NBS: A Community-Based Approach to Developing an Integrated Surveillance System
Authors: Hildebrandt Christi , Ward Jennifer , Patel Akshar 
Published: May 2017

ObjectiveThe NEDSS Base System (NBS) is designed and developed usinginput from CDC programs, public health standards organizations,as well as its expansive user community. This community-basedapproach to development of an integrated surveillance system isdescribed.IntroductionThe NEDSS Base System (NBS) is a web-based, standards-driven, integrated disease surveillance system launched in 2001 andis currently in use in twenty-two public health jurisdictions. Over thepast fifteen years, the NBS has grown into a highly functional, modernapplication that supports: case management, electronic data exchange,metadata-driven data collection, workflow decision support, and ahost of other functionalities, all of which are defined and designedthrough a community-based approach.MethodsIn order to encourage open communication and collaborationacross and among the community, there is a well-publicized, long-standing communication plan in place. Further, tools such as an onlinecollaboration and support forum, NBSCentral, are made availableto any person who requests access. Also, the NBS source code isprovided in an open source package to anyone interested, alongwith each release, and a demonstration version of the applicationcan be accessed online by anyone to review the latest release of theapplication. All of these channels are in place to ensure there are waysfor all who have in interest in collaborating to easily participate.The NBS community regularly meets to provide input into furtherdevelopment of the system, as well as discuss topics affecting publichealth. As a community, members:■ Share best practices, tools, and lessons learned across jurisdictions■ Share innovative local approaches to disease surveillance andreporting■ Access NBSCentral for support and collaboration■ Participate in the change control and planning process for eachNBS release■ Work collaboratively with CDC to define high-level vision andpriorities■ Provide input to create community-defined requirements forsystem development■ Participate in weekly subject matter expert (SME) calls to discussdevelopment and best practices■ Have the opportunity to participate in beta testing for releases■ Attend a bi-weekly NBS User Group (NUG) call to discussthe system as well as reach out to colleagues to brainstorm creativesolutions to common problems in public health surveillanceAll meetings with stakeholders are recorded and shared withthe larger community to ensure full transparency and for historicalreference.ResultsThrough this inclusive development approach, the NBS hasevolved into a highly extensible, configurable system that can meetthat needs of twenty-two very different public health jurisdictions; thesystem can be implemented without the need for custom developmentin a relatively short timeframe due to the fact that it was designed tomeet the needs of many. Further, it has encouraged interoperabilityprojects, such as: piloting electronic case reporting use cases betweenNBS implementation sites and building and sharing electronic caseinvestigation forms for data collection using the NBS Page Buildermodule. All NBS sites use the same translation routes for electroniclab report, case report, and Nationally Notifiable Disease messageprocessing – embracing the build once, use many concept. Mostrecently, having this collaboration network in place made it very easyfor the NBS community to quickly adapt to the changing needs ofZika virus surveillance.ConclusionsIt does require clear definition of processes and communicationchannels, as well as regular update and transparency into the processfor community-based development to work. However, when theproper tools and processes are in place, the benefits of collaborationwith all key stakeholders are exponential when realized. Developingan application in this way has provided NBS users not only with amuch better, integrated surveillance system, but also a forum forunderstanding how other jurisdictions have solved similar issues; itprovides a springboard for sharing and building upon novel ideas andnew approaches in public health surveillance.