With just a little adjustment of an existing Web-based disease surveillance system, the Illinois Department of Public Health (IDPH) was able to track incidences of H1N1 across the state, cut down on reporting errors and respond much more quickly. 

The Illinois National Electronic Disease Surveillance System (I-NEDSS) allowed the IDPH and local health departments to monitor the symptoms hospitals were seeing, determine which of those symptoms met the case definition for H1N1 infection, and encourage the public to take precautions to stay healthy.

In the past, health-care providers and other local agencies mailed reports to the local health departments and the IDPH. This process led to reporting errors, redundant data entry and long delays in information reaching the IDPH. “We used to have to wait for those reports to have to come in on paper, and so the ability for us to just create a report and see what new cases have been added at the local level is very important,” said Judy Kauerauf, I-NEDSS administrator.

“We’re able to identify outbreaks more quickly because we get data reported much more quickly than we would on paper,” Kauerauf said. “And electronic laboratory reporting has definitely proven to increase the comprehensiveness of reporting. We definitely get more reports through electronic lab [reporting] than we previously had.”

The system tracks information on patients’ symptoms, hospitalization history, where they might have been infected, where they have traveled and if anyone else in the same household or close contacts have become ill. Health-care providers and local governments enter the data into a Web interface, while information from labs is typically sent directly to the system.

The IDPH and local health departments can run reports looking at trend data, to get an understanding of the disease’s transmission filtered by ZIP code, county, symptoms and other factors.   

System Flexibility

At the start of the H1N1 outbreak, the system wasn’t set up for the collection of influenza-related information, Kauerauf said. However, that wasn’t a big hurdle. “We were able to add new questions within two hours that were necessary for monitoring this form of influenza virus,” she said. “Because we had already had data exchange with [the state labs] it wasn’t too difficult to add influenza and H1N1 testing.”

The initial implementation of I-NEDSS went live in 2004 providing the state’s 95 local health departments a secure link to the IDPH. Hospitals and health-care providers were added in February 2005 with labs added later. I-NEDSS allows health officials to analyze information on 77 diseases including measles, mumps, chickenpox, hepatitis and salmonella. The IDPH plans to add forms for gonorrhea and chlamydia by the end of the month, Kauerauf said.

The system cost an estimated $10 million, which was mostly funded with federal grants, including the Epidemiological and Laboratory Capacity grant program.

[Photo courtesy of the James Gathany/CDC.]