RESEARCH Multijurisdictional Approach to Biosur veillance, Kansas City Mark A. Hoffman,* Tiffany H. Wilkinson,† Aaron Bush,* Wayne Myers,* Ron G. Griffin,† Gerald L. Hoff,† and Rex Archer† An electronic reporting system for a network of 22 lab- oratories was implemented in Kansas City, Missouri, with an independent organization acting as a data clearing- house between the reporting laboratories and public health departments. The system ran in tandem with conventional reporting methods. Laboratory test orders and results were aggregated and mapped to a common nomenclature. Reports were delivered through a secure Internet connec- tion to the Kansas City Health Department (KCHD); during the first 200 days of operation, 359 qualified results were delivered electronically to KCHD. Data were received more quickly than they were with conventional reporting meth- ods: notification of chlamydia cases arrived 2 days earlier, invasive group A streptococcal disease cases arrived 2.3 days sooner, and salmonellosis cases arrived 2.7 days sooner. Data were more complete for all demographic fields, including address, age, sex, race, and date of birth. Two hundred fourteen cases reported electronically were not received by conventional means. Bmation sources of potential value in detecting an iosurveillance is the automated monitoring of infor- emerging epidemic, whether naturally occurring or the result of bioterrorism. Information sources that can be monitored for early warning include purchases of nonpre- scription medication (1) and symptoms reported during ambulatory care (2). Although these sources offer opportu- nities for early detection, they may also lead to high rates of false-positive reactions. A more definitive tool for bio- surveillance is the electronic reporting of diagnostic results confirming the presence of a pathogen. Heightened concerns about bioterrorism have led pub- lic health organizations to reevaluate methods used to report diseases. Currently, most healthcare providers noti- fy public health organizations of reportable diseases by telephone, fax, or mail (3). These techniques generally delay the communication of confirmatory test results and notification of the appropriate public health organization *Cerner Corporation, Kansas City, Missouri, USA; and †Kansas City Health Department, Kansas City, Missouri, USA (4). Underreporting is a major concern with traditional dis- ease surveillance strategies (5); even cases of severe dis- eases sometimes go unreported (6). In addition, substantial variability exists in the completeness of the information sent to public health; initial reports often include only the test result and the patient name. They lack demographic details that are useful to public health officials, requiring them to perform followup calls to get the additional infor- mation (7). These delays and inconsistencies may impair the ability of public health officials to detect or respond to a bioterrorist event. One solution to these deficiencies is to use an electronic system to report disease to public health authorities. Three approaches to electronic disease reporting are feasible. The first approach (Figure 1A) requires each healthcare provider to standardize clinical results (i.e., by using the Systematized Nomenclature of Medicine [SNOMED]) before sending results electronically to the appropriate authority. Researchers in Pittsburgh, working in an integrated delivery network that used a single data dictionary to minimize the difficulty of reconciling dis- parate coding systems, found this approach effective for electronic disease reporting (8). However, developing this type of system can be challenging because of the difficul- ty in updating multiple data dictionaries (translation tables that associate terms from multiple organizations). The sec- ond approach (Figure 1B) requires the use of result stan- dardization software (which collects data from multiple sites and attempts to automatically associate terms to stan- dard terms) at public health facilities. This approach places the responsibility for technology and personnel with the public health organizations. The third approach to elec- tronic reporting (Figure 1C) involves an intermediary organization that aggregates the data and distributes stan- dardized reports to public health organizations. Single jurisdiction systems using this approach have been devel- oped in Hawaii and Indianapolis (9,10). We developed a multiple-jurisdiction data clearinghouse system (11) and assessed the benefits of the system in terms of timeliness, data completeness, and geographic depth of coverage. Emerging Infectious Diseases • Vol. 9, No. 10, October 2003 1281