This project aims to assess the impacts of state and federal laws on the practice of electronic syndromic surveillance (SyS) to monitor disease trends in near “real time.” The project will examine SyS systems operated by state and local health departments and their willingness to share SyS data with the Centers for Disease Control and Prevention (CDC) via the national BioSense system—a CDC-funded Internet “cloud-based” service hosted by the Association of State and Territorial Health Officials. The project team will examine five case-study sites to discern the impacts of disease reporting and health data security laws or regulations, data-sharing contracts, and the population health objectives of HITECH Act of 2009 to incentivize the “Meaningful Use” of electronic health records. The project will inform interpretation or revisions to laws and contracts in ways that would foster ongoing state and national efforts to strengthen SyS capacities.