FY 2019 Annual Performance Plan and Report - Goal 4 Objective 1

Fiscal Year 2019
Released April, 2018

Topics on this page: Goal 4. Objective 1 | Objective 4.1 Table of Related Performance Measures

Goal 4. Objective 1:  Improve surveillance, epidemiology, and laboratory services

The Department is dedicated to conducting and funding scientific research that leads to evidence-based, high-quality care and responsive interventions to mitigate health crises.  Data and information from surveillance, epidemiology, and laboratory services can aid in the prevention and early intervention of foodborne illnesses, such as listeria and norovirus, and infectious disease outbreaks, such as Zika and Ebola.  To achieve this objective, the Department is working to facilitate information exchange to identify risks quickly and efficiently, strengthen the quality and safety of our Nation’s laboratories, and strengthen the alignment of surveillance, epidemiology, and laboratory services.

As response rates to surveys fall and primary data collection costs increase, the need to use and leverage new sources of data for public health surveillance becomes critical.  Within the Department, efforts are underway to use electronic health records for infectious disease surveillance and to facilitate coding of causes of death on death certificates.  At the National Center for Health Statistics, linkages between survey data, mortality data, hospital administrative data, electronic health records, Medicare data, and housing data have been created and should greatly expand public health surveillance opportunities. In addition, HL7 Continuity of Care Document specifications have been published to facilitate the submission of standardized electronic health information to the National Health Care Surveys, enhancing their usability for surveillance.

The Office of the Secretary leads this objective.  The following divisions are responsible for implementing programs under this strategic objective: ASPR, CDC, CMS, FDA, NIH, OCR, OGA, and SAMHSA.

Objective 4.1 Table of Related Performance Measures

Increase the percentage of laboratory reports on reportable conditions that are received through electronic means nationally (Lead Agency - CDC; Measure ID - 3.5.2)
Measure FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019
Target N/A Set Baseline 65 % 70 % 75 % 80 % 82 % 90 %
Result 54 % 62 % 69 % 69 % 75 % 80% Dec 31, 2018 Dec 31, 2019
Status Historic Actual Baseline Target Exceeded Target Not Met Target Met Target Met Pending Pending

Advancing national implementation of Electronic Laboratory Reporting (ELR) is a priority in CDC’s efforts to protect the public’s health. ELR replaces paper-based reporting, which accelerates reporting to public health labs; reduces the reporting burden on clinicians, hospitals, and commercial laboratories; and decreases errors and duplicate reporting. As of FY 2017, electronic laboratory reports accounted for nearly 80% of laboratory reports for reportable conditions received, which exceeds FY 2016 results and continues the upward trend since FY 2012. As of the end of 2017, the national average for ELR is expected to be very close to 90%. There are diminishing returns if trying to push the ELR volume number higher than 90%, therefore the program considers moving from 62% in 2013 to 90% as a success.  In FY 2018 and 2019, CDC will continue to monitor the implementation of ELR as part of its efforts to protect the public health.

Increase the percentage of notifiable disease messages transmitted in HL7 format to improve the quality and streamline the transmission of established surveillance data (Lead Agency – CDC; Measure ID - 8.B.1.4)
Measure FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019
Target N/A N/A N/A Set Baseline 10 % 40 % 40 % 40 %
Result N/A N/A 1 % 1 % 3 % 5% Dec 31, 2018 Dec 31, 2019
Status N/A N/A Historic Actual Baseline Target Not Met but Improved Target Exceeded Pending Pending

During FY 2017, CDC advanced the modernization of infectious disease surveillance by producing technology upgrades to the Message Validation, Processing and Provisioning System , which receives production data from the states using the new HL7-based messages. This system streamlines data processing to more efficiently provide the data to CDC programs for analysis and action. When new HL7 messages have been implemented for all diseases, the new strategy will allow the retirement of older, less efficient legacy systems, and will increase the number of HL7 messages received at CDC. Although CDC did not meet its FY 2017 target, the five percent achievement represents an increase over the proportion in FY 2016 and the FY 2015 baseline.  The FY 2017 accomplishments demonstrate increasing momentum toward achieving the targets in outlying years.  In FY 2018 and 2019, CDC will continue to increase its use of HL7 formatting to receive surveillance data from the states.

Increase the number of people for whom FDA is able to evaluate product safety through Mini-Sentinel/Sentinel system (Lead Agency – FDA; Measure ID – 292202)
Measure FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019
Target 100 million 100 million 150 million 180 million 185 million 195 million 233  million 243  million
Result 126 million 149 million 178 million 182 million 193 million 223 million Jan 31, 2019 Jan 31, 2020
Status Target Exceeded Target Exceeded Target Exceeded Target Exceeded Target Exceeded Pending Pending Pending

The FDA’s Sentinel Initiative provides significant public health benefits by developing new approaches and methods to actively monitor the safety of marketed medical products to complement existing FDA surveillance capabilities.  Through the Sentinel System, the FDA is able to evaluate drug safety issues that may require regulatory action. In FY 2017, the Sentinel System expanded surveillance to 223 million members, which is an increase of 30 million members from FY 2016.  FDA held the Ninth Annual Sentinel Initiative Public Workshop in February 2017 to bring together stakeholder communities to discuss a variety of topics on active medical product surveillance and emerging Sentinel projects.  To date, the Sentinel Initiative has contributed to multiple safety communications and labeling changes to better inform patients and providers about safe use of drugs and vaccines.  The Sentinel System ensures FDA will continue to have the tools necessary to conduct active safety surveillance work.


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