In 2010, as rules for the Centers for Medicaid and Medicare Electronic Health Record (EHR) Incentive Programs (Meaningful Use) (1) were finalized, ISDS became aware of a trend toward new EHR systems capturing or sending emergency department (ED) chief complaint (CC) data as structured variables without including the free-text. This perceived shift in technology was occurring in the absence of consensus-based technical requirements for syndromic surveillance and survey data on the value of free-text CC to public health practice.