title: Identifying Challenges to the Integration of Computer-Based Surveillance Information Systems in a Large City Health Department: A Case Study.
abstract: OBJECTIVE
  Integrated infectious disease surveillance information systems have the potential to provide important new surveillance capacities and business efficiencies for local health departments. We conducted a case study at a large city health department of the primary computer-based infectious disease surveillance information systems during a 10-year period to identify the major challenges for information integration across the systems.
  
  
  METHODS
  The assessment included key informant interviews and evaluations of the computer-based surveillance information systems used for acute communicable diseases, human immunodeficiency virus/acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis. Assessments were conducted in 1998 with a follow-up in 2008. Assessments specifically identified and described the primary computer-based surveillance information system, any duplicative information systems, and selected variables collected.
  
  
  RESULTS
  Persistent challenges to information integration across the information systems included the existence of duplicative data systems, differences in the variables used to collect similar information, and differences in basic architecture.
  
  
  CONCLUSIONS
  The assessments identified a number of challenges for information integration across the infectious disease surveillance information systems at this city health department. The results suggest that local disease control programs use computer-based surveillance information systems that were not designed for data integration. To the extent that integration provides important new surveillance capacities and business efficiencies, we recommend that patient-centric information systems be designed that provide all the epidemiologic, clinical, and research needs in one system. In addition, the systems should include a standard system of elements and fields across similar surveillance systems.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Jacky M
authors.initials: JM
authors.lastname: Jennings
authors.affiliation: Office of Epidemiology, Division of Disease Prevention, Virginia Department of Health, Richmond, VA; Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Stover
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Megan H
authors.initials: MH
authors.lastname: Bair-Merritt
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Baltimore City Health Department, Baltimore, MD.
authors.forename: Caroline
authors.initials: C
authors.lastname: Fichtenberg
authors.affiliation: Baltimore City Health Department, Baltimore, MD.
authors.forename: Mary Grace
authors.initials: MG
authors.lastname: Munoz
authors.affiliation: Baltimore City Health Department, Baltimore, MD.
authors.forename: Rafiq
authors.initials: R
authors.lastname: Maziad
authors.affiliation: Baltimore City Health Department, Baltimore, MD.
authors.forename: Sherry Johnson
authors.initials: SJ
authors.lastname: Ketemepi
authors.affiliation: Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Zenilman