After ELR implementation in Houston, the annual number of cases and number of reportable cases increased substantially (chart1); prior to the ELR implementation it took longer to report a case. The use of electronic disease surveillance system and the implementation of ELR improved the Houston disease surveillance system capacity of early case detection (table1); however, after ELR implementation, probably due to increase in case volume, it took longer to complete an investigation (table2); not substantial differences were found between cases pre and post ELR implementation, but cases populated by ELRs were less complete with case reporting information (table3).
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