Page 38 - Driving Public Health in the Fast Lane

• During outbreaks, CDC will often set up ad hoc disease-specific surveillance systems that have
different data requirements than the routine surveillance system. This results in duplicative,
manual data entry: one entered into NEDSS and one into the outbreak system. Due to different
requirements, the health department must reformat the data several times to satisfy the needs of
its own database and the multiple databases at CDC.

Manual data entry and paper-based data

exchange through phone calls, faxes,

and emails impede timely responses,

perpetuate outbreaks, and can potentially

cause loss of life.

• Disparate software systems between epidemiologists and public health laboratories prevent
electronic data exchange; therefore, public health staff must create and manually enter data into
spreadsheets.
• Epidemiologists must retrieve copies of laboratory reports in-person from the public health
laboratory multiple times per week because electronic systems are not available to exchange data.

• Vital records registrars, epidemiologists, and public health laboratorians must call health care
providers to request patient medical history, records, and other documents, which are then faxed
to the health department.

Manual processes like these leave room for error. Inaccurate data entry, reports that are delayed or
never submitted, reports faxed to the wrong entity, incomplete data reporting—these all compromise
data quality and impede timely data exchange. Because data exchange relies on paper records, phone
calls, spreadsheets, and faxes, public health threats are moving faster than the nation’s current public
health surveillance system. The consequences of inefficient and slow data sharing are significant:
delayed detection and response, lost time, lost opportunities, and lost lives.

2. Siloed Systems: The Need for an Enterprise-Wide Approach

Public health surveillance systems traditionally have been created to serve specific programmatic
needs. The evolution of these systems has arisen because funding to establish and maintain
surveillance systems is allocated to one disease agent, such as influenza. Within the federal
government, siloed funding streams have created more than one hundred disease-specific
surveillance systems at CDC. Focus group members shared that within their own health departments,
some diseases and conditions are set up for electronic data exchange while others are not, because
funding mechanisms are program-specific and hamper efforts to make systematic improvements.

Progress Made, but Silos Remain 38