The New York City Department of Health and Mental Hygiene (NYC DOHMH) is a world leader in the use of electronic data for disease surveillance. The syndromic surveillance systems maintained by the Bureau of Communicable Disease process nearly four million emergency department encounters, 1.5 million calls for emergency medical service ambulance dispatch, 14 million pharmacy transactions, and over one million school health nurse visits annually. Sloan provided early support in 2002 ($700,000) and 2003 ($697,000) to the New York Academy of Medicine to help the NYC Department of Health to develop and disseminate the SATSCAN syndromic surveillance software which was very successful. Since that time, new tools and methods applicable to syndromic surveillance have been developed elsewhere, and NYC DOHMH would like to put them into practice. Funds from this grant will allow NYC DOHMH to make their system "state of the art", share their improvements with other public health departments across the country, and expand the applicability of electronic data for disease surveillance by incorporating novel statistical approaches and additional data streams for outbreak and cluster detection. Over the next three years, the NYC DOHMH team will conduct three main activities. First, they will review the literature of recent research and syndromic applications in other local jurisdictions. Second, they will analyze and evaluate select statistical methodologies that can be applied to existing data to determine if they prove more useful and informative for disease surveillance. Third, they plan to apply selected methodologies to everyday practice and prepare a user's guide-a basic how-to guide-that includes their code and examples of data visualizations.