Back at the CDC, NEDSS seeks systems integration

Tower-of-Babel surveillance schemes must go

While TB controllers out West are trying to get an electronic case management system up and running, information technology specialists back East are hot on the same trail —or, perhaps more accurately, a superhighway version of the trail.

Thanks to a dose of federal funding, the Centers for Disease Control and Prevention in Atlanta is hard at work getting various surveillance programs to talk to each other and at the same time to talk to other banks of clinical data — laboratories and pharmacies, for example.

The CDC project is known as the National Electronic Disease Surveillance Systems (NEDSS). At the helm of the project is John Loonsk, MD, associate director for informatics at the CDC and director of the Information Management Resource Office, the central information technology organization of the CDC.

Part of the NEDSS mission, Loonsk says, is to create "an integrated surveillance environment." That means taking the 120 or so surveillance systems that currently feed data to the CDC and making them look and act more alike. More important, it involves giving them new "interfaces" so they can share data with each other.

Same look will ease load on users

"Right now, what you often have are two or more systems running on the same desktop," says Loonsk. "You might hit F10 on one, and it deletes a record; hit the same key in another, and it saves a record." Nor, under the current Tower-of-Babel framework, is it easy to determine whether an HIV patient is also a customer at the sexually transmitted diseases clinic or if he’s well-known to the TB controllers down the hall. Loonsk hopes to change this situation.

Next comes figuring out how to mine data that exist in other clinical information systems. Loonsk cites a recent study of TB case reporting in which researchers found that by sifting through a health management organization’s data bank, they uncovered 18% more cases than had been reported through routine public-health surveillance.1

So far, Loonsk’s office has parceled out about $10 million to states to get their state systems built to NEDSS standards. That doesn’t necessarily mean rebuilding from the ground up, he adds, so much as rehabbing systems so they can interface with others.

"By analogy, you could say we don’t all have to have the same houses, but we need to share the same electrical grids," he says. TIMMS, the CDC’s TB surveillance software, is getting its own overhaul and will be rebuilt to conform to NEDSS standards.

Loonsk says the CDC will start piloting its own NEDSS-compliant software next month, with a bigger rollout due in the fall. The newly configured products won’t necessarily work as case-management tools "right out of the box," he cautions; still, "there will be a work-up feature that will accumulate information."

One reason for the dissonant array of surveillance systems at the CDC is that funding for programs has historically been categorical. Though that helps protect the integrity of programs, categorical funding has also tended to force programs to function in relative isolation, with each building its own software to its own standards.


1. DS Yokoe, GS Subramanyan, E Nardell, et al. Supplementing TB surveillance with automated data from health maintenance organizations. EID 1999; 6:779-787.