NH's surveillance consists of assessing individual but compatible surveillance systems for (1) rapid detection of a covert bioterrorism attack and (2) early detection of naturally occurring outbreaks (i.e., influenza). The OTC pharmaceutical system was implemented with automated data processing and alerting within an enterprise architecture. Modified Shewhart charting was developed with dynamic system modeling using a knowledge base technique. Community health status was charted with a set of state syndrome variables and dynamic processes, where baselines, thresholds, trend analysis and alerts from historic data were automatically charted (1). This technical framework was implemented in STEMS with OTC data, school absentee data and occupational health data, then later in AHEDD. The AHEDD system also used the Real-Time Outbreak and Disease Surveillance CoCo chief complaint classifier with electronic data feeds from four hospitals. AHEDD was later expanded to include drill down custom querying for all 26 acute care hospitals (allowing NH to realize statewide ED surveillance).