During the planning phase, it was necessary to gain a full understanding of what not only just public health personnel expected but also what the medical staff at participating hospitals expected from the ED-SSS. Public health officials tended to prefer a timely and sensitive surveillance system able to detect all possible outbreaks of emerging or known infectious diseases. Mostly concerned over the limited public health resources, they wanted more evidence to prove the cost-effectiveness of ED-SSS and fewer false positive signals from pilot studies before integrating the system into routine public health surveillance workflow. On the other hand, the hospitals and their medical staff had three major expectations. First, the hospitals expected an easily operated feedback mechanism and quick feedback of useful information for better decision-making. Those who had experienced nosocomial infection of SARS during the 2003 SARS outbreak were particularly interested having analyzed information, based on their own hospital or regional/national hospital data, quickly fed back them. They believed that this would provide incentive for them to share hospital data and routinely maintain the high quality of their data for public health usage. Second, the hospitals anticipated two-way communication with public health agencies, as they frequently been requested or even forced to send data on short notice when they were too busy or too involved in emergency care. What made matters worse, despite their compliance; they had difficulty in obtaining useful feedback information from the public health agencies so that they could improve their care of patients at the time of an outbreak crisis. Third, the hospital decision-makers wanted immediate firsthand feedback, particularly with regard to control of nosocomial infection and hospital management in order that their health-care workers could be protected during regional outbreaks. Considering the expectations of both public health agencies and hospitals, we learned that the syndromic surveillance system should provide efficient means of feedback and effective two-way communication.