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News Analysis

Seven years and counting: National disease-tracking system still unfinished

A dozen states have yet to install technology needed to enable public health officials to monitor disease outbreaks via the Web

By Todd R. Weiss
July 14, 2008 12:00 PM ET

Computerworld - You might think that in the event of a major epidemic across the U.S., public health officials at the federal, state and local levels could track the outbreak electronically, using real-time data to try to control the spread of the disease.

But you'd be wrong.

An effort to develop those capabilities has been under way since 2001 through the U.S. Centers for Disease Control and Prevention. The CDC is pushing the adoption of a Web-based system designed to give it and other health agencies nationwide rapid access to information about outbreaks of infectious diseases.

Local and state health officials who are using the system can submit case reports to the CDC more quickly than they could before, and they are eventually supposed to be able to view data from other jurisdictions online.

Seven years after the CDC launched the initiative, though, the National Electronic Disease Surveillance System has yet to be completed. At this point, only 38 of the 50 states, plus the District of Columbia, are fully compliant with the technical requirements of NEDSS.

As a result, the data being input into the fledgling system is far from complete. And for now, information is flowing only in one direction — from local and state health agencies to the CDC. Until NEDSS is finished, state and local health officials can't go into the system and see what's happening across the nation, limiting their ability to monitor the spread of diseases.

The slow progress on NEDSS is forcing health agencies to continue relying on an existing system in which disease reports are manually entered into state-level databases and then transmitted to the CDC on a weekly basis.

For many health officials, the continuing inability to track outbreaks in real time is a source of both frustration and public-safety concerns.

"As a nation, we should be astounded that this capacity doesn't exist," said Dr. Scott McNabb, an epidemiologist who heads the NEDSS program in his job as director of the CDC's Division of Integrated Surveillance Systems and Services. "It should be a call for action."

McNabb described the capabilities of NEDSS as "absolutely mission-critical" for health officials. "With disease outbreaks, if local and state health departments are able to identify them quicker, then we are able to prevent future cases," he said. "But if we don't identify cases in a timely way, then people are at risk."

NEDSS Compliance Status, by Number of States

Compliance Criteria Nov. '04 Nov. '05 Nov. '06 Nov. '07
No. 1: Integrated data repository 17 23 36 44
No. 2: Electronic lab-result messaging 15 19 35 41
No. 3: Web-based software 21 28 37 44
States meeting Criteria 1, 2
and 3
15 19 30 38
Source: National Center for Public Health Informatics, Centers for Disease Control and Prevention


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