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Specifically, public health authorities use vital records data to:

• Identify at-risk populations and rare causes of death;

• Monitor deaths in an important cohort under public health surveillance (e.g. HIV-infected cases);
• Plan programmatic activities;

• Implement programs and policies to address health disparities.

Timely, accurate death data reporting is necessary to promptly assess and respond to emerging public
health threats with high mortality rates such as natural disasters. Within the last 20 years, there has been
12
a shift from manual, paper-based vital statistics data collection methods to electronic means such as an
13
electronic death registration system (EDRS). EDRS enables automated death data processing—such as
electronic data entry and transmission to the NVSS—which facilitates data reporting and improves death
data quality by providing real-time scanning processes that highlight data entry errors such as missing or
inaccurate information.
14

Because EDRS promote timely, accurate death data collection and reporting, NCHS encourages all
jurisdictions to adopt an EDRS. However, for the many jurisdictions that implemented EDRS over 15–20
15
years ago, systems and software have not been maintained or upgraded, leaving them out of date and not
interoperable with other systems.

National Notifiable Diseases Surveillance System (NNDSS)

To effectively monitor and respond to public health threats, the nation’s public health surveillance
16
system relies upon timely disease reporting and notification systems. Disease reporting is the series of
events that begins with infection or exposure—whether it is an infected person or environmental hazard
including insect and tick vectors—and concludes with case reporting to the health department at the
territorial, tribal, state, or local level. With diseases that are deemed notifiable, voluntary case notification
to CDC occurs. In the United States, notifiable diseases are those that require regular, frequent, and
17
timely information about individual cases of communicable conditions, such as tuberculosis and E. coli,
18
and noncommunicable conditions such as lead poisoning.

Pursuant to jurisdictional laws and regulations, health care providers, hospitals, laboratories, and other
individuals are required to report cases of designated conditions to health departments within a certain
19
timeframe. Working in coordination with the CSTE, CDC recommends which conditions and data
elements are recommended to be sent to the federal level.
20

12 Howland RE, Li W, Madsen AM, et al. Evaluating the Use of an Electronic Death Registration System for Mortality Surveillance During and After Hurricane Sandy: New York City, 2012. Am J Public
Health. 2015;105(11):e55–e62. doi:10.2105/AJPH.2015.302784
13 Electronic Death Reporting System Online Reference Manual. cdc.gov. https://www.cdc.gov/nchs/data/dvs/edrs-online-reference-manual.pdf. Published December 2016.
14 Ibid.
15 Howland RE, Li W, Madsen AM, et al. Evaluating the Use of an Electronic Death Registration System for Mortality Surveillance During and After Hurricane Sandy: New York City, 2012. Am J Public
Health. 2015;105(11):e55–e62. doi:10.2105/AJPH.2015.302784
16 Swaan C, van den Broek A, Kretzschmar M, Richardus JH. Timeliness of notification systems for infectious diseases: A systematic literature review. PLoS One. 2018;13(6):e0198845. Published June
14, 2018. doi:10.1371/journal.pone.0198845
17 Ibid.
18 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.
19 Swaan C, van den Broek A, Kretzschmar M, Richardus JH. Timeliness of notification systems for infectious diseases: A systematic literature review. PLoS One. 2018;13(6):e0198845. Published June
14, 2018. doi:10.1371/journal.pone.0198845
20 National Notifiable Diseases Surveillance System (NNDSS). cdc.gov. https://wwwn.cdc.gov/nndss/. Updated March 13, 2019. Accessed May 1, 2019.

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