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California syndromic surveillance (calsys)

About CalSyS (California Syndromic Surveillance)

Last updated: September 9ā€‹, 2024

Colleagues pointing at graphsā€‹ā€‹

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CalSyS Visionā€‹ā€‹ā€‹ā€‹

ā€‹Improving public health outcomes in California through timely information, enabling rapid and equitable response.ā€‹

Before Caā€‹lSyS

Separated puzzle

Participation in syndromic surveillance in California has been decentralized, with independently participating local health departments (LHDs) in different stages of onboarding (i.e., from staging to live production environment) to the National Syndromic Surveillance Program's (NSSP's) BioSense Platform.  

  • As of July 2024, about 80% of all hospitals with emergency departments in the United States were reporting to the BioSense Platform. In comparison, about 30% of Californiaā€™s 340 hospitals with emergency departments currently report to BioSense. 
  • In total, there are about 340 general acute care hospitals in California with emergency departments that are eligible for onboarding to BioSense. Eligible emergency departments are distributed across 58 of the 61 LHDs (Alpine, Colusa, and Sierra LHDs do not have eligible emergency departments).   ā€‹
Learn more about how data is exchanged in CalSyS: Data Exchange in Syndromic Surveillance diagram.

Establishing CalSyS

Completed puzzle

The Office of Infectious Disease Preparedness and Response (OIDPR) in CDPHā€™s Center for Infectious Diseases (CID) is working towards establishing a coordinated, centralized statewide syndromic surveillance (SyS) program with standardized data across California using the NSSP BioSense Platform. The official name for this new program is CalSyS (California Syndromic Surveillance). ā€‹ā€‹ā€‹

The CalSyS team aims to have 100% of hospitals with emergency departments in California contributing standardized syndromic data to BioSense.  

On July 1, 2024, Trailer Bill Language (TBL) passed which supported the launch of the statewide CalSyS program and granted CDPH legal authority to collect and require syndromic data submissions from hospitals with emergency departments.

*Until regulations are finalized, there is no immediate action required of LHDs or hospitals. Regulations are expected to take up to 12 months to finalize. Once finalized, hospitals will have a 6-month grace period to act upon the requirements. Entities in LHDs where there is already required reporting to their local system should continue to report as usual. 

If LHDs and hospitals with emergency departments would like to start the onboarding process, they can do so by contacting the CalSyS team at CalSyS@cdph.ca.gov.

CDPH Becoming the BioSense Site Administrator  

CDPH is now the site administrator for the statewide California Site (CA Site) that currently exists in the BioSense Platform (separate from local Sites in the BioSense Platformā€‹). The CA Site coordinates the centralized exchange of syndromic data for CalSyS.  

The CalSyS team at CDPH is now the central coordinator for NSSP BioSense activities in California. NSSP is transferring administrator duties of the existing CA Site to the CalSyS team, handing over the responsibility to provide technical and administrative support to LHDs to onboard facilities, training and data access support, as needed.

CDPHā€™s initial priority will be managing existing data in BioSense, including: 

  • Accessing existing data from the approximately 30% of California emergency departments at general acute care hospitals that have already onboarded to BioSense.
  • Ensuring that local health departments retain access to any existing data in BioSense.   

Next priority will be integrating and analyzing new data, including:ā€‹ā€‹ā€‹ā€‹

  • ā€‹ā€‹ā€‹Integrating other data sources to inform a more complete picture of public health in California. ā€‹ā€‹ā€‹ā€‹
    • This will be more possible after local health departments and the CalSyS team collaborate to increase the percentage of emergency departments onboarded to BioSense and consequently the amount of health data available in BioSense.
  • ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹Importing data from the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE)ā€‹ within BioSense into a state infrastructure.ā€‹

    • ā€‹ā€‹ā€‹ā€‹ā€‹This will improve the efficiency of combining and sharing different data sets. ā€‹ā€‹For example, influenza-like illness (ILI) data in BioSense could be paired with ILI vaccination data, medical data, or vital records. 

ā€‹Program Goals 

The CalSyS program aims to:  

  • ā€‹Help protect health and safety of Californians by supporting rapid detection and response to emerging health and safety threats like outbreaks and climate related events that threaten health.
  • Inform a more complete picture of public health threats in California through increased submission of patient data from emergency departments to the BioSense Platform and data integration. 
  • Standardize data to be comparable across jurisdictions and to support streamlined collaboration between public health and healthcare groups to detect and respond to events of public health concern. 
  • Quantify health inequities and inform effective policymaking and resource allocation. 

LHD & CDPH Data Sā€‹haring ā€‹

The CalSyS team is drafting a Data Use Agreement (DUA) to be used with LHDs that would facilitate syndromic surveillance data sharing and outline related responsibilities of LHDs and CDPH, including the role of CDPH as site administrator of the statewide CA Site in the BioSense Platform.

Onboarding 

As site administrator of the statewide CA Site in the BioSense Platform, CDPH will be able to support LHDs with onboarding processes, in collaboration with NSSP. Regardless of whether LHDs/emergency departments have already submitted data to the BioSense Platform or have yet to start, CalSyS will provide support. 

LHDs fall into one of the following categories:  

  • LHDs Currently Conducting Syndromic Surveillance Activities: 
    • The CalSyS team plans to first contact this group of LHDs, which includes LHDs that are currently site administrators for their own local sites or are currently accessing data from the CA Site in BioSense.  
    • The CalSyS team will work with these LHDs to sign Data Use Agreements (DUAs) and manage existing data in the BioSense Platform. These LHDs will continue to access and analyze data as usual.  
  • LHDs Not Currently Conducting Syndromic Surveillance Activities: 
    • The CalSyS team plans to support this group of LHDs after working with LHDs that have already contributed syndromic data to BioSense. This group includes LHDs that are not currently contributing data in BioSense. 
    • These LHDs are not required to take any action at this time. However, any LHDs that would like to start the onboarding process can contact the CalSyS Team at CalSyS@cdph.ca.govā€‹
ā€‹ā€‹Until regulations are finalized, there is no immediate action required of LHDs or hospitals. ā€‹ā€‹Regulations are expected to take up to 12 months to finalize. Once finalized, hospitals will have a 6-month grace period to act upon the requirements. Entities in LHDs where there is already required reporting to their local system should continue to report as usual. 
However, if LHDs would like to start the onboarding process, they can do so by contacting the CalSyS team at CalSyS@cdph.ca.govā€‹.ā€‹

Benefits of Onboarding to the California Site 

The statewide syndromic surveillance program will establish a centralized CA Site in the BioSense Platform in which CDPH, LHDs, and healthcare facilities can exchange and access standardized, comparable data across jurisdictions to support monitoring of public health.

Benefits of onboarding to the CA Site include:

  • Access to Standardized, Near Real-Time Data that is Comparable Across Jurisdictions
    • Increased contribution of syndromic data from hospitals with emergency departments to BioSense will inform a more complete understanding of public health in California, including disease trends that may impact hospitals. 
      • As of July 2024, about 80% of all hospitals with emergency departments in the United States were reporting to BioSense, but only about 30% of hospitals with emergency departments in California were reporting to BioSense. 
    • For example, the statewide system will support quick tracking of hospital capacity as well as the burden of disease on healthcare systems. The data can also be queried for syndromes of interest. 
    • The CalSyS team also aims to standardize this data so that it is comparable across jurisdictions. 
  • Streamlined Onboarding When LHDs onboard to the CA Site in BioSense, the CalSyS team will be able to streamline onboarding of new facilities and healthcare systems, as well as provide troubleshooting and help desk support to LHDs. For example, the CalSyS team aims to onboard healthcare systems together when possible. 
  • Coordination between Public Health and Healthcare Systems 
    • BioSense will enable hospitals to provide automated data to public health that could reduce the need for ad hoc data requests associated with outbreaks and emergency responses, thus saving time and resources.   
    • BioSense data may also be valuable for community health needs assessments for strategic planning between hospitals with partnership with LHDs. 
  • Meeting Centers for Medicare & Medicaid Services (CMS) Requirements for Promoting Interoperability Program (PIP) Participation in syndromic surveillance can help hospitals meet requirements for CMS PIP. CDPH is investigating next steps to support hospital participation in CMS PIP as it pertains to syndromic surveillance. Learn more about the CMS PIP requirements: CMS Resource Library.ā€‹

  • Access to Communities of Practice The CalSyS team will lead a California Syndromic Surveillance Community of Practice (CoP) where LHDs participating in the statewide program can collaborate on syndromes of interest, surveillance trends, methodology, and more.
  • Support from CDPH The CalSyS team will provide support to both LHDs who have and have not already submitted data to NSSP with onboarding emergency departments to the BioSense Platform. The CalSyS team will work with LHDs to maximize benefits of participating in the CalSyS Program. Support will include: 
    • Technical Support The CalSyS team will provide technical support with onboarding emergency department data to BioSense for both LHDs which are in the process of participating in syndromic surveillance as well as those with existing syndromic surveillance programs. 
    • Data quality and surveillance support The CalSyS team will support data quality efforts and spearhead statewide analysis and reporting of syndromic trends. 
    • Data Integration In the future, CalSyS aims to lead efforts to integrate syndromic data with other data sources to inform a more complete picture of public health in California. ā€‹

ā€‹ā€‹ā€‹ā€‹More Information 

More Information for Health Departments and Providers ā€‹


Please email the CalSyS team at CalSyS@cdph.ca.govā€‹ā€‹ ā€‹with any questions.
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