Notifiable disease surveillance is essential to rapidly identify and
respond to outbreaks so that further illness can be prevented. Automating
reports from clinical laboratories has been proposed to reduce underreporting
To compare the timeliness and completeness of a prototypal electronic
reporting system with that of conventional laboratory reporting.
Laboratory-based reports for 5 conditions received at a state health
department between July 1 and December 31, 1998, were reviewed. Completeness
of coverage for each reporting system was estimated using capture-recapture
Three statewide private clinical laboratories in Hawaii.
Main Outcome Measures
The number and date of reports received, by reporting system, laboratory,
and pathogen; completeness of data fields.
A total of 357 unique reports of illness were identified; 201 (56%)
were received solely through the automated electronic system, 32 (9%) through
the conventional system only, and 124 (35%) through both. Thus, electronic
reporting resulted in a 2.3-fold (95% confidence interval [CI], 2.0-2.6) increase
in reports. Electronic reports arrived an average of 3.8 (95% CI, 2.6-5.0)
days earlier than conventional reports. Of 21 data fields common to paper
and electronic formats, electronic reports were significantly more likely
to be complete for 12 and for 1 field with the conventional system. The estimated
completeness of coverage for electronic reporting was 80% (95% CI, 77%-82%)
compared with 38% (95% CI, 37%-39%) for the conventional system.
In this evaluation, electronic reporting more than doubled the total
number of laboratory-based reports received. On average, the electronic reports
were more timely and more complete, suggesting that electronic reporting may
ultimately facilitate more rapid and comprehensive institution of disease