OBJECTIVE Syndromic surveillance for influenza-like illness (ILI) is predominantly performed in the outpatient setting. The objective of this study was to compare patterns of ILI activity in outpatient, emergency department (ED), and inpatient settings using an electronic syndromic surveillance algorithm. DESIGN Retrospective cohort study over 7.5 years. SETTING A large community health system comprised of 5 hospitals and >50 clinics. METHODS We applied an electronic syndromic surveillance algorithm for ILI to all primary-care outpatient visits, inpatient encounters, and ED encounters at our health system. Comparisons of ILI activity over time were performed using Spearman's rank correlation coefficient. Cross correlation was used to compare the timing of ILI activity among treatment settings. RESULTS Overall, 4,447,769 patient encounters occurred during the study period; 152,607 of these (3.4%) were consistent with ILI. The correlation coefficient for ILI activity in the outpatient versus ED setting was 0.877, and for the outpatient versus inpatient setting, the correlation coefficient was 0.699. ILI activity among outpatients preceded ILI activity among inpatients by 1 week. ILI activity among children in the outpatient setting preceded ILI activity among adults in all 3 settings by 1 week. CONCLUSIONS Syndromic surveillance for ILI in the outpatient setting yields similar results to surveillance in the ED setting, but it produces less similar results than ILI surveillance in the inpatient setting. ILI activity in the pediatric outpatient population is a potential predictor of future ILI activity in the general population. Infect Control Hosp Epidemiol 2017;38:393-398.