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We have developed a real-time syndromic surveillance system with geographic information system disease mapping capabilities. The system includes four major components: real-time data collection, syndrome classification, dynamic spatial mapping, and query capabilities. An electronic medical record system at an urban teaching hospital is the source of real-time ICD-9 discharge data which are then mapped into syndrome categories. The GIS disease mapping is a web-based tool of value to epidemiologists and public health officials for the interpretation and analysis of both routine and outbreak related health data.