Direct Data Upload from Fillable PDF forms: Improving National Outbreak Surveillance through Enhanced Capacity to Report Electronic Data by State and Local Health Departments

Project Name: Direct Data Upload from Fillable PDF forms: Improving National Outbreak Surveillance through Enhanced Capacity to Report Electronic Data by State and Local Health Departments

Project Status: Proposed

Point of Contact: Jonathan Yoder

Center: NCEZID

Keywords: Outbreak surveillance, fillable PDF, National Outbreak Reporting System

Project Description: The National Outbreak Reporting System (NORS) is a web-based platform designed to support reporting to CDC by local, state, and territorial health departments all waterborne disease outbreaks and all enteric disease outbreaks transmitted by food, contact with environmental sources, infected persons or animals, or unknown modes of transmission ( Data collected through NORS are used to better understand the human health impacts of outbreaks, evaluate the causes and contributing factors of outbreaks, determine major modes of transmission for agents that cause illness and the settings where outbreaks occur, assess the burden of outbreaks in the United States and its territories, and develop guidance and recommendations for preventing future outbreaks.

This project aims to increase the ease, frequency, and timeliness for reporting outbreaks to NORS, as well as the quality of data contained within submitted reports. CDC and seven states are piloting NORSDirect, a system that reduces manual data entry by state and local health departments by enabling data to be uploaded directly from state databases to NORS. However, state partners want NORSDirect to be able to upload data from NORS PDF forms, which local health departments often complete to submit outbreak reports to state-level NORS users. The PDF form upload will allow those state health departments to submit all NORS variables to CDC in a single step—generating or updating a NORS report for each uploaded PDF form—and will make it easier for states with limited technical resources, decentralized reporting processes, or databases that are less compatible with NORS to use NORSDirect. CDC has already developed user-fillable PDF forms for local-to-state reporting that IT developers could adapt for this project.

Impact: More complete, timely, and accurate data to inform policy and prevention related to all waterborne, foodborne, and other enteric disease outbreaks. It will also reduce the need for state employees to hand-enter reports that they receive from their local health departments, thus reducing costly delays and data entry errors.
Scalability:  This project has broad potential for application at CDC among programs that collect data from state and local health departments. For CDC surveillance systems that do not have an electronic user interface for state and local users, it will provide a model mechanism for directly uploading data from user-fillable PDF forms into a system within the CDC firewall, For example, this functionality could be used in outbreak settings to avoid delays and errors associated with manual data entry when case and control interview forms need to be rapidly deployed to multiple settings and data must be efficiently and accurately collected and analyzed. The NORS team will be glad to share lessons learned with other CDC programs interested in this type of surveillance project.

Methodology: This project will be a collaboration between the NORS IT contract staff and CDC epidemiologists from NCEZID and NCIRD that manage the NORS system. This multidisciplinary team, representing different CIOs, has an established track record of developing an outbreak surveillance platform and working with state and local partners to provide needed functionality. Project components include developing requirements, programming the application, internal testing, and deploying to a pilot group of state NORS users. Final deployment will incorporate feedback from CDC and state-based NORS users.

Measure of success: Deployment of an application that directly uploads foodborne, waterborne, person-to-person and zoonotic outbreak data from fillable PDF forms into NORS

For more information about this project, please contact the CHIIC at or Brian Lee at

Page last reviewed: February 15, 2019