Acute cases also trigger high-priority interventions to limit the spread of disease. Clinician-initiated reporting of acute hepatitis B, however, is typically incomplete, delayed, and inaccurate: public health departments have found that up to 40% of cases reported by clinicians as acute hepatitis B turn out to be chronic infection upon Rebaudioside-A further investigation. Electronic laboratory reporting systems have improved both the volume and timeliness of hepatitis B case reports but these systems typically only report the presence of a positive test for hepatitis B�Cthey cannot distinguish between acute and chronic infections. The central challenge for both clinicians and lab surveillance systems in identifying acute hepatitis B is distinguishing acute cases from ����flares���� of previously undiagnosed chronic disease. Both can present with markedly elevated transaminases and positive hepatitis B specific tests such as hepatitis B surface antigen, envelope antigen, and viral DNA. Clinicians can make a probable distinction between acute and chronic disease by considering the context of diagnosis�Casymptomatic patients diagnosed after incidental discovery of elevated transaminases most likely have chronic disease whereas newly symptomatic patients with elevated transaminases likely have acute disease. This distinction is not entirely reliable, however, since new infections, hepatotoxins, cholelithiasis, and other unidentified factors can cause dramatic ����flares���� of chronic hepatitis B that resemble acute infection. Laboratory systems can only identify acute cases amongst patients that have positive tests for IgM to hepatitis B core antigen but this test is rarely ordered by clinicians investigating hepatitis. Analysis of data captured in electronic medical record systems and regional health information exchanges might be able to overcome the limitations of both clinician-initiated and electronic laboratory reporting of acute hepatitis B. Neferine Integration of multiple streams of electronic health data present in these systems such as current and prior diagnoses, prescriptions, and laboratory results may yield enough information to distinguish acute infection from chronic disease.