Public Health Interoperability: Disease Surveillance, Labs & Hospital Networks

January 8, 2026 admin Population Health Management

Public health depends on timely, high-quality data flowing from clinical and laboratory systems into public health agencies for disease monitoring and response. In the U.S., interoperability efforts have focused on automating “reportable condition” data exchange: lab-confirmed results, case notifications, syndromic visits, immunizations, and more. By using standardized messages and networks, healthcare providers and labs can send data directly into state and federal public health systems without manual entry. For example, investments in electronic laboratory reporting allowed state and local labs to transmit about 90% of COVID-19 test results by 2022, greatly accelerating outbreak management.

This article reviews the U.S. public health data infrastructure, highlighting the standards, processes, and networks that link hospital systems, clinical labs, and public health surveillance systems. We discuss how cases and lab results are reported, the role of health information exchanges (HIEs), and the programs and policies (such as CDC’s Public Health Data Interoperability initiative and federal EHR requirements) that drive these integrations.

Standards and Frameworks for Public Health Data

HL7 Messaging and Core Surveillance Code Systems

Interoperability rests on open, common standards and defined data sets. Most U.S. public health reporting today uses HL7 messaging.

For example, electronic lab reports and case notifications typically use HL7 version 2.x (often 2.5.1) messages that include standardized codes.
Tests and results in laboratory messages are coded using LOINC for test names and SNOMED-CT for results or organism names.
Syndromic surveillance is also sent via HL7 ADT (admit/discharge) messages (CDC’s PHIN Guide for syndromic surveillance specifies HL7 v2.5.1).
Other code systems common in surveillance include ICD diagnosis codes, RxNorm for medications, and UCUM for units, ensuring consistent meaning across systems.

Related: Building Public Health Reporting & Surveillance Systems with FHIR

FHIR, TEFCA, and National Interoperability Frameworks

Alongside HL7 v2, FHIR (Fast Healthcare Interoperability Resources) is emerging for modern public health interfaces. FHIR’s API-based approach can simplify data exchange and reduce maintenance. The CDC and its partners have developed a Public Health FHIR Playbook to guide agencies in implementing FHIR for case reporting, immunizations, and other uses.

In addition, the federal Trusted Exchange Framework and Common Agreement aims to establish a national network of networks: it defines common policies and connectivity so that public health agencies, healthcare providers, and HIEs can exchange information seamlessly across jurisdictions.

Overarching these standards are data element definitions: the Office of the National Coordinator’s US Core Data for Interoperability defines a set of standardized fields (names, values, formats) for health data; in 2023 it launched USCDI+ with public health extensions, helping ensure public health data is represented consistently.

PHIN Infrastructure and Secure Public Health Data Exchange

At the infrastructure level, public health agencies often rely on CDC’s Public Health Information Network (PHIN) tools. PHIN provides a secure messaging backbone for transporting HL7 messages, a Vocabulary Access Distribution System of public health code sets, and a Public Health Directory of facility and practice IDs. Together, these build a “network of trust” so that hospitals, labs, and local health departments can exchange data securely and unambiguously.

Disease Surveillance and Case Reporting

Automated Electronic Case Reporting (eCR)

Automated case reporting transforms how doctors and hospitals notify health departments about infectious diseases. Electronic Case Reporting enables a patient’s EHR to generate and send a reportable-condition alert directly to public health as soon as it is documented in the chart.

In practice, when an EHR “recognizes” a diagnosis or lab result that matches a reportable condition, it triggers an HL7 message to a centralized exchange, which routes the validated case report to the appropriate state or local public health agency.
This automated eCR process (now required by the federal Promoting Interoperability program for most hospitals and eligible clinicians) yields more timely, complete data than traditional manual reporting.

Public health agencies receive the report in real-time and can immediately respond (e.g. begin contact tracing or outbreak investigation) and even send feedback to providers, enabling bidirectional collaboration.

Standards and Technologies Supporting eCR

Behind the scenes, eCR relies on several published standards. Early implementations use HL7 Clinical Document Architecture (CDA) messages to carry demographic and clinical details.

Vendors are moving toward HL7 FHIR for eCR as well (for instance, the “eCR Now” FHIR app lets certified EHRs push FHIR resources for cases). In all cases, eCR leverages standardized vocabularies (e.g. ICD-10 for diagnoses, LOINC for lab tests) to ensure public health agencies can automate case detection and database integration.

National Notifiable Disease Reporting (NNDSS and NEDSS)

Public health surveillance also includes notifiable disease reporting through the CDC-managed National Notifiable Diseases Surveillance System (NNDSS). Traditionally, states aggregated case data and sent periodic batch updates to CDC. Under the NNDSS modernization, states are encouraged to use HL7 messages to share individual case notifications with CDC.

The CDC’s NEDSS architecture specifies exactly what data must be included (case demographics, risk factors, diagnosis, lab results, etc.) and uses HL7 standards so that a state’s disease tracking system can automatically forward new case reports to CDC in a common format. As of 2024, all 50 states use NEDSS-compatible systems, which integrate lab reports (ELR), case data entry, and HL7 messaging into a single repository that connects to CDC.

Syndromic Surveillance from Emergency Departments

Another pillar of surveillance is syndromic surveillance. Hospitals’ emergency departments (and urgent care clinics) transmit near-real-time visit data to the CDC’s National Syndromic Surveillance Program (NSSP). These feeds use HL7 ADT messages containing patient demographics, chief complaints, diagnosis codes, and other information. CDC’s PHIN messaging guide for syndromic surveillance is based on HL7 v2.5.1, and is aligned with the ONC’s Meaningful Use criteria.

Real-Time Detection and Standardized Data Analysis

By collecting ED visit data across many hospitals, public health analysts can detect unusual spikes or clusters (e.g. flu-like illness surges, opioid overdoses) in near real time, even before lab confirmation or provider reports are available.

Syndromic systems use standard code sets so that data from different hospitals are comparable. Importantly, the MU program has mandated that participating hospitals connect to syndromic surveillance; most HIEs and hospitals now forward their HL7 ED data into state BioSense platforms.

Impact of Automated Surveillance on Public Health Operations

In sum, disease surveillance data flows from hospital EHRs and labs into public health via standard electronic channels. These automated pipelines (eCR, ELR, syndromic) have dramatically improved timeliness and completeness of case data.

For example, CDC notes that receiving rapid, quality ELR data lets health departments identify outbreaks faster and manage cases more effectively.
It also reduces the manual work of public health and clinicians: data such as demographics, lab values, immunizations, and comorbidities travel along with the report, eliminating redundant data entry at the health department and clinician offices.

Laboratory Data Exchange

Electronic Laboratory Reporting (ELR) for Public Health Surveillance

Clinical laboratories are a primary source of surveillance data. Electronic Laboratory Reporting automates the transmission of positive test results from labs to public health agencies. When a lab performs a test for a reportable disease, the result is entered into the lab’s information management system.

The LIMS then generates an HL7 message (typically an ORU^R01 result message) according to the state’s ELR profile. That message includes key patient and specimen details (mapped to standard codes like LOINC for the test and SNOMED for the result), and is sent electronically to the state’s health department or CDC. From there, the report can be automatically ingested into the jurisdiction’s disease surveillance system and linked to any existing case file, or it can initiate a new case investigation.

National ELR Infrastructure and Accelerated Reporting

In practice, ELR significantly accelerates lab reporting. CDC and APHL have built messaging infrastructure so that public health labs, commercial labs, and hospital labs can deliver results via a secure national network. States require both public and private labs to implement ELR to report notifiable diseases.

Because ELR uses codes and electronic messaging, it yields more complete data than faxes or manual entry.
CDC points out that ELR provides “timely, accurate, complete, and consistent” data to health departments, improving outbreak response efficiency.
For instance, during the COVID-19 pandemic, existing ELR connections allowed reporting of the vast majority of test results, CDC estimates 90% of U.S. tests were delivered electronically to public health, informing national decisions.

Laboratory Data Sharing Through HIEs and Care Networks

Laboratory interoperability also extends beyond notifiable disease. HIEs often aggregate lab results so that any treating clinician can see a patient’s complete lab history. A 2023 survey of HIEs found that nearly 80% make lab data available to participants, and most HIEs receive lab results in near-real-time from hospitals, physician practices, and commercial labs.

However, some large commercial labs historically have limited direct HIE connections, citing technical and value concerns. Nonetheless, regulatory measures like the 21st Century Cures Act’s information-blocking rule require labs to allow data access in most cases. The upshot is that patient-centric lab reporting (electronically delivered result messages) is now the norm: hospitals and public health programs routinely get lab data via HL7 interfaces or HIE feeds, rather than waiting for phone calls or faxes.

Standards, Code Sets, and LIMS Integration

Key to all lab data exchange is adherence to standards. CDC’s National Electronic Disease Surveillance System (NEDSS) architecture requires all jurisdictional systems to use LOINC to name tests and SNOMED to name results.

Likewise, the CDC’s Public Health Information Network publishes implementation guides for lab messaging. Because clinical labs already maintain LIMS that support HL7 output, most integration work is in mapping local test codes to LOINC and configuring HL7 endpoints. Federal funding through CDC’s Epidemiology and Laboratory Capacity grants has helped many states upgrade LIMS and interface engines to support ELR.

Hospital Networks and Health Information Exchanges

Hospitals as the Clinical–Public Health Data Bridge

Hospitals and health systems are the bridge between clinical care and public health. Nearly all large hospital systems now share data via Health Information Exchanges or direct networks. HIEs can operate centrally or federated or both. In a typical scenario, a hospital EHR publishes key clinical events either to a state HIE or directly to public health systems.

For example, a hospital’s lab system may send ELR to the state via the same HL7 interface it uses for HIEs, or a health system’s immunization module may automatically update the state IIS (immunization registry) as required.

Role of HIEs in Public Health Surveillance and Alerts

HIEs provide important services for public health. Many state or regional HIEs have agreements to forward relevant data to health departments.

A 2023 nationwide survey found that 70% of HIEs exchange data with state public health agencies, underscoring their role in disease surveillance.
HIEs collect data from hospitals, labs, clinics, and connect that data to PHAs.
For instance, some HIEs make patient encounter alerts available to public health when an individual with a chronic condition or outbreak-potential illness visits an emergency department.
Conversely, HIEs can route public health alerts or notifications back to hospitals (for follow-up or population health interventions).

Regulatory and Policy Drivers for Hospital Connectivity

Hospitals themselves are often required by law or policy to send data to public health. Under the CMS Promoting Interoperability (formerly Meaningful Use) programs, eligible hospitals and clinicians must connect to public health reporting services for certain data types.

For example, most hospitals must now send syndromic surveillance data, immunization records, electronic lab reports, and case reports via certified EHRs.
This policy linkage means that hospital IT teams are actively engaged in configuring interfaces: an EHR may be connected via HL7, DIRECT messaging, or FHIR APIs to each relevant public health registry or database.
Hospitals also participate in the Trusted Exchange Framework (TEFCA) through their role in Qualified Health Information Networks (QHINs).
TEFCA, by establishing trust rules and APIs, ultimately lets hospitals query and obtain data from public health systems and vice versa under a common governance.

Technical Interoperability Models and Exchange Mechanisms

At the technical level, hospital networks handle interoperability through a mix of methods: secure APIs (HL7 FHIR or older SOAP/REST interfaces), direct messaging, and HIE protocols. For example, under NNDSS modernization, a state might provide a secure FHIR endpoint for hospitals to send case data instead of HL7.

Or an HIE might use query-based exchange to let a public health user pull lab history on a patient. However, the most common and longstanding mechanism remains HL7 v2 messaging over secure channels (PHINMS, NwHIN DIRECT, or VPN tunnels). In effect, hospitals act as data sources, PHAs as data sinks/consumers, and HIEs or national networks as the plumbing enabling the flow.

Policy Initiatives and Governance

Federal Programs Driving Public Health Interoperability

Interoperability does not happen by itself, it is driven by coordinated programs, standards bodies, and funding. At the federal level, agencies have launched initiatives to modernize public health IT.

The CDC’s Public Health Data Interoperability initiative provides guidance and resources for states to adopt standards and streamline data sharing. CDC awarded hundreds of millions in Infrastructure and Capacity Improvement grants to build Implementation Centers, which help local health departments upgrade systems and connect to HIEs and TEFCA networks. On the standards side, the Public Health Information Network develops messaging guides and vocabularies, and the ONC’s Health IT Certification program now includes public health use cases.

Legal and Regulatory Frameworks for Data Sharing

Laws and regulations play a role too. The 21st Century Cures Act’s information blocking provisions prevent hospitals and labs from unreasonably withholding data from public health; public health is explicitly a priority purpose for interoperability.

The HIPAA Privacy Rule permits PHAs to receive individually identifiable health information for public health activities, and often states have their own public health reporting laws.

At the same time, concerns about privacy and data use mean that some jurisdictions use Data Use Agreements and technical safeguards to govern how data flows. CDC’s Core DUA initiative provides common templates to expedite agreements between providers and agencies.

State and Local Governance and Operational Oversight

Within state and local agencies, governance is key. Effective interoperability requires leadership and coordination across programs and between IT and epidemiology teams.

Many states have centralized enterprise architectures so that a single data warehouse or integration engine feeds multiple surveillance applications. This avoids duplicating interfaces for each disease program. States also often use master person indexes and provider directories to reconcile patients and send reports to the right jurisdiction. Operationally, health departments maintain IT support staff who onboard new hospital connections, monitor data flows, and work with CDC and APHL on technical issues.

Challenges and the Road Ahead

Despite progress, challenges remain. Data standards are still evolving (e.g. gradually moving from HL7 v2 to FHIR-based reporting). Smaller hospitals and rural clinics may lack IT capacity to implement new interfaces. Laboratories, especially large commercial ones, sometimes resist sharing certain data without clear incentives. Mismatches in local codes or workflows can cause data quality issues. Moreover, public health agencies must balance the flood of data (which can overwhelm surveillance staff) with the need for analytic tools to extract actionable signals.

However, the trend is clear: healthcare and public health are becoming better connected. Modernization efforts like TEFCA promise to unify national health data exchange. Ongoing initiatives like the CDC’s Data Modernization Initiative, APHL’s support programs, and HIE expansion will continue to weave hospital, lab, and public health IT together. In an age of emerging diseases and precision medicine, this interoperability ensures that no critical information falls through the cracks, enabling epidemiologists to detect threats and protect communities faster and more effectively than ever before.

Public Health Interoperability Services by CapMinds

CapMinds delivers end-to-end public health interoperability services that help hospitals, laboratories, HIEs, and public health agencies achieve compliant, real-time data exchange at scale.

We translate complex standards, policies, and surveillance requirements into reliable, production-ready integrations that reduce manual reporting and improve public health responsiveness.

Our service-led approach covers the full interoperability lifecycle, from strategy and architecture to implementation, optimization, and long-term support, ensuring your systems remain aligned with evolving CDC, ONC, and CMS mandates.

Our associated services include:

HL7 v2.x, FHIR, CDA interface development and management
Electronic Case Reporting (eCR) and ELR implementation
Public health registry integrations (NNDSS, IIS, syndromic surveillance)
HIE and TEFCA connectivity and onboarding
LOINC, SNOMED, ICD, RxNorm code mapping and data quality optimization
Security, governance, and HIPAA-compliant exchange design

With CapMinds, public health data moves faster, cleaner, and with confidence and more.