Frequently Asked Questions

Some of the more frequently asked questions (FAQ) in EPHT involve the need for and use of the network. The objective of this article is to identify those questions and answer them.

How will Environmental Public Health Tracking make it easier to answer questions about how the environment can impact community health?
We will be able to better assess human exposure to environmental hazards, thereby improving the accuracy and speed of public health action.

Why does it matter that Environmental Public Health Tracking brings together, for the first time, environmental data and public health data?
The CDC is working with other government agencies and partners to utilize existing information systems for environmental public health tracking and to identify information gaps. We will gather data about human exposure to environmental factors – including air pollution, pesticides, waste sites, weather extremes, water pollution, and other factors. We will also gather information on adverse health effects from disease registries and other sources. By working together, we will be better equipped to identify problems and effective solutions. This will result in reducing the burden of environmentally related diseases on the American population.

Will the EPHT Network be a national data system to track exposures and health effects that may be related to environmental hazards?
The National EPHT Program is a CDC-led initiative. The EPHT Network will be available at the state and national level.

Will the EPHT Network show where diseases are?
Tracking allows for identification of unusual patterns or disease. Practicing physicians can apply the knowledge gained from the network in treatment/patient care and public health researchers need this information to better study how environment impacts health status.

Why is it important that the EPHT Network be able to identify potential environmental hazards to reduce likely exposures?
Identification of environmental hazards allows for better exposure assessment. The EPHT Program/Network will reduce the time and resources needed to respond to public concerns. Practicing physicians can be made aware of potential environmental risks within the community. The EPA and other regulators need to understand which environmental problems can and/or could affect health.

Will the EPHT Program improve early detection of diseases?
Knowing where diseases are more prevalent may allow for more timely diagnosis. The CDC estimates that some diseases thought to be affected by the environment, e.g., asthma, have risen by 70% since the 1980s. Early detection allows effective and targeted public health actions leading to healthier communities.

Will the EPHT Network prevent disease?
Better information is needed to successfully prevent and control environmentally related health problems in our communities. In 2001, the PEW Environmental commission brought this issue to national attention in its report for Congress that called for action to fill what it called, “America’s Environmental Health Gap.” 

There are many suspected associations between environmental exposures and health effects that need further research. Although better detection methods is a major reason why the rates of some health problems have increased, researchers don’t think that this reason alone can explain the increase. 

Better information will trigger more immediate action to prevent and assist in controlling environmentally related health problems. The public health successes of the 20th century have increased life spans and eliminated infectious disease as the leading cause of death. Historically, disease tracking has resulted in public health actions such as improved sanitation and hygiene, chlorinated drinking water, and improvements to food safety. Tracking conditions can provide more and better scientific data to help doctors, researchers, and public health officials improve treatment plans and prevent the disease.

How will the EPHT Program improve my hometown?
The EPHT Program/Network will help to protect communities from adverse environmental health effects by providing more accurate information for use in health studies and improve efforts to identify causes of, and prevent, future health problems.  Use of environmental public health tracking will aid in identifying clusters of non-infectious health effects. In addition tracking conditions can provide more and better scientific data to help doctors, researchers, and public health officials improve treatment plans and prevent disease.

How will the government use the EPHT Network?
The EPHTN will be used by federal, state, and local regulators/officials to help reduce the burden of adverse environmental related health effects in communities.  Officials will use information obtained from the EPHTN to plan, apply, and evaluate public health actions to prevent and control environmentally related diseases. The network will be available at the state and national level. In addition, the CDC is working with other government agencies and partners to utilize existing information systems to identify information gaps.

Will the EPHT Network save the taxpayers money?
The EPHTN will enable health care dollars to be directed toward prevention instead of treatment. Health care dollars will go toward areas that need the most help – those areas with higher numbers of health problems linked to environmental hazards. The network will assist in measuring the effects of regulatory and prevention strategies.

Will scientists use the EPHT Network to communicate environmental and health information?
The EPHT Network can be used to generate and test hypotheses. The studies generated can drive public health actions, policies, and practices.

Will the EPHT Program/Network provide the public with credible information about environment and disease?
The EPHT Program/Network will provide the community and physicians with credible information that can help in identifying unusual events. Ongoing systematic data collection allows communities to better understand health status and actions they can take to improve health.

Will patient privacy be protected?
Federal law will continue to protect privacy (HIPAA). Public health agencies will continue to be protectors of data. All requests for health information must be reviewed and approved by governing bodies. Agreements between agencies protect information and how it is used. All users must sign confidentiality agreements to ensure privacy. Information will be stored in a secure environment. Access to the data will be restricted. Sharing of information is necessary, but strictly controlled. All agencies and individuals are held accountable by law. The consequences are severe and penalties include prosecution and fines. Only authorized public health researchers will have access.

Why isn’t all the data the same on both the Missouri and National EPHT Network Portals?
There are many scientifically valid reasons that the data presented on the Missouri and National EPHT Network Portals may not be identical, including:
• Not every state or government health agency collects data on every condition and/or disease. Even when data is collected for the same condition and/or disease, different data elements may be required.
• Condition and/or disease definitions can vary between jurisdictions.
• Data element definitions can vary between jurisdictions.
• Conditions and/or diseases may have drastic seasonal variations across geographic areas.
• Different datasets and/or sources may have been used.
• Suppression of small cell values or complimentary suppression may be used.
• Data may be aggregated by different ages, races, or other demographic.

Specific questions regarding data differences should be addressed to the Missouri EPHT Program Manager via e-mail at EPHTN@health.mo.gov or by calling 573/751-6102.

Why isn’t record level data for health conditions available on Missouri’s EPHT Network Portal?
Patient level records are not public information, and may be shared only with other public health authorities and coinvestigators of a health study if they abide by the same confidentiality restrictions required by DHSS under section 192.067, RSMo.

In addition, federal law protects patient privacy. All requests for health information must be reviewed and approved by governing bodies. Agreements between agencies protect information and how it is used. All users must sign confidentiality agreements to ensure privacy and information must be stored in a secure environment. Access to this level of data will always be restricted and strictly controlled with all agencies and individuals held accountable by law.

The data I want isn’t available on the Missouri EPHT Network Portal. How can I request it?
To submit a special request for specific data for research, a principal investigator must submit a completed Application for Missouri Vital Records or Patient Abstract System Data for Research Purposes. The application requires detailed information about the study protocol, justification for all data elements requested (each data element must be related to the hypotheses), and measures to ensure the confidentiality and security of the data. All information must be clear, consistent and specific. General descriptions do not allow accurate assessment of the value of the study or the need for the data items. Release of data from vital records and/or the Patient Abstract System by DHSS is granted to an agency/institution for the sole purpose of the research project described in the protocol application. The applicant will be required to complete and sign an Agreement for Oversight. All persons that will have access to the data must be listed in the application and will be required to sign the Confidentiality Pledge prior to being granted access to the study data.

It is the principal investigator's responsibility to design a valid study that would make a contribution to public health, and it is not the department's role to help refine a faulty study or a poorly described study until it meets generally acceptable scientific standards. Protocols of this nature will be rejected and further processing of such applications will be discontinued. An application will be immediately rejected if it is determined that:

  1. it does not clearly describe a well-designed research or epidemiologic study,
  2. the data will be used for commercial or marketing purposes, or private gain,
  3. being a co-investigator would overburden the department, or
  4. there is reason to believe that confidentiality of the data would be jeopardized by its release.

Researchers interested in obtaining DHSS data should first familiarize themselves with the data sets prior to designing their studies (see Data and Surveillance Systems available at https://health.mo.gov/data/index.php). Only those data elements related to the hypotheses and necessary for the study should be requested. The principal investigator will be notified of any discrepancy between the list of data elements requested in the research protocol and those determined by DHSS staff to be needed. Vital Records and Patient Abstract Data custodian contact information may be found at https://health.mo.gov/data/pdf/contactus.pdf.

Additional information on Missouri DHSS data release policies, procedures, and guidelines are available at https://www.health.mo.gov/data/policies.php.

Suggestions for adding additional data sets, sources, and/or content areas to Missouri’s EPHT Network Portal should be addressed to the Missouri EPHT Program Manager via e-mail at EPHTN@health.mo.gov or by calling 573/751-6102.

Can I share data that I’ve obtained from Missouri’s EPHT Network Portal?
You can share data obtained from Missouri’s public EPHT Network Portal; however, sharing of data obtained by special request or from Missouri’s Secure EPHT Network Portal is forbidden.

Releasing, sharing, or publishing DHSS-provided data or subsets of such data to any person or entity not directly identified in the study personnel section of the application or annual review form is not allowed.

Analytic tables, graphs, charts, or maps produced from DHSS-provided data for analytic purposes are allowable and not considered re-release.

What criteria are used to determine if a research study will be approved by DHSS?
Studies and/or research projects must meet the following specific standards and criteria:
• be scientifically valid and statistically sound;
• contribute to public health practice;
• not use Missouri Department of Health and Senior Services’ resources unreasonably and unnecessarily;
• be conducted ethically and with integrity;
• be in compliance with state and federal statutes and regulations, including confidentiality provisions;
• be reviewed by the Missouri Department of Health and Senior Services’ Institutional Review Board when required; and
• be consistent with Missouri Department of Health and Senior Services’ policy.

Is there a cost for accessing the data on the Missouri EPHT Network Portal?
There is no cost for accessing data on Missouri’s EPHT Network Portal; however, special requests for data may have a cost associated. In an effort to recover the service cost incurred for staff time and other expenses involved in data delivery, DHSS may charge fees for data and services based on the fee schedule (https://health.mo.gov/data/pdf/datafeepolicy.pdf). Fees are assessed for preparation of data based on programming time and materials. Payment is required before data files can be released.

Questions regarding Missouri’s EPHT Network Portal should be addressed to the Missouri EPHT Program Manager via e-mail at EPHTN@health.mo.gov or by

The National Environmental Public Health Tracking Program

Environmental Public Health Tracking Program

Missouri Environmental Public Health Tracking (EPHT) is a program within the Missouri Department of Health and Senior Services and funded by the Centers for Disease Control and Prevention. EPHT is part of a larger initiative to establish Environmental Public Health Tracking systems at the national and state levels.

Environmental Public Health Tracking