Current Trends National Electronic Telecommunications System for Surveillance -- United States, 1990-1991

The National Electronic Telecommunications System for Surveillance (NETSS) was developed by CDC and the Council of State and Territorial Epidemiologists (CSTE) for collecting, transmitting, analyzing, and publishing weekly reports of notifiable diseases and injuries (Figure I (1) and Tables I and II, pages 496-9) from the 50 states, New York City, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and Commonwealth of the Northern Mariana Islands. Operation of NETSS is facilitated by CDC/CSTE agreements on reportable conditions, protocols for formatting and transmitting data, standard case definitions, and designated staff members in each participating agency who provide and prepare the data for weekly publication in MMWR. This report describes the development and operation of NETSS and presents tabulations of national surveillance data for 1990 (tables on pages 505-10).

Before 1984, reports for each of 37 notifiable diseases (23 common diseases and 14 less frequent conditions) were transmitted weekly by telephone from each agency to CDC, but only the total number of cases could be transmitted by this method. In 1984, six state health departments and CDC developed a system for transmitting individual case records to CDC over commercial telecommunications systems. The system is based on a common record format permitting health agencies to use different computer software and hardware. Since 1989, all 50 states and some territories and cities have used computerized disease surveillance systems and transmitted surveillance data in the standard format to CDC, thus fulfilling one of the 1990 health objectives for the nation (2).

Data for the tables published each week in MMWR and its annual summary are provided through NETSS. Reports of notifiable conditions are forwarded from local sources (e.g., health-care providers and health departments) to the participating agencies, where they are entered into a computer in a format chosen by each agency. A variety of computer systems (e.g., Epi Info (3) in 36 states, dBase|Pr*, or mainframe programs) then create data files in the standard NETSS format without names or other personal identifiers. Most of the files are transmitted through the Public Health Network on BT North America* (formerly Dialcom) to CDC, where they are processed in a mainframe computer. During a 24-hour period each Tuesday and Wednesday, tables are produced, edited, and typeset for publication in the MMWR.

In January 1991, a new format for NETSS records was sent to each state epidemiologist. The new format provides for transmission of both individual and summary (aggregate) records, supplementary disease-specific forms, frequent updating of state and national databases, and other improvements. CDC is now receiving records in the new format from a limited number of states; complete implementation is expected in 1993. Reported by: Council of State and Territorial Epidemiologists. Div of Surveillance and Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Many records previously submitted as paper forms or computer files to various programs at CDC will be transmitted through NETSS to a single entry port at CDC for distribution to the relevant programs. Other improvements will include enhancements in accuracy and completeness of surveillance data, as well as more timely return of data to the states.

A new software system is being developed on the CDC mainframe for receiving and error-checking records transmitted by the states and for returning status reports and annual summaries. This system will be linked with a different system, the Wide-ranging ONline Data for Epidemiologic Research (WONDER) (4), to provide access on-line to summaries of disease reports beginning with 1989 data later this year.

Thirty-six states now use Epi Info surveillance software written and supported by CDC staff. A new version of this software that offers more extensive error checking, the ability to review summary data for 5 years, and enhanced graphics is available for installation. The new system contains both standard and customizable elements to enable achievement of both local needs and file exchange of standardized software systems.

The annual summary of disease totals for 1990 (tables on pages 505-510) is available earlier in the year than any previous report. Completion of the enhancements in NETSS may facilitate earlier publication of annual summary data in the future.

References

1. CDC. Changes in format for presentation of notifiable disease report data. MMWR 1990;39:234.

2. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980:59.

3. Dean AD, Dean JA, Burton JH, Dicker RC. Epi Info, version 5: a word processing, database, and statistics program for epidemiology on microcomputers. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1990.

4. CDC. WONDER (Wide-ranging ONline Data for Epidemiologic Research) (software users\' manual). Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1991.

*Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.

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