RESEARCH Acknowledgments We thank Lesha Dennis, Gary Dickerson, Suzanne Fiske, Andrew Friede, Jody Gosch, Kim Hlobik, and Karen Miscavish; the Information Technology staff at Health Midwest; St. Luke’s Shawnee Mission, Truman; Sisters of Mercy; and the Kansas City Health Department. This project was funded independently by Cerner Corporation and the Kansas City Health Department. Cerner Corporation has a financial interest in the HealthSentry clearing- house system. Dr. Hoffman is a molecular microbiologist at Cerner Corporation. His research interests include biosurveillance, bioinformatics, medical informatics, and clinical decision sup- port software. In addition to his work on the HealthSentry biosur- veillance system, Dr. Hoffman is a co-investigator on an Agency for Healthcare Research and Quality HIV clinical decision sup- port grant and leads efforts at Cerner to capture and structure genomic information in electronic medical records. References 1. Goldenberg A, Shmueli G, Caruana RA, Fienberg SE. Early statisti- cal detection of anthrax outbreaks by tracking over-the-counter med- ication sales. Proc Natl Acad Sci U S A 2002;99:5237–40. 2. Lazarus R, Kleinman K, Dashevsky I, Adams C, Kludt P, DeMaria A Jr, et al. Use of automated ambulatory-care encounter records for detection of acute illness clusters, including potential bioterrorism events. Emerg Infect Dis 2002;8:753–60. 3. Thacker SB, Choi K, Brachman PS. The surveillance of infectious diseases. JAMA 1983;249:1181–5. 4. Schwarcz SK, Hsu LC, Parisi MK, Katz MH. The impact of the 1993 AIDS case definition on the completeness and timeliness of AIDS surveillance. AIDS 1999;13:1109–14. 5. Kimball AM, Thacker SB, Levy ME. Shigella surveillance in a large metropolitan area: assessment of a passive reporting system. Am J Public Health 1980;70:164–6. 6. Ackman DM, Birkhead G, Flynn M. Assessment of surveillance for meningococcal disease in New York State, 1991. Am J Epidemiol 1996;144:78–82. 7. Teutsch S, Churchill RE. Principles and practice of public health sur- veillance. New York: Oxford University Press; 1994. 8. Panackal AA, M’ikanatha NM, Tsui FC, McMahon J, Wagner MM, Dixon BW, et al. Automatic electronic laboratory-based reporting of notifiable infectious diseases at a large health system. Emerg Infect Dis 2002;8:685–91. 9. Effler P, Ching-Lee M, Bogard A, Ieong MC, Nekomoto T, Jernigan D. Statewide system of electronic notifiable disease reporting from clinical laboratories: comparing automated reporting with conven- tional methods. JAMA 1999;282:1845–50. 10. Overhage JM, Suico J, McDonald CJ. Electronic laboratory report- ing: barriers, solutions and findings. J Public Health Manag Pract 2001;7:60–6. 11. HealthSentry [computer program]. Kansas City (MO): Cerner Corp.; 2002. 12. Syndromic surveillance for bioterrorism following the attacks on the World Trade Center—New York City, 2001. MMWR Morb Mortal Wkly Rep 2002;51:13–5. 13. Zelicoff A, Brillman J, Forslund DW, George JE, Zink S, Koenig S, et al. The rapid syndrome validation project (RSVP). Proc AMIA Symp 2001;771–5. 14. Torok TJ, Tauxe RV, Wise RP, Livengood JR, Sokolow R, Mauvais S, et al. A large community outbreak of salmonellosis caused by inten- tional contamination of restaurant salad bars. JAMA 1997;278:389–95. 15. Harkess JR, Gildon BA, Archer PW, Istre GR. Is passive surveillance always insensitive? An evaluation of shigellosis surveillance in Oklahoma. Am J Epidemiol 1988;128:878–81. 16. MacKenzie WR, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, et al. A massive outbreak in Milwaukee of cryptosporid- ium infection transmitted through the public water supply. N Engl J Med 1994;331:161–7. 17. National Electronic Disease Surveillance System (NEDSS): a stan- dards-based approach to connect public health and clinical medicine. J Public Health Manag Pract 2001;7:43–50. Address for correspondence: Mark Hoffman, Cerner Corporation, 2800 Rockcreek Parkway, Kansas City, MO 64117-2551, USA; fax: (816) 571- 3291; email: mhoffman1@cerner.com 1286 Emerging Infectious Diseases • Vol. 9, No. 10, October 2003