The Ohio Department of Health (ODH) has created a biosurveillance network, which was originally based on the Real-time Outbreak and Disease Surveillance (RODS TM created by the University of Pittsburgh and is now developed as EpiCenter TM and managed by Health Monitoring Systems, Inc. (HMS) (1Á3). The web-based system uses advanced statistical algorithms to generate alerts from thresholds that are tuned at the state scale of geography for surveillance of chief complaints during emergency department admissions. Interpretation of output and the use of the system is geared toward trained epidemiologists and infection control practitioners.