Health Department Name
* must provide value
Health Department Address
Jurisdiction Type
* must provide value
City County Tribal Territorial State
May your jurisdiction be named in the final report?
* must provide value
Yes
No
Would you like a copy of the final report?
Yes
No
Is your department funded for ELR by the Centers for Disease Control and Prevention (CDC) through the Epidemiology and Laboratory Capacity (ELC) Grant?
Yes
No
What was the percent volume of ELR received in calendar year 2018 that was reported during your 2019 3rd Quarter ELC Call for communicable diseases? (If not funded by ELC, what was your percent volume received by ELR for calendar year 2018.)
What percent of the ELR volume received is automatically ingested by the surveillance system?
What percent of the ELR volume received is ingested by the surveillance system but requires manual intervention?
What percent of the ELR volume received is manually entered into the surveillance system?
Please complete this sentence: My organization was/is a(n) ______________________ of ELR.
Innovator (trailblazer)
Early Adoptor (benefit was recognizaed)
Early Majority (a gain in productivity was documented)
Late Majority (support was readily available)
Laggard (grant required or managment decision)
Surveillance/Informatics staff requirements pre-ELR.
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Technical Experience Level
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Add another staff classification?
Yes
No
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Add another staff classification?
Yes
No
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
i.e. data entry clerk
i.e. data entry, quality assurance
Number of full-time equivalents
Entry level Professional Mid-level manager Senior level manager
Not applicable Fundamental awareness (basic awareness) Novice (limited experience) Intermediate (practical application) Advanced (applied theory) Expert (recognized authority)
Which surveillance system did your jurisdiction use pre-ELR?
Was the system referenced in the previous question a homegrown (created-in-house) or commerical off-the-shelf (COTS) system?
homegrown COTS
Which surveillance system does your jurisdiction currently use?
Is the system reference in the previous question a homegrown (created-in-house) or commercial off-the-shelf (COTS) system?
homegrown COTS
How long in months (from identification of need to implementation) does it take for a change to be made to your surveillance system?
average number in months
How did your ELR workflow develop?
Organically - developed in a slow and natural way Responsive - developed in response to external forces Deliberately planned - developed in a formal process prior to implementation
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