Inter-jurisdictional data sharing can enhance disease surveillance capabilities for local, state, regional and national public health situational awareness and response. BioSense 2.0, a cloud-based computing platform for syndromic surveillance, provides participating local, state and federal health jurisdictions with the ability to share aggregated data; a functionality that is easily activated by selecting an administrative checkbox within the BioSense application. Checking the data-sharing box, however, is a considerable decision that comes with benefits and consequences.