Public Health Informatics Platforms

Abstract

Public health informatics platforms -- the integrated digital infrastructure that enables disease surveillance, outbreak response, population health monitoring, and health policy evaluation -- vary enormously in their technical architecture, interoperability, and operational effectiveness across European health systems. The COVID-19 pandemic exposed critical weaknesses in many national public health information architectures, including siloed data sources, slow reporting pipelines, absent real-time analytics, and limited capacity to share data across institutional and national boundaries. Simultaneously, a cohort of high-performing countries demonstrated that integrated informatics platforms enabled faster outbreak characterisation, more targeted intervention deployment, and more robust policy evaluation than fragmented systems. We evaluated five public health informatics platform architectures across 32 European countries covering 580 million population-years of health surveillance data from 2015 to 2023. Architectures ranged from siloed national reporting systems through federated AI-integrated platforms with cross-national real-time data sharing. Performance was benchmarked using our Public Health Informatics Platform Score (PHIPS), integrating outbreak detection speed, policy evaluation capability, data interoperability, equity in data capture, and pandemic response effectiveness. The AI-integrated federated platform achieved the highest PHIPS (0.924), detecting outbreak signals 9.4 days earlier than siloed reporting systems and enabling cross-national policy evaluation that reduced COVID-19 mortality by an estimated 14.2% relative to counterfactual non-integrated scenarios. Data interoperability -- the capacity to link individual-level records across administrative, clinical, and registry sources -- was the single infrastructure feature most strongly associated with platform performance across all five architectures.