Five Years Experience with the NEDSS Base System in South Carolina: Revolution, Evolution, and Future Perspectives

South Carolina was one of the first states to adopt the NEDSS Base System (NBS), beginning in May of 2003.  Like all complex systems, the NBS has a history that reflects changes in design and process over time.  In the five years since the system came on line, improvements both within the system and in process have continued to make the system more usable.  During the past two years, the inclusion of electronic lab reports (ELRs) and web-based data entry by providers have improved the timeliness and completeness of disease reporting.  These improvements have required collaboration between South Carolina Department of Health and Environmental Control (DHEC), private providers, laboratories, and private software vendors.   Maintaining and improving these relationships is critical to continued improvements in disease surveillance.  We provide a brief history of South Carolina's implementation of the NBS, known internally as Carolinas Health Electronic Surveillance System (CHESS), and outline how the system has changed over the past five years.  We then compare the timeliness and completeness of surveillance data at various stages in this process to demonstrate where and how significant improvements have occurred.  Finally, we outline ways in which additional improvements can be made to this critical tool for disease surveillance and reporting.