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The rocky road to complete reportable infectious disease system integration.

Posted By Sara Ramey, Wednesday, February 26, 2014
Updated: Tuesday, February 25, 2014
Untitled Document
Since the introduction of electronic disease surveillance systems, states and localities have worked to migrate disparate and siloed legacy surveillance systems into more integrated surveillance platforms. The goals for surveillance system integration are to utilize national standards, reduce redundancy, streamline reporting, understand disease and risk factor interactions, and increase data sharing. However, the costs, benefits and obstacles of achieving complete disease surveillance system integration are poorly understood.

CDC’s Program Collaboration and Services Integration (PCSI) program recommends integration and data harmonization of disease surveillance that currently exists both in CDC-supported legacy systems (i.e., eHARS, STD*MIS) and in state-based electronic disease surveillance systems (NEDSS) (1). While the 2010 CSTE assessment of states’ NEDSS capacity identified 34 (71%) states with some degree of integration, an increase from 23 states in 2007 (2), there are few states and localities to have fully integrated all legacy reportable infectious disease surveillance systems.
In 2013, the North Carolina completed customization of modules for reporting, case management, and entry of contact investigation data of HIV and syphilis cases. Legacy systems, eHARS and STD*MIS respectively, were converted into modules within a customized commercial-off-the-shelf NEDSS product which already included modules all reportable communicable diseases including vaccine preventable disease, sexually transmitted diseases, and tuberculosis (TB).
The conversion process began in 2010 following implementation of TB and general communicable disease modules in 2006 and 2008, respectively. The integration required conversion and harmonization of hundred of case report data fields and laboratory results fields from the legacy systems. The mapping of data fields from eHARS to North Carolina’s NEDSS additionally required a corresponding extract mapping back into eHARS in order to report data to CDC. New releases of eHARS will necessitate continual validation of these extract maps until CDC is able to receive HL7 message feeds into NNDSS. The two-year process involved more than approximately 6,500 person-hours. Following integration, de-duplication of more than 20,000 case records was required prior to system roll-out to local health departments.
A completely integrated NEDSS platform will provide the opportunity to monitor disease overlap geographically within population subgroups, and to evaluate the effectiveness of the delivery of integrated public health program services. While an integrated system provides new surveillance opportunities, the process was long, complex, and expensive; and many challenges still remain. State and local health departments considering complete reportable infectious disease surveillance system integration should weigh the informatics challenges and personnel expenditures with the opportunities to enhance program integration.
Megan Davies, MD
State Epidemiologist
North Carolina Division of Public Health


  1. CDC. Program Collaboration and Service Integration: Enhancing the Prevention and Control of HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis in the United States. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009.
  2. CDC. State Electronic Disease Surveillance Systems – United States, 2007 and 2010. MMWR. 2011; 60(41): 1421-1423.

Tags:  infectious disease  member spotlight  surveillance 

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Lei Chen says...
Posted Friday, March 7, 2014
Thanks, Megan, for your post. This is very informative and helpful for us to understand challenges and expected resources for planning such an integration.
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