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Lawrence P. Hanrahan,¹ Henry A. Anderson,¹ Brian Busby,² Marni Bekkedal,¹ Thomas Sieger,¹ Laura Stephenson,¹ Lynda Knobeloch,¹ Mark Werner,¹ Pamela Imm,¹ and Joseph Olson¹

¹Division of Public Health, Wisconsin Department of Health and Family Services, Madison, Wisconsin, USA; ²E-Commerce, University of Wisconsin Division of Information Technology, Madison, Wisconsin, USA

Abstract
In this article we describe the development of an information system for environmental childhood cancer surveillance. The Wisconsin Cancer Registry annually receives more than 25,000 incident case reports. Approximately 269 cases per year involve children. Over time, there has been considerable community interest in understanding the role the environment plays as a cause of these cancer cases. Wisconsin's Public Health Information Network (WI-PHIN) is a robust web portal integrating both Health Alert Network and National Electronic Disease Surveillance System components. WI-PHIN is the information technology platform for all public health surveillance programs. Functions include the secure, automated exchange of cancer case data between public health-based and hospital-based cancer registrars ; web-based supplemental data entry for environmental exposure confirmation and hypothesis testing ; automated data analysis, visualization, and exposure-outcome record linkage ; directories of public health and clinical personnel for role-based access control of sensitive surveillance information ; public health information dissemination and alerting ; and information technology security and critical infrastructure protection. For hypothesis generation, cancer case data are sent electronically to WI-PHIN and populate the integrated data repository. Environmental data are linked and the exposure-disease relationships are explored using statistical tools for ecologic exposure risk assessment. For hypothesis testing, case-control interviews collect exposure histories, including parental employment and residential histories. This information technology approach can thus serve as the basis for building a comprehensive system to assess environmental cancer etiology. Key words: childhood cancer, environment, exposures, informatics, information systems, public health, surveillance, tracking. Environ Health Perspect 112:1434-1439 (2004) . doi:10.1289/ehp.7150 available via http://dx.doi.org/ [Online 3 August 2004]

This article is part of the mini-monograph "National Environmental Public Health Tracking," which is sponsored by the Centers for Disease Control and Prevention (CDC) .

Address correspondence to L.P. Hanrahan, Bureau of Health Information and Policy, Division of Public Health, Wisconsin Department of Health and Family Services, Room 372, 1 West Wilson St., Madison, WI 53702 USA. Telephone: (608) 267-7173. Fax: (608) 267-4853. E-mail: hanralp@dhfs.state.wi.us

This work was funded by CDC through the Wisconsin Environmental Public Health Tracking Program (grant U50/CCU522439-01) .

This article was supported by an environmental public health tracking cooperative agreement from CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

The authors declare they have no competing financial interests.

Received 1 April 2004 ; accepted 3 August 2004.