In 1869, Massachusetts made history—though almost nobody noticed at the time.
The legislature created the Massachusetts State Board of Health, the first of its kind in the United States. Its founding mission was modest by modern standards: collect vital statistics, investigate disease outbreaks and advise local governments on sanitation matters. There were no laboratories or real-time data of any kind. Notebooks and telegrams were the tools of choice.
The board was a product of its time. As the United States emerged from years of civil war, American cities were expanding. With rapid industrialization and urbanization came overcrowding, poor sanitation, contaminated water supplies and outbreaks of diseases like cholera and typhoid fever. With no state-level public agency dedicated to investigating health conditions, collecting data, promoting sanitation and helping to prevent disease, Massachusetts knew it had to act.
The U.S. Civil War taught health officials the importance of sanitation, hygiene and accurate health data. Four years after the war ended, Massachusettes created the country's first state-level board of health.
As cities like New York began growing rapidly in the 1860s, it became clear that protecting public health required organized action at the state level.
Today, there are more than 2,800 state, local and tribal health departments across the United States.
A New Age
Now, 150 years later, data scientist Roger Gonzales, PhD, MPH, of the CDC Foundation helps the Michigan Department of Health and Human Services—established four years after the one in Massachusetts—do something those 1869 founders could not have imagined: track the spread of a drug-resistant fungus through hospital units using electronic health records (EHRs), machine learning algorithms and real-time data feeds.
“We’re moving from reactive to proactive,” said Dr. Gonzales. “Real-time data means earlier detection, better decision-making and faster interventions.”
The shift from notebooks to dashboards and from fax machines to automated data pipelines is what the CDC Foundation’s Workforce Acceleration Initiative (WAI) was designed to accelerate. Launched in 2024 to help amplify Centers for Disease Control and Prevention’s (CDC) Public Health Data Strategy, WAI embeds tech professionals from the private sector into state and local health departments. As of the end of 2025, 49 participating agencies had retained 125 tech and data professionals. Nine out of 10 came from fields outside of public health.
“Coming out of the pandemic, we accelerated our knowledge base in placing highly skilled individuals within public health agencies around the country,” said Michelle Panneton, director of programs at the CDC Foundation. "We were able to lean into some of those learnings to be adaptive and move rapidly to meet these needs."
The need is real. Delays in collecting, sharing and analyzing data during the fast-moving COVID-19 pandemic exposed what public health professionals had long understood: the country’s data infrastructure was dangerously fragmented. States were faxing case reports. Systems couldn’t talk to one another. Critical information that needed to move in hours took days.
Dr. Gonzales traces the arc of that problem through his own career. Before being hired through WAI, he worked at a health information exchange—an intermediary between hospitals and health agencies attempting to make disparate systems communicate. What he found was a persistent, fundamental challenge: data silos.
“Each partner organization operates within a distinct workflow ecosystem,” Dr. Gonzales said. “You have to assess what platforms and systems they’re working with before any meaningful integration can happen.”
Michigan has 45 local health departments, each with its own infrastructure. Harmonizing data is less like conducting an orchestra than tuning 45 instruments built in different countries.
Real-time data means earlier detection, better decision-making and faster interventions
Dr. Gonzales’ work centers on electronic health record data—specifically, finding ways to use hospital admissions, discharges and transfer messages to investigate how diseases affect populations. His focus has been on chronic disease data modernization and Candida auris, a multi-drug-resistant fungus that had been spreading in Michigan and proving difficult to monitor.
“The goal isn’t just to answer one question about one disease,” Dr. Gonzales said. “It’s to build systems that can handle whatever comes next—that means integrating electronic health records, standardizing how data flows between hospitals and health departments, and making sure the right information gets to the right people at the right time.”
The work, Dr. Gonzales emphasizes, requires a team effort. In total, Michigan has four WAI placements. “This is what modern public health can look like when the right people are working together,” Dr. Gonzales said. “We’re building something meant to last—infrastructure that will make it easier for the next team, and the team after that, to do this work better.”
Arsalaan Khan, MD, WAI project implementation manager for the Illinois Department of Health. Dr. Khan is working with colleagues on electronic case reporting for infectious diseases.
Michelle Panneton, director of programs at the CDC Foundation.
Data scientist Roger Gonzales, PhD, MPH, of the CDC Foundation helps the Michigan Department of Health and Human Services track the spread of a drug-resistant fungus.
Adaptable Systems
More than 600 miles south in Chicago, Arsalaan Khan, MD, is solving a related problem—not the tracking of disease, but the reporting of it. As a WAI project implementation manager for the Illinois Department of Health, Dr. Khan is working with colleagues to replace the faxing of health data.
For decades, the standard process for reporting an infectious disease was slow. A clinician identified a patient with tuberculosis, then filled out a paper form and faxed it to the state health department. The state received it the next day, then forwarded it to the appropriate agency. By the time anyone could act, days had passed.
Electronic case reporting—known as eCR—replaces that chain with something closer to real time. When a clinician enters an infectious disease diagnosis into a hospital’s electronic health record system, the state health department and CDC are automatically and simultaneously alerted.
“The epidemiologists start working on it right away,” Dr. Khan said. “We can do contact tracing. We can deploy resources.”
Illinois, like many states, presents challenges based on its two very different public health environments: the dense, heavily resourced Chicago metropolitan area and a vast rural downstate with minimally staffed health departments.
“A rural health department might have two or three people wearing numerous hats,” Dr. Khan said.
His response has been to design adaptable systems rather than uniform ones—a tier-based structure that gives each local health department a seat at the table and a voice in how solutions are shaped. Illinois is currently working with five local health departments, from Chicago’s massive infrastructure down to a department with fewer than five employees.
“When we’re creating these solutions, the smaller departments will say, ‘We don’t have this license, we can’t use this,’” Dr. Khan said. “Illinois has done well by providing them a voice regardless of their resources.”
Creating an entire eCR system for a state can truly save lives. Epidemiologists can now instantly receive diagnostic data, versus three or four days later. “Think about how many people could have been infected in that time,” Dr. Khan said.
It’s not just coming in with fancy technology then leaving. That’s not sustainable
Both Drs. Gonzales and Khan are quick to point out something that often gets lost in data modernization discussions: the work is less about technology than about trust, relationships and patience. Infrastructure projects don’t show results overnight. Sustainability—building systems the health department can maintain after the WAI placement ends—is as important as the tools themselves.
“It’s not just coming in with fancy technology then leaving,” Dr. Khan said. “That’s not sustainable.”
WAI makes knowledge-sharing across state lines possible. The Massachusetts Board of Health of 1869 proved a durable idea: that states have a responsibility to organize themselves around the health of their populations. While tools were primitive, the intention was not. What Drs. Gonzales and Khan are building now, one data pipeline and one workflow at a time, is the infrastructure the original idea has always needed.
“I can only imagine what public health experts will unlock once this infrastructure is fully in place and we are no longer just responding to public health threats, but predicting and preventing them,” Dr. Gonzales said.
Check back here for the next story in our 250th anniversary series exploring public health milestones and their legacy today.
