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The Johns Hopkins University Applied Physics Laboratory (JHU/APL) implemented state and district surveillance nodes in a central aggregated node in the National Capital Region (NCR). Within this network, de-identified health information is integrated with other indicator data and is made available to local and state health departments for enhanced disease surveillance. Aggregated data made available to the central node enable public health practitioners to observe abnormal behavior of health indicators spanning jurisdictions and view geographical spread of outbreaks across regions.Forming a steering committee, the NCR Enhanced Surveillance Operating Group (ESOG), was key to overcoming several data-sharing issues. The committee was composed of epidemiologists and key public health practitioners from the 3 jurisdictions. The ESOG facilitated early system development and signing of the cross-jurisdictional data-sharing agreement. This agreement was the first of its kind at the time and provided the legal foundation for sharing aggregated health information across state/district boundaries for electronic disease surveillance.Electronic surveillance system for the early notification of community-based epidemics provides NCR users with a comprehensive regional view to ascertain the spread of disease, estimate resource needs, and implement control measures. This article aims to describe the creation of the NCR Disease Surveillance Network as an exceptional example of cooperation and potential that exists for regional surveillance activities.

Emerging technologies, such as Web-based data query systems (WDQSs), provide opportunities for state and local agencies to systematically organize and disseminate data to broad audiences and streamline the data distribution process. Despite the progress in WDQSs' implementation, led by agencies considered the "early adopters," there are still agencies left behind. This article explores the organizational issues and barriers to development of WDQSs in public health agencies and highlights factors facilitating the implementation of WDQSs.

This article describes the process for developing consensus guidelines and tools for releasing public health data via the Web and highlights approaches leading agencies have taken to balance disclosure risk with public dissemination of reliable health statistics. An agency's choice of statistical methods for improving the reliability of released data for Web-based query systems is based upon a number of factors, including query system design (dynamic analysis vs preaggregated data and tables), population size, cell size, data use, and how data will be supplied to users. The article also describes those efforts that are necessary to reduce the risk of disclosure of an individual's protected health information.

The All Kids Count program began in late 1991 with funding from The Robert Wood Johnson Foundation. The purpose was to improve child health and the delivery of immunizations and preventive services through the development of health information systems. All Kids Count concluded in mid-2004 having worked directly with 38 state and local health agencies through its grant and Connections program. The lessons learned from the 13-year program are applicable to other public health and medical care initiatives. Health information systems projects should: (1) involve stakeholders from the beginning, (2) recognize the complexity of establishing a population-based information system, (3) develop the policy/business/value case for information systems, (4) define the requirements of the system to support users' needs, (5) develop information systems according to current standards, (6) address common problems collaboratively, (7) plan for change, (8) plan boldly but build incrementally, (9) develop a good communications strategy, and (10) use the information (even if not perfect). Opportunities exist for public health agencies to share their experiences from developing immunization registries and integrated child health information systems and to develop collaborative approaches to improving the nation's health information infrastructure.

Development of effective public health information systems requires understanding public health informatics (PHI), the systematic application of information and computer science and technology to public health practice, research, and learning. PHI is distinguished from other informatics specialties by its focus on prevention in populations, use of a wide range of interventions to achieve its goals, and the constraints of operating in a governmental context. The current need for PHI arises from dramatic improvements in information technology, new pressures on the public health system, and changes in medical care delivery. Application of PHI principles provides unprecedented opportunities to build healthier communities.