From 2003 to 2005, the Missouri Department of Health and Senior Services (DHSS) designed and implemented a new "syndromic" surveillance system.
It allows public health officials to use hospital electronic medical records to detect unusual clusters of disease symptoms that might signal an outbreak related to bioterrorism agents, such as anthrax, plague and smallpox, or more common conditions, such as influenza or sexually transmitted diseases.
In September 2005, 41 of Missouri's 126 hospitals were participating in the new bioterrorism surveillance system, reporting their disease symptom data electronically to state public health officials daily. By June 2006, 82 of the state's hospitals were participating. Psychiatric and rehabilitation hospitals; small, rural hospitals; and those without emergency rooms are exempt from the legal requirement to participate in the system.