BACKGROUND: Maricopa County Department of Public Health (MCDPH) investigates over 27,000 communicable disease reports and over 100 outbreaks annually. A reliable and timely surveillance system is critical to these efforts. Prior to 2013, MCDPH used in-house surveillance software, the Communicable Disease Report database (CDR). In 2013, MCDPH transitioned to Arizona’s web-based statewide surveillance system, Medical Electronic Disease Surveillance Intelligence System (MEDSIS). To evaluate the transition to MEDSIS, four CDC surveillance system evaluation framework attributes were evaluated; simplicity, acceptance, data quality (completeness) and timeliness.
METHODS: A pre and post survey assessing simplicity and acceptance was administered via Qualtrics℠ in 2015. Analysis was conducted using Fisher’s exact test and odds ratios. Morbidities analyzed included hepatitis A virus (HAV), pertussis, salmonellosis, and shigellosis during 3 time periods: 2012 (CDR), 2013 (MEDSIS I) and 2015 (MEDSIS II). Timeliness was calculated using time from MCDPH case notification to investigation start and completion. Mean duration to start time and completion for all 4 morbidities combined and individually were compared using Tukey’s test. Completeness of disease-specific key fields was compared longitudinally for each morbidity using Chi-square.
RESULTS: Seventeen (89.5%) investigators completed the survey. Among respondents, > 80% described MEDSIS as easy to learn and use; 73% agreed MEDSIS was efficient; and 65% reported overall satisfaction with MEDSIS. Timeliness evaluation of four morbidities combined demonstrated a decreased start time from 3.4 days (CDR) to 1.3 (MEDSIS I) and 0.7 days (MEDSIS II). Completion time decreased from 21.8 days (CDR) to 14.5 (MEDSIS I) and 13.5 days (MEDSIS II). All longitudinal comparisons were statistically significant (p<0.05). For individual morbidities, significant timeliness improvements were measured for salmonellosis and shigellosis; no significant timeliness changes were measured for HAV or pertussis. Completeness increased significantly (p<0.0001) for shigellosis [34.5% (CDR), 83.5% (MEDSIS I), 90.2% (MEDSIS II)] and salmonellosis [40.4% (CDR), 75.7% (MEDSIS I), 67.0% (MEDSIS II)] and decreased for pertussis [24.5% (CDR), 19.6% (MEDSIS I), 9.3% (MEDSIS II) p<0.0001]. HAV completeness decreased but the difference was not significant.
CONCLUSIONS: Transition to a state-wide surveillance system affected Maricopa County communicable disease surveillance variably. Significant improvements in time to initiate and complete investigations resulted, however, completeness was affected differently depending on the morbidity. Outside of the system itself, workforce and workload can affect system performance and should be considered in result interpretation. MCDPH plans to systematically review the identified metrics over time to detect gaps in both the system and processes, implementing changes as necessary.