A Guide to the Implementation of the National Electronic Disease Surveillance System (NEDSS) in State Public Health Agencies

This document is targeted to program managers and surveillance staff in state health agencies who are involved in the implementation of the National Electronic Disease Surveillance System (NEDSS). The target audience includes epidemiologists and other professional staff with varying degrees of computer knowledge and skills. The goals of the document are: A ~ To present the basic principles of the NEDSS architecture and how they affect state-based surveillance systems; B ~ To assist state surveillance programs in deciding how to implement the NEDSS architecture; C ~ To discuss some current issues related to the NEDSS implementation. The document is divided into three sections. Section I describes NEDSS and the NEDSS architecture. Included in that section is a discussion of what an integrated system is and how the integration of multiple systems can be achieved in different ways. The multiple layers of modern information systems (i.e., user interface, middle layer with business rules, and database) are also discussed. Finally, the NEDSS architecture and its elements are summarized. Section II deals more in detail with NEDSS implementation options for state programs. Fully integrated systems are compared with data warehouses. The option of using CDC-developed NEDSS software is discussed against the alternative of adopting state-developed applications. Some guidance is provided on how to choose the best solution for each state and how many systems should be included in NEDSS. Section III includes a brief description of the resources needed at the state level for the implementation of NEDSS. In addition, connectivity, security, and other important issues (such as confidentiality and legal authority to collect and access surveillance information) are discussed. A section with Frequently Asked Questions (FAQs) and a glossary complete the document. NEDSS is an important initiative, originated in part as a result of requests and proposals formulated by state epi-demiologists and their professional organization, the Council of State and Territorial Epidemiologists (CSTE). It has the potential to change dramatically the way public health surveillance is conducted in this country. We hope that this document, while not exhaustive or comprehensive, can be helpful in assisting those of us who struggle every day to remain an active part of this process.