RESEARCH Table 1. Comparison of reporting times between conventional and electronic reporting and evaluation of reporting coverage Pathogen Average days earliera Electronic and traditionalb Electronic onlyc Total reports Reporting improvementd (%) Campylobacter sp. 0.6 10 7 17 70 Chlamydia trachomatis 2.2e 29 81 110 279 Cryptosporidium parvum 0.0 1 - 1 - Escherichia coli O157:H7 0.0 1 2 3 200 Giardia lamblia 0.0 1 12 13 1,200 Neisseria gonorrhoeae 0.3 50 48 98 96 Haemophilus influenzae 3.0 3 3 6 100 (invasive) Hepatitis A 0.0 1 - 1 - Hepatitis B 0.5 4 3 7 75 Hepatitis C 3.6 5 22 27 440 Influenza 1.2 5 3 8 60 Group A streptococcal infections 2.3f 7 1 8 14 (invasive) Borrelia burgdorferi 1.3 4 3 7 75 Salmonella sp. 2.7f 14 6 20 43 Shigella sp. 0.0 2 1 3 50 Streptococcus pneumoniae 8.0 1 - 1 - (invasive, drug-resistant) Treponema pallidum 0.4 5 21 26 420 Yersinia sp. 0.0 1 - 1 - aAverage days earlier was calculated by comparing the date on which the initial conventional report arrived to the date on which an electronic report was received. Only cases received by both means were used to calculate this value. bReports for these cases were received by both conventional means (mail, telephone, fax) and the laboratory information network. All reports received through traditional reporting were also received by the data clearinghouse. cReports for these cases were received only through the data clearinghouse and are not included in the counts for the “electronic and traditional means” column. dReceived electronically only/received through both means x 100. eSignificant as determined by Student t test (p<0.05). fSignificant as determined by Wilcoxon signed rank (p<0.05). and Indianapolis (8–10). Unlike these earlier studies, our data clearinghouse system gathered data from nonaffiliat- ed healthcare providers, applied a centralized data-map- ping team to provide efficiency of scale, and delivered data to multiple governmental entities with jurisdictions in a region that crossed state lines. Following the bioterrorist attack involving anthrax tainted letters during fall 2001, we developed and deployed this system rapidly. Formal design of the system began in December 2001; the system was fully operational by March 29, 2002. The use of standardized extraction scripts and a centralized data-mapping operation expedited this work. The data clearinghouse system was easy for cli- nicians to use because data extraction was automatic and did not require them to modify their workflow, unlike other biosurveillance systems that require users to reenter data into a Web page (12,13). This clearinghouse was also the first reported system to provide laboratory order-trend- ing information to public health organizations. Analysis of the data clearinghouse system adds to the evidence that electronic reporting of disease can offer sub- stantial benefits to public health. Our finding that electron- ic reporting improves timeliness is consistent with reports from Hawaii and other areas (9). Notably, our system attained a significant improvement in timeliness of detec- tion for Salmonella spp., as well as an improvement in underreporting of this pathogen. Salmonella and other pathogens tracked by the clearinghouse, including Shigella, E. coli O157:H7, Giardia lamblia, and Cryptosporidium parvum are classified by the Centers for Disease Control and Prevention as Class B bioterrorism agents: food or water safety threats. Class B agents have been used in biologic crimes, including the Dulles, Oregon, contamination of salad bars with salmonellae in which 751 people became ill (14). We compared the completeness of the data delivered by electronic reporting to data delivered by conventional means and found improvement for every data element evaluated. Greater completeness of data delivered by elec- tronic reports is a tangible benefit for both healthcare providers and public health workers as it reduces followup requests for additional information. Some fields, address in particular, had low values for completeness even for electronic reporting, which reflects gaps in the information in patient demographic information that is provided by physician offices to clinical laboratories. The data clearinghouse system reduced underreporting, especially for sexually transmitted diseases and enteric 1284 Emerging Infectious Diseases • Vol. 9, No. 10, October 2003