Syndromic surveillance; Meaningful Use; free-text; EHR Introduction NC DETECT provides near-real-time statewide surveillance capacity to local, regional and state-level users across NC with twice daily data feeds from 117 (99%) emergency departments (EDs), hourly updates from the statewide poison center and daily feeds from statewide EMS runs and select urgent care centers. The NC DETECT Web application provides access to aggregate and line listing analyses customized to users' respective jurisdictions. The most active users are state-level epidemiologists (DPH) and hospital-based public health epidemiologists (PHEs). The use of NC DETECT is included in PHE job descriptions, and functionality has been developed specifically to meet their surveillance needs, including data entry of aggregated laboratory results for flu and respiratory panels. Interviews of local health department (LHD) users completed as part of an evaluation project have suggested that functionality specifically tailored to LHDs may increase their use of the NC DETECT Web application (1). As of June 2011, there were 139 LHD users with active NC DETECT accounts (out of 384 total users with active accounts). Methods Initial information-gathering sessions were held with DPH stakeholders on April 7 and 12, 2011. Mock-ups based on these meetings were discussed with LHD focus groups on April 13 and 14 via Web conference. A later version of the prototype was shown in person at a health department epidemiology team meeting on May 13, and feedback from that meeting was incorporated into the initial release of the dashboards, which were made available to LHD users on June 14, 2011. On June 21, 2011, drill down functionality was added to the dashboards, and on June 30, 2011, the dashboards were made available to DPH users. The dashboards were developed in Java to integrate with our existing Web application using Java and jQuery.