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As of 2018, 80 percent of laboratory reports are received electronically by health departments, greatly
reducing the manual administrative burden of paper-based laboratory reporting. However, limitations
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still exist when exchanging reportable data between the laboratory and health care providers, and few
laboratories within CDC have implemented ELR. As a result, manual reporting methods such as phone
calls, emails, and faxes are still relied upon heavily.

Syndromic Surveillance

The 9/11 terrorist attacks and the subsequent anthrax attack using the United States Postal Service
demonstrated a strong need for non-traditional public health surveillance methods that provided early
detection of emerging public health threats. The process of identifying a potential case, submitting a
clinical sample to public health laboratories, conducting testing, and reporting a result can be long and
drawn out. In many instances, by the time a diagnosis is confirmed through conventional data sharing the
outbreak has likely spread. To stay ahead of public health threats, the advent of syndromic surveillance
created a faster, near real-time early warning system that provided data based on clinical symptoms prior
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to a definitive diagnosis.
By relying on clinical indicators, syndromic surveillance systems collect data from hospital emergency
departments and urgent care, or can be used with other data sources such as school or work absenteeism,
over-the-counter medicine sales, emergency medicine service runs, poison center calls, and spikes in
keywords used in social media or internet searches such as “flu” and “fever.” Although originally developed
to monitor bioterrorism events, it has become a tool to monitor outbreaks, drug overdoses, environmental
conditions, natural disasters, and other public health threats. This enables early situational awareness to
federal, state, territorial, local, and tribal public health agencies.

Many public health departments have adopted syndromic surveillance as a part of their broader public
health surveillance strategies because it serves a vital role in population health monitoring, as well as
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emergency preparedness and response efforts. While syndromic surveillance can enhance public health
surveillance, it comes with limitations and thus cannot supplant traditional methods. Despite these
limitations, syndromic surveillance adds valuable public health data and can be incredibly useful in an
overall response.

Electronic Vital Records Systems

The National Center for Health Statistics (NCHS) within CDC is responsible for overseeing and
coordinating the National Vital Statistics System (NVSS). NVSS collects detailed information from the
vital records jurisdictions—50 states, five territories, the District of Columbia, and New York City—that are
legally responsible for tracking the millions of births and deaths that occur each year. These data enable
public health authorities to track key indicators of population health status such as life expectancy, infant
and maternal mortality rates, pregnancy rates, and health disparities at the federal, state, territorial, local,
and tribal levels.
11

8 Office of Public Health Scientific Services. CDC Public Health Surveillance Strategy Report: 2014-2018. cdc.gov. https://www.cdc.gov/surveillance/pdfs/Surveillance-Series-Bookleth.pdf. Published
September, 2018.
9 Henning K. Overview of Syndromic Surveillance What is Syndromic Surveillance? MMWR. 2004; 53(Suppl):5-11. https://www.cdc.gov/mmwr/preview/mmwrhtml/su5301a3.htm. Published
September 24, 2004. Accessed May 1, 2019.
10 Ibid.
11 Ventura SJ. The U.S. National Vital Statistics System: Transitioning into the 21st century, 1990–2017. Vital and Health Statistics. 2018;1(62). https://www.cdc.gov/nchs/data/series/sr_01/
sr01_062.pdf. Published March 2018.

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