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Improving Disease Surveillance at CDC—A Strategic Approach
Information on this site provides context, achievements, and future plans generated by CDC’s Surveillance Strategy. It is updated as new reports and information become available. It also serves as a hub to initiatives and technical work generated by the Strategy.
Public health surveillance and its essential health data is the nation’s portal for progress in protecting our health. CDC’s overarching goal for federally supported surveillance activities is to get the right information into the right hands at the right time.
In a renewed effort to better achieve this goal, and in response to the observations and recommendations of experts, the agency launched the CDC Surveillance Strategy in February 2014 that sets aggressive targets1 to:
- Improve availability and timeliness of data
- Advance the use of electronic health records, mobile technologies, and cloud computing
- Retire redundant systems and reduce reporting burden on health departments
- Maximize performance and effectiveness of agency resources
The CDC Surveillance Strategy
CDC’s Surveillance Strategy is an agency priority. This cross-agency effort responds to requests from multiple stakeholders, including Congress, state public health leaders, and federal advisory committees asking for a strategy to transform and modernize CDC’s surveillance systems and approaches.
The Strategy addresses fundamental problems found through this review. It is not meant to be a national surveillance strategy; rather, it focuses on what CDC must do to drive progress and inspire trust with the agency’s surveillance partners in the field. It builds on previous work inside and outside CDC to arrive at a vision of public health surveillance for the 21st century. By embracing the current challenges as opportunities, fixing what needs to be fixed, and working closely with its state and local partners, CDC can help revitalize U.S. public health surveillance. 3
Public health surveillance, sometimes referred to as tracking, or monitoring disease and other health conditions, is the cornerstone of public health practice.
It is defined as the regular collection, analysis, use, and sharing of data to prevent and control disease and injury.2
Supporting States Through Improvements at CDC
CDC aims to rapidly improve its activities in the short term, while laying the groundwork for ongoing evaluation and modification of surveillance systems in the long term. The Strategy guides CDC efforts to make U.S. surveillance systems more adaptable to rapidly changing technology, more versatile in addressing evolving health threats, more adept at accessing and leveraging health-care data, and more capable of meeting demands for timely, population-specific, and geographically-specific information.4
This step-wise course of action is improving the value of our data, beginning with how we interface with states—where information is first collected and shared with CDC. We are making progress on improving surveillance data for public health action at the local, state, and federal levels. Examples include advancing data timeliness, leveraging existing data platforms to address emerging needs, using nontraditional data sources, and improving the representativeness of data through better population coverage.3
A Step-wise Approach
The Strategy outlines 3 goals and 10 aims to improve surveillance capabilities, outcomes, and overall public health. Through steady leadership and partnership, it facilitates work to consolidate surveillance systems, eliminate unnecessary redundancies, reduce reporting burden, and improve data availability, quality, and timeliness for all stakeholders.5 Specific aims are contained within each of the three goals.
Goals and aims are building blocks to better connect systems and resources inside CDC with more than three thousand agencies at the federal, state, local, and territorial levels. Already we have moved beyond initial initiatives. The next phase of the Strategy concentrates on improved program and data integration, better connectivity between public health and healthcare, and more efficiency at CDC through shared IT services.
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Progress in Reaching Goals 1 and 2 Include:
Putting Data to Work: Initial Findings
CDC invests in surveillance systems and a surveillance-related workforce internally as well as externally supporting surveillance-related activites by providing grants for work happening around the country and globally.
- Prompted by the strategy, an institutional profile of CDC’s investments in surveillance was constructed to identify gaps and opportunities for enhancements to CDC’s surveillance programs.
- We utilized a variety of CDC administrative databases to conduct our analyses. We consulted subject matter experts (SMEs) in the design phase to ensure we understood the business processes and the resultant data collected. We also engaged SMEs to validate the findings for some of our analyses.
- Results of our inquiry found that the agency hosts multiple surveillance systems that span a spectrum of health conditions and risks factors that fall into four broad categories: infectious diseases; non-infectious health conditions; both infectious and non-infectious health conditions; and risk factors and exposures.
- The majority of CDC resources for surveillance go to state and local health departments.
- We are in the process of assessing CDC’s surveillance-related workforce as well as grants going to state and local health departments. This information will help us identify and fill gaps in the skills needed to modernize surveillance systems. These analyses will also serve as a guide to better target surveillance resources and create efficiencies without losing quality.
CDC’s Surveillance Board Pushes for Progress
CDC brings experts together to solve problems and create innovative solutions to advance the fields of public health data, statistics, informatics, surveillance, epidemiology, laboratory practices, and workforce development.
- The CDC Deputy Director for Public Health Scientific Services chairs the CDC Surveillance Leadership Board, which is accountable to the CDC Director. The board reviews, guides, and oversees the evolution of CDC surveillance systems to optimize resource investments devoted to existing and emerging surveillance systems.
- Every CDC Center, Institute, and Office (CIO) participates on the board. Workgroups across the agency have been established to drive select priorities from standardizing data elements across surveillance systems to reducing costs.
Innovation through Informatics
As part of CDC’s Surveillance Strategy, a consortium was launched, which fosters and shares creative solutions to surveillance challenges that are unique to public health. The CDC Health Informatics Innovation Consortium is a forum for sharing innovation successes and failures. The consortium holds quarterly open webinars and has funded 16 projects (<$50 000 per project) that made important contributions to informatics evolution at CDC.6 A key benefit of the consortium has been to increase the sharing of lessons learned, and to improve collaboration and innovation among agency surveillance programs.
- Since the strategy’s inception in 2014, every CIO at CDC has participated in this forum with direct involvement by 94 different CDC groups and programs and about 30 outside organizations.
- Examples of projects include, reducing data collection burden on healthcare providers to deliver surveillance data, studying early warning systems for disease transmission along national borders, developing an App to report stroke cases, and developing new ways track antibiotic resistance in foodborne pathogens.
Pulse Check: Our Progress So Far
Through the Strategy, steady progress has been made at CDC in advancing systems and participation, and sets the stage for the next wave of improvements.
*Percentage changes in the table were furthered by the Strategy, with baseline numbers for some initiatives starting prior to 2014.
**~20M laboratory reports are received annually at health departments—80% are now received electronically
***Date of Information: July, 2017
For the Strategy’s third goal, 4 initiatives were initially selected for their importance to state and local health departments, their potential for quick results, and their foundational importance to CDC centers and programs.
Four Initial Initiatives
Select Examples of Initial Impacts Include 3:
- Faster reporting of mortality records to know how people are dying and from what
- Reduced burden on states for reporting notifiable disease conditions
- Better and faster situational awareness through tracking emergency department visits nationally
- More timely reporting of laboratory results through improved electronic submission
- Increased connectivity with the medical community through electronic case reporting.
- Modernizing data platforms for increased productivity
Next Steps:
Going forward, strategic goals include:
- Enriched program and data integration
- Better connectivity between public health and healthcare
- Improved efficiency at CDC through shared IT services
Modernizing Data Platforms for Increased Productivity
To modernize information technology supporting disease tracking and control, we initiated a Surveillance Data Platform with a set of core shared services within CDC. Launched in 2016 as an outcome of CDC’s Surveillance Strategy, this platform is dedicated to making disease tracking more efficient through the use of cloud-based technology. The platform is a multi-phase initiative with the first set of shared services scheduled to be released in 2017. When the platform is fully realized in 2020 it will reduce the number of different ways CDC asks for the same type of information from health departments, and as a result, decrease the burden on partners to send and use data.
Exchanging Healthcare Data Electronically
We identify approaches for increasing the use of electronic health records (EHRs) as part of an integrated strategy to improve reporting from both clinicians and public health practitioners and better link information that can be used by multiple users.7
- With the proliferation of disease outbreaks and the need for fast access to patient health data, EHRs are critical to successful management of patient care. Hospitals and health professionals need information in electronic format that is available quickly to make well-coordinated clinical decisions that improve overall health.
- With healthcare adoption of EHR, interoperability between public health and healthcare is essential for public health surveillance. We are working with the Digital Bridge Initiative, bringing together public health, health IT developers and health systems in a multi-jurisdictional approach to electronic case reporting (eCR). This is a valuable tool that reduces the burden of public health reporting of infectious diseases, while improving the timeliness, accuracy, and completeness of data. Early detection of cases allows for earlier intervention, diminished transmission of disease, and improved detection of outbreaks.
- We are using the HL7 data standards such as Clinical Document Architecture (CDA) and Fast Health Interoperability Resources (FHIR) as potential solutions for exchanging healthcare data electronically.
1 Richards CL, Iademarco MF, Anderson TC. A new strategy for public health surveillance at CDC: improving national surveillance activities and outcomes. Public Health Reports. 2014; 129(6):472-476. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187298/.
2 Buehler JW; Centers for Disease Control and Prevention. CDC’s vision for public health surveillance in the 21st century: Introduction. MMWR Suppl. 2012;61(3):1-2. https://www.cdc.gov/mmwr/pdf/other/su6103.pdf.
3 Richards CL, Iademarco MF, Atkinson D, Pinner RW, Yoon P, MacKenzie WR, Lee B, Qualters JR, Frieden TR. Advances in public health surveillance and information dissemination at the Centers for Disease Control and Prevention. Public Health Reports. 2017 [epub ahead of print]. http://journals.sagepub.com/doi/full/10.1177/0033354917709542.
4 Richards CL, Lee B. CDC Surveillance Strategy—A strategy for improving CDC activities in public health surveillance. Online J Public Health Inform. 2015;7(1):e49. http://europepmc.org/articles/PMC4512337.
5 Centers for Disease Control and Prevention. Surveillance Strategy. 2014. https://www.cdc.gov/ophss/docs/CDC-Surveillance-Strategy-Final.pdf.
6 Centers for Disease Control and Prevention. CDC Health Information Innovation Consortium (CHIIC). https://www.cdc.gov/ophss/chiic.
7 MacKenzie WR, Davidson AJ, Wiesenthal A, Engel JP, Turner K, Conn L, Becker SJ, Moffatt S, Groseclose SL, Jellison J, Stinn J, Garrett NY, Helmus L, Harmon B, Richards CL, Lumpkin JR, Iademarco MF. The Promise of Electronic Case Reporting. Public Health Reports. 2016;131(6):742-746. http://journals.sagepub.com/doi/full/10.1177/0033354916670871.
- Page last reviewed: August 7, 2017
- Page last updated: August 7, 2017
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