This original article appeared on the LF Public Health project’s blog.

The past three years have redefined the practice and management of public health on a global scale. What will we need in order to support innovation over the next three years?

In May 2022, ASTHO (Association of State and Territorial Health Officials) held a forward-looking panel at their TechXPO on public health innovation, with a specific focus on public-private partnerships. Jim St. Clair, the Executive Director of Linux Foundation Public Health, spoke alongside representatives from MITRE, Amazon Web Services, and the Washington State Department of Health.

Three concepts appeared and reappeared in the panel’s discussion: reimagining partnerships; sustainability and governance; and design for the future of public health. In this blog post, we dive into each of these critical concepts and what they mean for open-source communities.

Reimagining partnerships

The TechXPO panel opened with a discussion on partnerships for data modernization in public health, a trending topic at the TechXPO conference. Dr. Anderson (MITRE) noted that today’s public health projects demand “not just a ‘public-private’ partnership, but a ‘public-private-community-based partnership’.” As vaccine rollouts, digital applications, and environmental health interventions continue to be deployed at scale, the need for community involvement in public health will only increase.

However, community partnerships should not be viewed as just another “box to check” in public health. Rather, partnerships with communities are a transformative way to gain feedback while improving usability and effectiveness in public-health interventions. As an example, Dr. Anderson referenced the successful VCI (Vaccination Credential Initiative) project, mentioning “When states began to partner to provide data… and offered the chance for individuals to provide feedback… the more eyeballs on the data, the more accurate the data was.”

Cardea, an LFPH project that focuses on digital identity, has also benefited from public-private-community-based partnerships. Over the past two years, Cardea has run three community hackathons to test interoperability among other tools that use Cardea’s codebase. Trevor Butterworth, VP of Cardea’s parent company, Indicio, explained his thoughts on community involvement in open source: “The more people use an open source solution, the better the solution becomes through stress testing and innovation; the better it becomes, the more it will scale because more people will want to use it.” Cardea’s public and private-sector partnerships also include Indicio, SITA, and the Aruba Health Department, demonstrating the potential for diverse stakeholders to unite around public-health goals.

Community groups are also particularly well-positioned to drive innovation in public health: they are often attuned to pressing issues that might be otherwise missed by institutional stakeholders. One standout example is the Institute for Exceptional Care (IEC), a LFPH member organization focused on serving individuals with intellectual and developmental disabilities, “founded by health care professionals, many driven by personal experience with a disabled loved one.” IEC recently presented a webinar on surfacing intellectual and developmental disabilities in healthcare data: both the webinar and Q&A showcased the on-the-ground knowledge of this deeply involved, solution-oriented community.

Sustainability and governance

Sustainability is at the heart of every viable open source project, and must begin with a complete, consensus-driven strategy. As James Daniel (AWS) mentioned in the TechXPO panel, it is crucial to determine “exactly what a public health department wants to accomplish, [and] what their goals are” before a solution is put together. Defining these needs and goals is also essential for long-term sustainability and governance, as mentioned by Dr. Umair Shah (WADOH): “You don’t want a scenario where you start something and it stutters, gets interrupted and goes away. You could even make the argument that it’s better to not have started it in the first place.”

Questions of sustainability and project direction can often be answered by bringing private and public interests to the same table before the project starts. Together, these interests can determine how a potential open-source solution could be developed and used. As Jim St. Clair mentioned in the panel: “Ascertaining where there are shared interests and shared values is something that the private sector can help broker.” Even if a solution is ultimately not adopted, or a partnership never forms, a frank discussion of concerns and ideas among private- and public-sector stakeholders can help clarify the long-term capabilities and interests of all stakeholders involved.

Moreover, a transparent discussion of public health priorities, questions, and ideas among state governments, private enterprises, and nonprofits can help drive forward innovation and improvements even when there is no specific project at hand. To this end, LFPH hosts a public Slack channel as well as weekly Technical Advisory Council (TAC) meetings in which we host new project ideas and presentations. TAC discussions have included concepts for event-driven architecture for healthcare data, a public health data sharing mesh, and “digital twins” for informatics and research.

Design for the future of public health

Better partnerships, sustainability, and governance provide exciting prospects for what can be accomplished in open-source public health projects in the coming years. As Jim St. Clair (LFPH) mentioned in the TechXPO panel: “How do we then leverage these partnerships to ask ‘What else is there about disease investigative technology that we could consider? What other diseases, what other challenges have public health authorities always had?’” These challenges will not be tackled through closed source solutions—rather, the success of interoperable, open-source credentialing and exposure notifications systems during the pandemic has shown that open-source has the upper hand when creating scalable, successful, and international solutions.

Jim St. Clair is not only optimistic about tackling new challenges, but also about taking on established challenges that remain pressing: “Now that we’ve had a crisis that enabled these capabilities around contact tracing and notifications… [they] could be leveraged to expand into and improve upon all of these other traditional areas that are still burning concerns in public health.” For example, take one long-running challenge in United States healthcare: “Where do we begin… to help drive down the cost and improve performance and efficiency with Medicaid delivery? … What new strategies could we apply in population health that begin to address cost-effective care-delivery patient-centric models?”

Large-scale healthcare and public-health challenges such as mental health, communicable diseases, diabetes—and even reforming Medicaid—will only be accomplished by consistently bringing all stakeholders to the table, determining how to sustainably support projects, and providing transparent value to patients, populations and public sector agencies. LFPH has pursued a shared vision around leveraging open source to improve our communities, carrying forward the same resolve as the diverse groups that originally came together to create COVID-19 solutions. The open-source journey in public health is only beginning.