The latter parts of 2007 and early months of 2008 witnessed an alarming number of deaths due to a Leptospirosis outbreak in Sri Lanka(1). An unusual number of patients presenting with symptoms of fever, headache or myalgia concentrated in particular geographic areas (North Central and North Western Province in Sri Lanka) could have signalled the epidemiologists of an abnormal event with the help of a quicker surveillance programme leading to possible implementation of optimal strategies which could possibly have minimized the early deaths and even prevented the progression of the outbreak. The present day paper-based disease surveillance and notification systems in Sri Lanka(2), confined to a set of notifiable diseases, often require 15-30 days to communicate data and for the central Epidemiology Unit to process it. This latency does not allow for timely detection of disease outbreaks and it limits the ability of the health system to effectively respond and mitigate their consequences. Therefore it negatively affects the health status of the work force and productivity of the country. The Real Time Bio-surveillance Program (RTBP) is a pilot study aiming to introduce modern technology to the Health Department of Sri Lanka to complement the existing disease surveillance and notification systems. The processes involve digitizing all clinical health records and analysing them in near real-time to detect unusual events to forewarn health workers before the diseases reach epidemic states. Similar studies have been conducted on bio terrorism surveillance in Winnipeg, Canada(3), pandemic surveillance in Morocco(4) and North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) in North Carolina(5). The infrastructure of the project RTBP is composed of an interconnected network between health care workers via mHealthSurvey mobile phone application, T-Cube web interface (TCWI) and Sahana Messaging/Alerting Module. Health records from health facilities, namely demographic information, symptoms, suspected and diagnosed diseases are collected through the mHealthSurvey, a mobile phone application(6), that feed in to the TCWI(7), a browser based software tool that detects adverse events; health officials are notified of the adverse events using the Sahana Alerting module that transports via Short Message Service (SMS), Email, and Web(10). Evaluation of the RTBP involves a replication study and parallel cohort study. This pilot study indicates the need for more robust mobile application for data collection with complete ontology, semantics and vocabulary in disease-syndrome information to reduce noise and increase reliability in the datasets. More rigorous capacity building and frequent use is required for health officials to take advantage of the full potential of TCWI. This paper discusses the technologies used in the pilot and the initial findings in relation to usability of the system