Figure. Steps in automated reporting of infectious disease data. The process begins with abstraction of reportable conditions using a software program. Data are stored in a file for future transmission or sent directly to the health department in the case of automated reporting systems. Typically, there are multiple clinical laboratories, and reports are transmitted in a variety of methods including file transfer protocol and dial-up modem at arranged intervals. State health departments review data and forward them to local health departments, where investigations are done and reportable conditions are determined. Local health departments forward data back to the state, where further analysis and interpretation are accomplished. The state uploads nationally notifiable diseases data to a secure data network at the Centers for Disease Control and Prevention. That agency sends data quality feedback to the state immediately. The level of feedback among states, laboratories, and local health departments is unknown but suspected to vary widely.