Page 28 - Driving Public Health in the Fast Lane

Measles is a nationally notifiable disease, meaning state, local, tribal, and territorial public health
departments voluntarily submit de-identified, public health patient data to CDC via NNDSS. A public
health surveillance system that monitors 120 diseases nationwide, NNDSS allows CDC to use public
health data to determine disease trends, monitor outbreaks, and evaluate prevention and control efforts
to protect Americans from serious public health threats. 16

Follow the Data

During large nationwide outbreaks, including the recent rise of measles spurred by vaccine refusal,
improvement efforts through NMI have helped to expedite public health control and prevention efforts.
However, these improvements are limited to data exchange between health departments and CDC, and
many barriers still remain at the territorial, tribal,
state, and local levels—ultimately slowing down
In a non-outbreak scenario, the public responses.

health laboratory prints and manually As part of the epidemiologic investigation by
faxes anywhere between 100-200 the health departments, rapid, immediate case
infectious disease test reports to identification and contact tracing are critical steps to

health care providers daily. This mitigate a measles outbreak. Currently, this is a labor
intensive and time-consuming process where 24/7 call
estimate increases exponentially centers are established to broker information about
during an outbreak. potential measles cases between health care providers
and the public health department. If a measles case
is suspected, it is necessary for epidemiologists to
collect clinical care characteristics, risk exposures, and demographics to initiate follow up. While this
information is collected in an EHR by the health care provider at the point of care, it is not automatically
or electronically exchanged with public health professionals. If a phone call or fax is delayed or neglected
to be sent to the health department, health and epidemiologic data remain incomplete, hindering a
comprehensive response to the outbreak. As a result, contagious patients or their exposed contacts may
not be identified in a timely manner, allowing them to perpetuate the outbreak by spreading the disease to
other vulnerable people.

Similar health data access challenges exist for public health laboratories. Information such as vaccine
status and symptom onset date help provide an accurate laboratory interpretation to health care
providers and epidemiologists. While the health department epidemiologists may have gathered this
information through phone calls, the inability of the laboratory to electronically access these data
from either the health department or EHR leaves information inaccessible for a time. The public health
laboratory often needs to call the health care provider for the same clinical information previously
requested by the health department epidemiologist, or receive emailed or faxed spreadsheets from
epidemiologists relaying this information. In a measles outbreak, the magnitude of the public health
investigation results in massive amounts of information shared through manual data entry, and often
requires removing critical public health employees from response duties to physically transport results
and data between health care providers, the laboratory, and epidemiologists.

Due to the fast-paced nature of a measles outbreak and the need for rapid test results, the large volume
of testing can overwhelm the capacity of the public health laboratory to provide diagnostic information

16 National Notifiable Diseases Surveillance System (NNDSS). cdc.gov. https://wwwn.cdc.gov/nndss/. Updated March 13, 2019. Accessed April 29, 2019.

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