Every line on his spreadsheet has a story. In Kansas City, for instance, the health-care vendor Cerner is working with local hospitals to automatically send certain computerized lab reports to health departments in Kansas and Missouri. Only health departments have the key to unencrypt identifying information, but physicians at any of the 23 participating hospitals can view the region’s trend data for research purposes. "Before, we were living in our own little pockets of data," says John Wade, vice president and CIO of Saint Luke’s Health System, one of the participating organizations.

In the Minneapolis area, after much wrangling over HIPAA, the nonprofit health-care organization Health Partners started sending information about flu-like illnesses to researchers at the Harvard Medical School, as part of a $1.2 million early warning system funded by the CDC. Other participants include Kaiser Permanente and Optum, which runs a national 24-hour health hot line. "I’ve spent as much time working on the privacy concerns as everything else combined," says Dr. James Nordin, a clinical research investigator at Health Partners. "What we have done is to be very limited about the information that goes out to the Minnesota Department of Health and even more limited about the information that we send to the data center at Boston."

And in New Mexico, researchers at Sandia National Labs have developed a system called the Rapid Syndromic Validation Project—the only one of the bunch that, instead of fishing information out of existing data streams, requires health-care providers to actually log on to a secure website and type in information about a patient’s symptoms in return for trend and treatment information. "We tell the doctor that we only want sick people, and we give the doctor something back that’s relevant to the patient they’re treating not in 10 days but in 10 seconds," says Alan Zelicoff, the senior scientist who developed the system and hopes it will eventually be used across the country.

In those programs and dozens of similar ones in the works, there’s more than a little braggadocio involved. "This one’s the best," Zelicoff says, by way of greeting a CIO reporter who called for an interview.

And there’s more than a little overlap too. "I see a lot of efforts out there that are redundant," McLamb says. "If people who are doing the same thing would get together, they wouldn’t have to reinvent the wheel."

A $918 Million Pie

With so many projects being developed by so many entities, the ultimate success of any national bioterror surveillance system will depend on one thing: whether those systems can ever talk to each other. And if there’s one thing that everyone involved agrees on, it’s the need for standards.