FHIR playbook companion guide

Since early 2024, the Big Cities Health Coalition (BCHC) has convened the Data Modernization Work Group (DMWG), comprised of the data modernization leads at BCHC’s member jurisdictions.

The DMWG meets monthly to share expertise, information, and peer experiences on data modernization issues; share and promote best practices; provide training/learning opportunities; and strengthen relationships and improve coordination between member jurisdictions.  

In 2025, the DMWG had the opportunity to participate in the following CDC-funded projects.  

FHIR Forum

BCHC member jurisdictions need sustainable investments to build more modern, interoperable systems to provide timely and actionable data, improving health outcomes for all. Fast Healthcare Interoperability Resources (FHIR) is a standard within the public health domain to enable efficient and standardized exchange of electronic health information between various health systems and public health agencies. This improves surveillance, outbreak detection, and reporting without cumbersome manual processes.

While members of the DMWG acknowledged the importance of FHIR standards, understanding how to get there was lacking. To bridge the knowledge gap, BCHC leveraged CDC funding to support activities focused on FHIR fundamentals.  

Between November 2024 and July 2025, BCHC hosted a monthly FHIR Forum to promote community learning and advocacy towards FHIR adoption. This included an in-depth review of the public health use cases, provided a space for peer learning, and brought in technical experts. In addition, numerous tools and templates were developed to support the following:  

Additional investments are needed to continue this shared learning and to provide direct technical support, ensuring successful FHIR adoption (only 50% were confident they had the resources they needed). Such support will allow public health to develop truly modernized data systems. 

Data Governance & Legal Workshops

In May 2024, BCHC hosted a Data Summit supported by CDC Foundation and CDC Office of Public Health Data Surveillance and Technology (OPHDST) to identify challenges and prioritize action areas to modernize data systems. During this event, jurisdictions highlighted the need to build partnerships between legal representatives and public health agencies to shape policies and laws around public health data use and sharing both internally and externally.  

Through CDC support, BCHC partnered with AISP to lead workshops focusing on governance and legal concepts among data modernization leads and their legal counterparts within their jurisdictions. A compilation of learnings can be found in the AISP Final Deliverable, which includes information on the following:

Through this effort there was a significant increase in knowledge (93%), with the majority making strides in their data request pathways (73%) needed for breaking down data silos to better respond to community needs.  

Additional investments are needed to continue the momentum for establishing legal frameworks, delving into the jurisdictional complexities in building partnerships between public health and legal teams to shape policies and laws around public health data use and sharing.  This includes efforts to develop data standards and data sharing agreements, demonstrating the data request process, and building model legislation that would drive more collaborative data sharing between state and local public health departments. Through this work, public health would continue to move towards modernized public health data infrastructure and further reduce the barriers to exchange data.   

CFA Forum

In 2024, BCHC hosted the Center for Forecasting & Outbreak Analytics (CFA) Forums to learn and engage in discussions around modeling and forecasting resources. This included bringing in technical experts, peer learning, and an opportunity to provide feedback on the following CFA resources/products: 

In just one year of intensive focus on forecasting and modeling, we have seen a significant increase in knowledge (100%), with all members planning to utilize CFA products needed for preparing and responding to public health threats.

However, additional support is needed to continue the momentum for establishing these models within member jurisdictions. Local public health would benefit greatly from hands-on assistance for implementation and a continued space for shared learning to efficiently and effectively respond to community needs. 

BCHC will continue to bring together our nation’s data modernization leaders and identify opportunities to transform the future of data exchange. To do so requires sustained support and an insistence on collaborative efforts across all levels of government. Direct funding is needed to modernize our data infrastructure, as we address ongoing challenges such as vaccine preventable disease outbreaks, drug overdoses, gun violence, and food-borne illness. Modernizing data systems will allow resources to get where they are most needed, ensuring everyone has their best chance at health.   

If you are interested in learning more about our work, please reach out to Jenny Schitter, Director of Public Health Data, jschitter@bigcitieshealth.org.