National Notifiable Disease Surveillance CSTE/CDC collaboration Reporting mandated at state level Reportable diseases vary by state Health care providers, labs report to local HD (county) Counties report to State Voluntary reporting by states to CDC

City/County Health Department State Health Department TIMSSTD*MISHARS STD*MISTIMSNETSSEIP Systems NETSS STD*MIS (Optional at the Clinic) TIMS (Optional at the Clinic) PHLISEIP Systems* PHLIS HARS STD*MISTIMSNNDSSEIP SystemsPHLIS *EIP Systems (ABC, UD, Foodnet) CDC Data Sources Physicians Varied communications methods and security - specific to each system- including paper forms, diskettes, , direct modem lines, etc. Varied communications methods and security - specific to each system - including diskettes, , direct modem lines, etc. Chart Review MMWR Weekly TablesMMWR Annual SummariesProgram Specific Reports and Summaries Lab Reports Reporting by Paper Form, Telephone and Fax Current Situation Statistical Surveys for Chronic Diseases, Injuries and Other Public Health Problems

Need for more information Bioterrorism, emerging infections Health reform Increased accountability Changing health care environment Consumer demand for data Data sources outside health arena

Motivators of Change Changing policy Increasing efficiency Evolving technology Increasing use of electronic information systems Enhancing security/confidentiality

The Vision Complementary electronic information systems that: - automatically gather health data from a variety of sources on a real-time basis, - monitor the health of communities, - assist in the ongoing analyses of trends and detection emerging public health problems, and -provide information for setting public health policy. Long-term ^

City/County Health Department State Health Department HIV/AIDS STD Clinics TB Clinics HIV/AIDS STDs TB Notifiable Disease Reports EIP Systems Lab Surveillance CDC Data Sources Physicians Electronic data interchange (EDI) using HL7 or other standardized format Chart Review Lab Reports Secure Internet Electronic data interchange (EDI) using HL7 or other standardized format Shared Facilities and Services, e.g. common interface, software components, terminologies and data files Shared Facilities and Services, e.g. common interface, software components, terminologies, and data files Secure Server Vital Statistics Emergency Departments Medicaid, Medicare Encounters Hospital Discharge Data Secure electronic reporting Paper Forms, Telephone and FAX Proposed Integrated Surveillance Systems Solution

A common framework for surveillance information systems Common data architecture (model, definitions, coding) Automated electronic reporting of data, e.g. HL7 messages for notifiable diseases Secure Internet pipeline for reporting to CDC Consistent user interface Reusable software components, e.g. outbreak detection algorithms Shared analysis and dissemination methods

Some Requirements for Integrated Systems Patient registry matching Rapid development and deployment of data entry screens Internet data entry Pyramid reporting and synchronization (clinic to local to state to CDC) HL7 import and export

Related Projects Electronic Laboratory Reporting pilots Negotiations for SNOMED license Data Elements for Emergency Departments pilot project Bioterrorism cooperative agreements Standards Development Organizations activities State integration activities

Next steps for Integration Project pilot test specifications and standards use specifications and standards in new system development--CDC and states funding proposed in FY2000 to support information system infrastructure engage public health community in ongoing standards development activities-- HIPAA, CDC