Local health departments (LHDs) and state health agencies (SHAs) require quantitative data to fulfill their obligation to ensure public health. However, data collection and sharing are not straightforward processes in the US public health system. Responsibilities are divided among many actors, jurisdictions overlap, events that can occur elsewhere, and not every public health agency possesses information systems capable of sharing data. Collectively, these characteristics define a system that likely has gaps in data sharing among public health entities.Objective:
A data-sharing gap is the inability to transmit, in near real time, data among public health agencies within a state for a specific public health activity. This article presents theoretically and empirically based typology of data-sharing gaps between LHDs and SHAs and describes the extent of data-sharing types for 6 activities.Design, Setting and Main Outcome:
Drawing on concepts from network theory, public health responsibilities, and technological capacity, we conceptualize a 9-category data-sharing typology that characterizes the flow of data between SHAs and LHDs. Using existing organizational surveys, we created a sample of LHD-SHA exchange dyads, which we use to describe the distribution of sharing and gaps for immunizations, vital records, reportable conditions, laboratory, well water, and electronic health records. State-level maps describe the prevalence of data-sharing gaps nationwide.Results:
For vital records, reportable conditions, and well-water assessments, gaps in data sharing were the norm. For the other 3 public health activities, a lower portion of the dyads experienced gaps, but gaps were still very common. Most troubling was the relatively infrequent occurrence of truly bidirectional information sharing.Conclusions:
The data-sharing typology provides a useful basis for the formulations of policies to improve public health information systems and to guide future research.