or What would you do with a billion dollars

for health data modernization?

By Dale Dauten, Syndicated Columnist, Special for the IINews

We keep hearing of a trillion dollars of government spending here and a trillion there. All those massive budget numbers got us thinking about how the spending decisions get made, particularly the funds assigned to modernization of public health data:  a billion dollars authorized in just the past year, with another half-billion in the Build Back Better legislation. 

So we turned to a couple of people working to write and/or influence legislation, both with Horizon Government Affairs (HGA), a lobbying organization specializing in public health. The organization was founded by Joel White, formerly the staff director of the Ways & Means’ Health Subcommittee, as a way to bring together clients to help shape policies and funding for things like improving health data. (STChealth is one of those clients.)

Here are three realizations that came from our conversation with Jennifer Steger and Brett Meeks of HGA.

Brett Meeks, Vice President at HGA, served as Deputy Health Policy Director on the Senate Committee on Health, Education, Labor and Pensions for Chairman Lamar Alexander of Tennessee where he wrote, negotiated, and oversaw passage of several federal health care laws, including the 21st Century Cures Act.

Prior to joining Horizon, Jennifer Steger, Assistant Vice President at HGA, spent seven years on Capitol Hill handling both operations and policy issues.

Realization #1:  It’s not just the legislation, it’s the implementation.

“You can authorize money to improve health data, but how do you make sure it doesn’t go to the same old outdated systems – how do you know it’s not being spent to buy more fax machines?”

That’s from Brett Meeks, talking about recently authorized funding to improve public health data. He told us, “Public health data has been front and center for decades. It’s struggled to keep up. But the pandemic was a fire drill. There has been a billion dollars in the past year and there’s another $500 million in Build Back Better legislation. We want to make sure that money is spent where it will do the most good. For instance, we don’t want a competing government-run health information system that could set health data back five years. We don’t just want the money to be used, but used better.”

Photo: Brett Meeks (left) with his old boss, Lamar Alexander

This is trickier than it might sound. “There’s a tension around the money sitting at Federal agencies,” Meeks explained. “You want to make sure the money is used in the ways it’s intended and that it gets to the people who most need it, but at the same time you’re reluctant to put a lot of strings attached to the money.” The solution is to go beyond working with Congress to working with HHS and the CDC, as well as working with governors’ offices.

So, there’s the problem and the solution, then the legislation, the funding and then the implementation.

Realization 2. Things are getting done even as we hear that nothing is getting done.

When asked about misconceptions about the work they do, Meeks was quick to point out, “You read that Republicans don’t talk to Democrats, but there are constant negotiations between staffs and things are getting done.”

Jennifer Steger pointed out that a current piece of legislation, HB 550, called the “Immunization Infrastructure Modernization Act of 2021” was introduced by Rep. Ann Kuster, a Democrat from New Hampshire who was joined by Rep. Larry Bucshon of Indiana, an M.D. and a Republican. The bill now has 14 co-sponsors, ten Dems and four Republicans. “Most of the people who went into public service,” Steger asserted, “did so for the right reasons.”

Photo: Jennifer Steger

“Our involvement means calling on Republicans and Democrats.”  Meeks added, “People are drawn to public service to serve and they keep at it, trying to right wrongs.”

It’s an appealing picture: earnest and thoughtful staff members working out legislation and implementation while the politicians huff and posture out front.

Realization #3. However hard you might think it is to make something happen in government, it’s much harder.

It’s easy to understand why politicians love that old line about “never wasting a good crisis”; after all, that’s when urgency strikes the bowels of government. Even then, however, there’s so-o-o much to accomplish besides writing a law.

Meeks offered an example:

“Back in ’09, as part of the stimulus bill, Congress included funding for Electronic Health Records. There were incentives for medical practices to digitize records and penalties for those who didn’t. Then, in 2015/2016 there was legislation that I worked on called the 21st Century Cures Act. Among other things, it said that a patient’s data should go with them when they go from one doctor to another. My fingerprints are on that statute and there’s a copy of it hanging on my wall. But it passed in 2016 and it’s still being implemented. At this point, I’m serving penance – there are parts of the law that don’t work and people say ‘What the hell?’ and I’m working to fix anything that’s wrong. Remember, that bill was drafted in 2016. It was introduced under Obama and then implemented under Trump and now under Biden.”

Steger put it this way: “We have to play the long game. It can take years to make a law… and then implementation starts.”

So, there it is again: don’t waste a good crisis. How long till people will look back and say, “There were some good things that came out of COVID-19”?

* * * *

Referral Regions:

A New Way to Look at Immunization Data?

By Bill Davenhall, Geomedicine Analyst

The COVID-19 pandemic has changed hand cleansing practices, standing in lines, greeting people, and certainly hugging people you barely know! The pandemic has also caused many  public health professionals to rethink many of their “time-tested” approaches to community outreach, especially after witnessing health and school boards become paralyzed by political discord when fights actually broke out. Meanwhile, even very large health care providers were unprepared to scale up their “just-in-time” supply chain logistics. Sometimes you have to turn your own chair in a different direction to get a better view of things!

One of the newest unexpected on-going challenges for many health-seeking consumers has been gaining digital access to their immunization information easily and quickly regardless of where they live.  The latest CDC data informs us where children and adults actually went to receive their seasonal flu shot in 2020-2021 and knowing this information might help us understand how immunization information flows and that will likely need to be integrated smarter to serve everyone who wishes to  maintain lifetime immunization records all in one place!  This is where knowing about referral regions might help.

Immunization Rates by Place of Service – Seasonal Flu 2020-2021

Place of ImmunizationChildrenAdults
Doctors’ Offices and Hospitals71%40%
Retail Pharmacies12%39%
Health Clinics13%8%

Data Source: CDC – CDC’s most recent  data on the 2020-2021

Seasonal Influenza Immunizations (Child and Adult) October 2021

Referral regions (aka HRR’s) are geographical boundaries whose shapes are inherited from the location data associated with where most people got health care services. There are 306 referral regions. These were identified by the health researchers at the Dartmouth Evaluative Clinical Center back in the early 90’s and they have kept them updated. The 306 regions have distinct characteristics such as strong physician referral patterns and patients have similar residential origins and service destinations. In other words, referral regions reflect the way patients move about a region and acquire medical care. They are essentially connected markets that are seldom captive of a single state, county, city, or town. This is what makes them useful, at least analytically. 

For example, the map below reveals that only 32 or 10% of the HRR’s across the US contain over 80% of the total number of persons under 18 in 2026 that likely will not get an annual flu shot- anywhere (if current immunization rates don’t improve).

Time to turn your chair!

2nd Opinions always appreciated.

Note: Data for this analysis is derived from 2020 Census data and estimated updates for of adults and children in 2021 and 2026 from Scan\US; Immunization rates by Age Groups and Place of Immunization are derived from the most recent CDC publication entitled “Flu Vaccination Coverage, United States, 2020-2021

* * * *

Vaccine Documentary Available

There’s a new documentary on immunizations and it’s one that an early supporter of the effort, Todd Watkins, President of STChealth, said this about: 

“This documentary isn’t just informative, it’s also moving and heartfelt and even, in places, witty and charming. Please watch it and see if you don’t agree that it’s a significant educational tool to address vaccine hesitancy wherever it may exist in sub-populations across the country, while combating the flood of misinformation surrounding all immunizations. And if you agree, please urge your local PBS station to run it. But more importantly, please use the many short lift-out videos on the website ( to share on your social media platforms.

“After all, this project wasn’t just about making a film. Instead it is about creating social change to rid our country and the world of vaccine preventable diseases. And like any successful movement, it requires each and every one of us to mobilize around this cause. This film and its content are invaluable resources to launch this movement in a profound way.”

Further, Chris Schueler, the noted filmmaker who created “Vaccination for the Misinformation Virus,” passed along his update:

Here’s the link for FREE viewing by anyone, anywhere (nothing to sign up for or do, just click and watch):

Vaccination from the Misinformation Virus is now available on the PBS video portal and also through the PBS Video app on Roku, Amazon Fire TV, Apple TV, Chromecast and Samsung Smart TV. Here is the link:

“Thus far over 30 PBS stations have picked up the program including 6 of the top 15 markets.  We’ve also done live and virtual screenings at universities from California to New York with many students using the short, lift out videos on social media platforms.

“It’s really going great guns.  I was at Savannah Tech live for a screening on November 11 and then up to Albany NY for a screening on Nov. 18 at the Pharmacy school there.”