Using the electronic data from the health information systems already in place in about eighty percent of the hospitals in Taiwan required by the National Health Insurance Payment Program and the technical support of the RODS Laboratory at the University of Pittsburgh, Taiwan's ED-SSS has been in operation since March, 2004 [14] . It is the first time in Taiwan that information technology and timely data directly from hospitals has been used with systematic approaches to facilitate public health surveillance. This report shares our experience of establishing an ED-SSS in a non-English-speaking country. It covers the process of taking into account the various needs at different levels of hospitals, discusses the stages of developing the system, and highlights the characteristics of ED-SSS data collected during the first year. The experiences reported here may benefit other countries seeking to establish or improve their own surveillance systems for infectious disease.