Fully Integrating Electronic Reportable Disease Surveillance, North Carolina, 2003 – 2012

BACKGROUND: In 2004, the North Carolina Division of Public Health (NC DPH) committed to fully integrating 13 CDC-supported but independently-operated, reportable infectious disease surveillance databases into a single electronic system.  The goal for surveillance systems integration was to support integrated communicable disease services delivery to clients at both the state and local levels. 

METHODS: In 2005, NC DPH contracted with an information technology vendor (Consilience Software Inc.) to begin customizing an internet-based, commercial-off-the-shelf product (Maven) for reporting and managing tuberculosis (TB), vaccine-preventable, and general communicable disease cases.  The North Carolina Electronic Disease Surveillance System (NC EDSS) was implemented for TB in late 2006, then began consuming electronic laboratory reports (ELR) in 2007 and was rolled-out in 2008 to all 85 local health departments to enter physician-reported cases, manage case investigations, comply with state reporting rules, and report cases to CDC for all reportable conditions other than HIV and syphilis.  In 2012, the NC EDSS development team completed customization of modules for reporting, case management, and entry of contact investigation data of human immunodeficiency virus (HIV) infections and syphilis cases. ELR is supported for all reportable infectious conditions. NC EDSS is designed to be person-centric and includes a master patient index (MPI) to facilitate identification of co-morbid conditions.  All legacy data from contributing systems was converted into the PHIN-compliant NC EDSS format and loaded into the system.

RESULTS: In December 2012, the HIV and syphilis modules went into live production following manual de-duplication of more than 20,000 records.  NC EDSS now possess general communicable disease data (since1991), HIV/AIDS reports (since 1984), syphilis reports (since 1999) and partner services and case management data (since 1991) in one interoperable platform, containing over 850,000 records and over 650,000 unique individuals. 

CONCLUSIONS: NCEDSS provides NC DPH the capability to monitor comorbidities and link co-reports for all reportable infectious diseases.  We are unaware of other states that have successfully integrated all legacy surveillance, case management, and partner services databases.  Previously disparate programs are able to manage data in real-time across programs and perform ongoing assessment of comorbidities and target interventions to their highest-risk populations.: