Standardizing Financial Information Systems: Implications for Addressing COVID-19

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by Gulzar H. Shah, PhD, MStat, MS, and Kristie C. Waterfield, DrPH, MBA

Health Informatics Innovations and Applications highlights ways that health informatics innovations and applications are supporting stakeholders in public health practice and policy to advance their mission of improved population health. The series highlights innovations in health care informatics.  

In my encounters with health informatics over the last 25 years, I have always thought of financial information systems as the total strangers that you pass on the street and make quick eye contact with but never fully interact with, not as the step-relatives that you see a few times a year that you have a couple of things in common with. In general, we all know that standardization and interoperability are key characteristics of health information systems; though somehow the standardization of the financial and accounting systems that are used in public health never crossed my mind until a casual conversation with one of the guests of this blog. So my co-blogger Dr. Waterfield and I invited our guests, Dr. JP Leider, Dr. Betty Bekemeier, and Mr. Greg Whitman to enlighten us and the patrons of JPHMP Direct about how standardization of financial information systems is important for public health practice and policy, particularly in the current COVID-19 crisis.

In the accompanying podcast, we were allowed to pick our guests’ brains about several aspects of financial information systems. We asked them to tell us about their work in financial data standardization. Also, given that Informaticians spend a lot of time on data standardization and harmonization, we asked them what those processes have been like for them in their work. Lastly, and most importantly, we asked our guests why, in their opinion, does standardizing financial information matter, particularly in our current COVID-19 crisis.

Standardization of Financial Information Systems

Our guests discussed the Uniform Chart of Accounts as an example of the standardized financial information systems for public health agencies. For our podcast, we took advantage of the fact that all three guests have been engaged with some aspect of the development of the nation’s first Uniform Chart of Accounts (UCOA) for public health agencies, as a part of the Public Health Activities and Services Tracking (PHAST) team. The UCOA Project was initiated via a Robert Wood Johnson Foundation-funded pilot study in a select number of governmental public health agencies. Now it is being scaled up with public health agencies across the US.

To our query about how public health agencies benefit from Uniform Chart of Accounts, our guests pointed out that this tool gives access to participating agencies’ data in the form of interactive dashboards. We all love dashboards, but that is not all; the dashboard will allow users to benchmark their revenues and expenditures and generate data visualizations. Users of the UCOA can download data in user-friendly formats such as spreadsheets to support additional in-depth analysis and visualizations as images or PDFs to be included in presentations, etc. Many agencies use this handy little tool to improve understanding of expenditures and revenues and to inform practice. Agency participants describe the UCOA as valuable to their efforts toward understanding the total costs of programs and capabilities, analyzing revenue sources to see if agencies are getting their “fair share,” streamlining external reporting, improving budgeting processes, and advocating for specific funding needs—including Communicable Disease Control, Emergency Preparedness, and core Capabilities.

Given that the Uniform Chart of Accounts tool is a recent development, we asked what did public health agencies miss in such a tool’s absence? The lack of a uniform financial data system severely undermined the capacity of public health policymakers and practitioners to demonstrate the value of public health and examine their own revenue and expenditure strategies. The UCOA is filling a critical gap among public health leaders in numerous ways to improve understanding of expenditures and revenues and inform practice.

Financial Management Standardization and COVID-19 Response

Given the current COVID-19 crisis, we were curious to know about the implications of the standardization of financial information systems when public health agencies are dealing with crises such as COVID-19. The podcast participants opined that currently, it is difficult to fully know the resources and capabilities that are available to each of the public health jurisdictions because the need, available resources, and the information regarding infrastructure investment varies greatly among the jurisdictions. We are seeing many local and state health departments struggling to reallocate resources in order to assist with identifying and monitoring those that may have been exposed to a confirmed COVID-19 case. We asked our guests, how would financial management standardization assist these public health jurisdictions in their response to the current COVID-19 crisis? They all three agree that standardizing financial information matters for 2 reasons:

  1. Transparency and Accountability: The Public Health System of the United States is underfunded, as a whole; however, certain areas such as Preparedness and Emergency Response are federally funded and thus it is easier to track the funds from the source to where they are being used. As public entities, it is important that local and state health departments are transparent and held accountable for how the funding is spent, especially during times such as the current COVID-19 crisis.
  2. Identification of Gaps in Financial Investments: Since there have been cutbacks in public health funding over the last several decades, it has become imperative that public health agencies look at the infrastructural investments being made within their own jurisdictions. The standardizing of financial management information would allow these health departments to compare their investments with peer jurisdictions to identify potential opportunities for an increase in investment in order to increase the overall outcomes of the population.

With the expectation of an influx in federal funding in the form of several billion dollars to respond to the COVID-19 crisis, the flow of the funding from the federal government to the states and then to local agencies will need to be carefully tracked and the appropriateness of the spending reported. The standardization of financial information would make this possible and relatively easy to do. It would also allow state and local public health agencies to prepare for the long-term by identifying the infrastructural investments that need to be made so that they will be prepared in the future for a similar type of crisis.

Related Research in the Journal of Public Health Management and Practice:

Drs. Leider and Bekemeier are nationally recognized leaders in public health systems research. Dr. Leider has a notable record of focusing on the public health workforce and the needs of public health organizations, such as systems and financial management. Dr. Bekemeier has spent her career as a public health nurse exploring the most effective public health systems strategies that will assist in eliminating health disparities and improving population health. Mr. Whitman has served as project manager for the Public Health Activities and Services Tracking (PHAST) program since 2011. He has spent his career developing web-based content and user-centered design data tools that assist in his research in public health systems and data management.

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