Evaluating digital maturity in public health systems: a statewide cross-sectional analysis of digital public health capacity in Missouri

Digital transformation is critical to strengthening public health infrastructure, yet implementation across jurisdictions remains uneven. In the United States, state-level public health systems vary widely in their digital capabilities. Missouri's Department of Health and Senior Services (DHSS) launched a digital modernization strategy to address these gaps. The objective of this work was to assess the digital maturity of Missouri's public health system and examine how a validated digital maturity framework can inform strategic planning and investment. This was a cross-sectional, quantitative study using primary data collected from 59 public health teams across six DHSS divisions in 2024. The validated <i>Digital Health Indicator (DHI)</i> framework was applied via structured interviews to assess digital maturity across four dimensions: governance and workforce, interoperability, person-enabled health, and predictive analytics. Descriptive statistics and ANOVA were used to compare results across divisions, with forest plots used to visualize pairwise differences. The mean DHI score was 35.6/100, with substantial variation across divisions (range: 7-68). The Division of Community and Public Health achieved the highest scores (mean 50.8), while the State Public Health Laboratory scored lowest (mean 19.0). Interoperability and predictive analytics showed the greatest variability. Organizational readiness was consistently high, but constrained by limited infrastructure and uneven workforce digital training. A standardized digital maturity framework can reveal systemic strengths and gaps within public health systems, guiding targeted, specific, measurable, achievable, relevant, and time-bound (SMART) digital investments. Missouri's experience demonstrates how structured assessment tools can support scalable and replicable digital transformation strategies applicable across U.S. states and other jurisdictions seeking to modernize public health services.