The federal government has taken one big step in that regard. In March, the U.S. Department of Health and Human Services along with the departments of Defense and Veterans Affairs jointly released the first set of uniform health information standards for exchanging clinical data electronically across the federal government. When developing new systems, all federal agencies are now obligated, among other things, to use the Health Level 7 messaging format—a set of drug-ordering guidelines already adopted under HIPAA—and a group of codes for laboratory results.

Ultimately, though, public health is a very local activity. It’s you, your doctor, your exam room, your lab test results. When it comes to reaching the state and local health departments that interact with all the players, the federal government has a lot less control than one might expect. "Typically, if there’s an outbreak of a disease at the local or state level, they will handle it locally or invite the CDC in on an as-needed basis," the CDC’s Seligman says. "We offer our assistance, but ultimately it’s their call."

The one place where the federal government does have power to persuade is with its pocketbook. And that’s where the CDC’s National Electronic Disease Surveillance System (NEDSS) comes in. This system lays out a sort of meta-standard for both health-care information and IT standards. All state health-department systems must be NEDSS-compatible—at least they do if they want a piece of the $918 million in bioterrorism grants that the CDC is handing out this year.

This pocketbook persuasion could pave the way for electronic medical records in the health-care industry. "These standards that make national disease surveillance work are the same standards that we’ll need if we’re going to move forward to a day when you can ask a doctor to send your medical records electronically to a new doctor," Gartner’s Klein says. But the work also highlights just how difficult the journey will be.

Pennsylvania is one of the few states that have already adopted the system. There, the state Department of Health built a NEDSS-compliant application that allows doctors to go to a secure website to report a disease. As soon as a doctor hits "save," the information is available to public health investigators.

Development was no small task, says Mary Benner, CIO and IT director for the department. The state had to consolidate some 6,000 data fields from 100 forms to 600 actual data elements in the database, and also work out problems with providers on antiquated operating systems trying to use the digital certificates that enable secure, encrypted communications.