Background: Electronic disease reporting systems (EDRSs) are imperative for local health departments (LHDs) operating in the post-H1N1 and evidence-based public health practice era. Studies regarding functionality and factors responsible for variation in implementation are important but rare.

Purpose: This primary objective for this study was to provide evidence regarding the level to which LHDs have implemented electronic disease reporting systems and factors associated with variation in implementation of electronic disease reporting systems.

Methods: A quantitative analysis was performed of the 2013 Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials (NACCHO). The Profile study used a nationally representative sample of 625 LHDs and received an 81% response rate. Using a Multinomial Logistic Regression model, significant factors explaining variation were examined.

Results: Significant factors associated with the implementation of EDRSs were experienced (tenure) top executive, jurisdiction population size, region of geographic location, presence of Local Board of Health, type of governance, presence of health information specialist on staff, and number of clinical services performed.

Implications: For the advancement of public health surveillance in the 21st century, LHDs need the capacity for real time surveillance data collection and use, as well as, interoperable and integrated disease surveillance systems. Policies aimed at advancing disease surveillance in the United States might benefit from our findings on modifiable factors associated with the difference in EDRS implementation.