Introduction: Key elements that can be measured objectively to evaluate the effectiveness of a surveillance system include sensitivity, specificity, and timeliness. Statistical algorithms and data sources have been evaluated frequently; however, factors that affect whether public health professionals will use a system (e.g., acceptability, generalizability, flexibility, representativeness, and reliability) are more difficult to assess and are reported less frequently. Through the Joint Services Installation Pilot Project (JSIPP), the Department of Defense provided nine military installations with enhanced capabilities to detect and respond to weapons of mass destruction. The Department of Homeland Security is funding BioNet to improve outbreak management in San Diego, California, by integrating military and civilian information. Both programs implemented versions of the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) IV for medical surveillance and required evaluation within these environments.

Objectives: This study measured JSIPP and BioNet users' perspectives of syndromic surveillance and the use of ESSENCE IV.