relatively rare. In part, this may be due to the traditional focus of medical informatics on process automation and the public health focus on data. As computer-based patient record systems generate more data and public health officials seek to automate an array of processes, the interests of the two groups become congruent.