The current 122 Cities Mortality Reporting System surveillance system also lacks flexibility for expanding the number of conditions and/or the geographic distribution. Moreover, the unavailability of coded death records due to the complexity of the National Center of Health Statistics (NCHS) coding process results in multiple strategies to identify common outbreaks such as pneumonia and influenza deaths, which greatly vary by jurisdiction. To bypass the lengthy NCHS process, a variety of approaches have been attempted that are close to 'realtime' but less than optimal. For instance, in Utah keyword searching is used to identify pneumonia and influenza deaths; although this method is fast and easy to implement, it can easily result in the over or under estimation of cases. This can occur by missing cases due to misspelled terms, synonyms, variations, or the selection of strings containing the search term.