We currently have 31 data requests in our online tracking system. Each data request represents multiple e-mails and phone calls, iterative revisions to the data request and multiple data pulls from the NC DETECT database. Requests can be delayed when researchers request data elements that are not collected by NC DETECT, submit unclear requirements, change requirements, do not understand the challenges of processing free text data and/or add/change researchers who will be accessing the data. Requesters have used NC DETECT data to publish manuscripts on topics including the health effects of wildfires, ED visits for cancer patients, tick-borne illness and asthma, and comparison of NC ED visit data to national data, among others. Because the ED visit data are collected under a state mandate and in collaboration with the NCHA, their release and use for research is thoroughly evaluated by the DOC. The complexity of the data requests over time has resulted in changing of data use restrictions, as well as revisions of the DUA wording. We do not have enough resources to closely monitor the use of the data once they are provided to researchers. However, researchers are expected to abide by all provisions detailed in their DUA and by signing acknowledge the potential penalties for violation of the terms the agreement.