Progress in improving state and local disease surveillance—United States, 2000-2005

Morbidity and Mortality Weekly Report, August 26, 2005

In September 2000, states began receiving federal funding to plan and implement integrated electronic systems for disease surveillance. CDC and state and local health departments had recognized the importance of such systems and of uniform standards to improve the usefulness of public health surveillance and the timeliness of response to outbreaks of disease. Previously, state health departments received most case-report forms by mail and then entered the data into computer systems, sometimes weeks after the cases of notifiable disease had occurred, including cases that warranted immediate public health investigation or intervention. In addition, depending on the disease, only 10%-85% of cases were reported, and more than 100 different systems were used to transmit these reports from the states to CDC (CDC, unpublished data, 2005). This report summarizes progress since the initial funding in 2000 in improving state and local disease surveillance through secure, Internet-based data entry and automated electronic laboratory results (ELR) reporting. Both are components of the National Electronic Disease Surveillance System (NEDSS), * the surveillance and monitoring component of the broader Public Health Information Network (PHIN) initiative. ([dagger]) Local, state, and national public health officials should continue to improve the timeliness and completeness of disease surveillance.

To ensure that information can be collected, exchanged, and interpreted at all levels (i.e., local, state, and national), CDC has worked with state and local health departments and clinical partners to identify data and information system standards to incorporate into NEDSS. By facilitating the identification, adoption, and implementation of standards for data content, format, transport, and security, the NEDSS project seeks to strengthen the ability of public health agencies to exchange pertinent information needed for surveillance and intervention between clinicians and public health agencies and among public health partners. State health departments have pursued these goals by developing, modifying, or commissioning their own NEDSS-compatible systems or by implementing and configuring the NEDSS Base System ([section]) to meet their specific needs.

As of April 2005, a total of 27 state health departments and two municipal health departments (New York City and Los Angeles) were entering at least some notifiable disease data by using a secure, Internet-based system (Figure 1). Twenty-three other states were actively planning, developing, and implementing Internet-based systems. Although Internet-based data entry is frequently performed by workers in local and state health departments, in at least 13 states, data entry is also performed by private health-care providers, infection-control practitioners, and/or clinical laboratory workers, expediting availability of the data to health departments.

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In addition to secure, Internet-based reporting, NEDSS supports ELR. When a test result indicates a notifiable condition, clinical diagnostic and public health laboratories with ELR transmit data from their computer systems directly to state and local health department systems. As of April 2005, a total of 26 state health departments (excluding those receiving only blood lead level results) received laboratory test results via ELR (Figure 1), and the remaining 24 states were in various stages of preparing for ELR.

The experiences of three state health departments illustrate capabilities provided through NEDSS and PHIN that have improved the practice of public health.

New Jersey

In late 2001, the New Jersey Department of Health and Senior Services (NJDHSS) implemented the secure, Internet-based, Communicable Disease Reporting System (CDRS). Since implementation of CDRS, the number of reported cases of notifiable diseases doubled from 14,608 in 2002 to 29,967 in 2004, and the percentage of cases entered by NJDHSS staff decreased from 67% in 2002 (and from 100% in 2001) to approximately 16% in 2004 (Figure 2). In addition, the percentage of cases entered by local health departments, hospitals, and Local Information Network and Surveillance Systems (i.e., regional public health networks) increased from approximately 11% in 2002 (and from zero in 2001) to 50% in 2004 (Figure 2), including 30% entered by health-care providers at hospitals or medical centers. During 2004, approximately 34% of the cases were reported via ELR by Laboratory Corporation of America (Burlington, North Carolina).

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Before CDRS, cases of notifiable diseases might have required several months for entry of data in the NJDHSS system because of delays in reporting, postal service, and data entry. However, timeliness has improved substantially. In 2003, NJDHSS determined that cases were entered into CDRS an average of 28 days after illness onset. In 2004, that average had been reduced to 3-4 days. In addition, cases can now be updated in minutes and are available statewide to authorized persons in seconds.