Five major laboratories gather and provide electronic laboratory results from health-care providers across Texas, and each submits as many as 7,800 records a year to the Texas Department of State Health Services (DSHS). The state then submits the data to the Centers for Disease Control and Prevention (CDC) as part of the National Electronic Disease Surveillance System (NEDSS).
The slow and costly process of manually entering data sent in by labs is now becoming a thing of the past in Texas as the state pioneers a data conversion tool that will automatically convert lab results to the appropriate data format regardless of the format in which it was submitted.
Since 1946, the CDC's mission has been to prevent disease outbreaks and deal with incidents that potentially could cause epidemics, such as the anthrax scare of 2001 and the spread of infectious diseases in the aftermath of Hurricane Katrina. When President George W. Bush signed the Public Health Security and Bioterrorism Preparedness and Response Act into law in 2002, the CDC introduced the NEDSS as part of a nationwide effort to provide real-time disease reporting and automate disease-tracking processes.
A key goal of the NEDSS, developed in part with the Texas DSHS, is to facilitate the development of integrated, registry-based public health surveillance systems through the exchange of data based on a single set of criteria. The data travels securely via the Internet to the CDC's Public Health Information Network Messaging System.
The system can identify people in a region who are developing common symptoms, such as a flulike illness or even bioterrorism.
The vision of NEDSS is to have an integrated surveillance system in all states that can transfer public health, laboratory and clinical data efficiently and securely over the Internet. The CDC claims NEDSS will revolutionize public health by gathering and analyzing information quickly and accurately. This will help improve the nation's ability to identify and track emerging infectious diseases and potential bioterrorism attacks, as well as investigate outbreaks and monitor disease trends.
Overcoming Slow Reporting
For agencies required to submit data, the process wasn't so simple. In 2004, the need to automate NEDSS reporting in Texas was clear, said Doug Hamaker, NEDSS coordinator for the Texas DSHS. Each lab result record took about three minutes to manually enter into the DSHS disease tracking system.
The problem was the Texas DSHS had a tracking system that involved several manual steps for converting data formats and electronic files to NEDSS compliance. The source files were often received by fax or download, then manually sorted and saved according to geographic jurisdiction. The files were then electronically copied to shared folders on a secure portal. To make matters worse, some labs submitted paper forms. The files were reviewed manually, and records requiring action were manually recorded in the NEDSS system and followed up with an investigation.
Hamaker wanted to take the state's time-sensitive laboratory result data and integrate it with statewide and national data systems -- without interfering with established practices.
"We needed to develop a solution that would not disrupt current business processes, yet moved us toward increased standardization of how laboratory result messages were processed, as well as working on standardization of message content when created at each participating laboratory," Hamaker said.
The Texas DSHS partnered with the CDC, which was in the process of implementing NEDSS. Through NEDSS, the CDC seeks to establish an Internet framework that allows states to collect data from the state and local level and report communicable diseases to the CDC's Public Health Information Network for analysis and response. The Texas DSHS served as a beta site for the CDC effort, and the DSHS worked with the CDC to develop the NEDSS system.
The electronic laboratory reporting process the Texas DSHS implemented