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

Morbidity and Mortality Weekly Report, August 26, 2005

Surveillance of communicable diseases focuses on ELR because a large proportion of cases can be identified front laboratory test results; diagnostic laboratories are also key surveillance partners for chronic and environmentally related disease surveillance (e.g., for blood lead level testing). ELR facilitated by NEDSS provides faster and more complete reporting of laboratory test results. Use of ELR has increased the number of cases reported to health departments by two- to threefold and has improved the timeliness of reporting by at least 3.8 days (1). ELR infrastructure also can be used to integrate public health laboratory and epidemiologic investigations. Ongoing efforts to ensure availability, of PHIN-compliant laboratory information systems will equip state and local public health laboratories for standards-based exchange of information and further strengthen public health surveillance and response.

Although many states are using the Internet for ELR, challenges remain to achieving national proficiency at standards-based, secure information exchange. In its "business case" for a nationwide health information network, the Center for Information Technology Leadership (CITL) (Partners HealthCare System, Boston, Massachusetts) has defined a four-level taxonomy for health information exchange (2). The highest level, Level 4 (machine integrable information exchange), requires adherence to the structured messages and standardized data content provided by NEDSS and PHIN. However, multiple states still use different electronic formats and nonstandard content for ELR, corresponding to CITL Level 3 (machine organizable data systems). According to the CITL model, although implementation of Level 3 systems can enhance information exchange, cost savings occur only with implementation of Level 4 systems (2).

This first phase of ELR is providing state health departments with results from large multijurisdictional laboratories and front certain state public health laboratories. The next phase will require broadening of reporting from the large multijurisdictional laboratories and enabling exchange of results with other laboratories, including large hospital and local laboratories. However, many of these facilities use proprietary information systems and local (i.e., nonstandard) coding systems that would require multiple custom interfaces to enable automated exchange of results. CDC is working with national partners to identify possible solutions.

Using standards and systems to enhance the exchange of information between the clinical sector and public health is a principal goal of NEDSS and PHIN. The ELR enhancements have required detailed specifications for the format, data elements, and standard codes for ELR messages by using the Health Level Seven (version 2.3) ([dagger][dagger]) standard message format and standard, controlled vocabularies for test names (LOINC[R] ([section][section])) and test results (SNOMED[R] ([paragraph][paragraph])). In addition, PHIN specifies the standards for secure transmission of these messages over the Internet; to meet these standards, CDC has provided the PHIN Messaging System *** for use by public and private partners. Successful ELR reporting provides experience with secure, standards-based, interoperable data exchange, relevant for public health agencies and also for their partners in clinical medicine.