Another major development is the advent of what has been termed ‘‘digital surveillance’’ or ‘‘digital disease detection .’’37 Although there is no precise definition of the term, it broadly includes the use of the internet and computer technologies for collecting and processing health information, including outbreak reports and surveillance data. These data may come from news reports on the internet, electronic submissions of surveillance data or reports from workers in the field or laboratory, or many other avenues. As such, there is some overlap with syndromic surveillance, although digital surveillance implies data collection through the use of electronic media and may include news reports or other sources that are not part of what would generally be considered syndromic surveillance. In an attempt to respond to what many saw as the fragmentation of disease surveillance systems and the lack of global capacity, ProMED (the Program for Monitoring Emerging Diseases) was begun in 1993 by a group of scientists, under the auspices of the Federation of American Scientists, as an international follow-up to earlier meetings, especially a 1989 National Institutes of Health (NIH) meeting on emerging viruses and the 1992 Institute of Medicine report.1,5 At meetings in Geneva and elsewhere, the ProMED Steering Committee recommended developing a system of regional centers to identify and respond to unusual disease outbreaks.38 This could be seen as elaborating on the system D. A. Henderson originally proposed at the 1989 NIH meeting.6 The original ProMED concept was for a surveillance network that could provide early warning of both emerging (previously unknown or unanticipated) infections as well as those more familiar. The strategy developed was vigilance for unusual clinical presentations of special concern based on specific case definitions (such as encephalitis or acute respiratory distress with fever in adults); a set of minimum microbiology capabilities at each site, to identify common diseases; and a system to refer unidentifiable samples to successively more sophisticated reference laboratories, through the network, for possible identification.38 The plan also included epidemiologic capacity, which could be provided rapidly through the network if needed.38 It soon became apparent that the 60 or so steering committee members from around the world had no consistent means of communicating with each other. As a result, in 1994, ProMED connected all its steering committee members by e-mail. Hard as it may seem to believe today, in 1994 the internet was only beginning to develop, e-mail was still not widely used, and the World Wide Web we take for granted today was virtually nonexistent, with little publicly available information or news sources. Internet coverage in many parts of the world was so limited that satellite uplinks were required (provided through another nonprofit organization, SatelLife, in Boston) to connect some of the members. The e-mail system, originally envisioned as a direct scientist-to-scientist network, rapidly grew into a prototype outbreak reporting and discussion list, and the decision was made almost immediately to make it publicly available to all at no charge. In October 1999, Although this often involves automated data collection,which offers obvious advantages, it is not a requirement.