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CalSyS Frequently Asked Questions

california syndromic surveillance (calsys)

CalSyS Frequently Asked Questions and Answers

Last updated: August 23, 2024

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Data Interoperability and Exchange

Centers for Medicare and Medicaid Services (CMS) Program for Promoting Interoperability

Has CDPH declared readiness for syndromic surveillance reporting for the CMS Program for Promoting Interoperability (CMS PI)?
What other CDPH programs use hospital data to guide emergency response efforts?

About CalSyS

1. What is CDPH’s vision for CalSyS?

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

CDPH has launched a new statewide syndromic surveillance program called CalSyS (California Syndromic Surveillance). The Office of Infectious Disease Preparedness and Response (OIDPR) in CDPH’s Center for Infectious Diseases (CID) is working to establish a coordinated, centralized statewide syndromic surveillance (SyS) program with standardized data across California.

On July 1, 2024, Trailer Bill Language (TBL) passed which supported the launch of CalSyS and authorized 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.

3. What is the current level of participation in syndromic surveillance across California?

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 California’s 340 hospitals with emergency departments currently report to BioSense.

In total, there are about 340 general acute care hospital 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).

Learn more about how data is exchanged in CalSyS: Data Exchange in Syndromic Surveillance diagram.

Establishing CalSyS

The Office of Infectious Disease Preparedness and Response (OIDPR) in CDPH’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).

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

Completed puzzle

Onboarding

1. What action is currently required of local health departments and hospitals with emergency departments?

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.

However, 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.

 LHDs Currently Conducting Syndromic Surveillance Activities – LHDs that are currently site administrators for their own local sites or are currently accessing data from the CA Site in BioSense will continue to access and analyze data as usual.
LHDs Not Currently Conducting Syndromic Surveillance Activities – LHDs that are not currently contributing data in BioSense 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.gov.

Support – Regardless of whether LHDs/EDs have already submitted data to the BioSense Platform or have yet to start, CalSyS will provide support. Reach out to CalSyS with any questions: CalSyS@cdph.ca.gov.

2. What is a Site on the BioSense platform?

According to NSSP, a Site is a public health department (local, state, county, or federal) that serves as the administrative hub for any number of facilities (e.g., hospitals, emergency departments, urgent care centers) that will submit data to the BioSense Platform.

Within a Site, facility data are pooled for a better understanding of community health. A Site oversees the activities of facilities, which share the same Site Administrator and Master Facility Table (a table to track facilities that are onboarding).

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

Learn more at the CDC NSSP’s Onboarding Resources webpage.

3. What is a site administrator on the BioSense platform?

According to NSSP, a site administrator oversees all aspects of onboarding and collaborates with NSSP to provide technical and onboarding support. Whether a Site Administrator oversees 1 facility or 500, the tools and processes are identical.

A Site Administrator creates user accounts, manages access to data on the BioSense Platform, assists with passwords and licenses, and should inform team members of new program guidance, publications, and tools.

CalSyS 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 Platform). CDPH will be 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.

Learn more at the CDC NSSP’s Onboarding Resources webpage.

4. What is facility onboarding?

According to NSSP, facility onboarding is a planning and four-phase process in which Site Administrators help local health information exchanges, facilities, and vendors prepare for transmitting data from internal medical record systems to the BioSense Platform; review data for adherence and completeness; and approve facilities for live operation.

5. What is the difference between local Sites and the California Site (CA Site) in the BioSense Platform?

California Site (CA Site)

The CA Site in the BioSense Platform coordinates the centralized exchange of syndromic data for the statewide CalSyS Program.

In the absence of a centralized statewide syndromic surveillance program prior to July 1, 2024, NSSP oversaw the CA Site in the BioSense Platform and facilitated data access and onboarding support. Some LHDs have already contributed data to the CA Site in BioSense. Now that CDPH has become Site Administrator of the CA Site, NSSP will transfer administrator duties on the 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.

Local Sites

Additionally, some LHDs have created their own local syndromic surveillance Sites in the BioSense Platform (these sites are separate from the CA Site) and have onboarded emergency departments to their local Sites. These LHDs have acted as their own Site Administrators to onboard facilities and facilitate data access.

6. Does CDPH recommend creating local BioSense Sites?

No, the CalSyS team strongly recommends that LHDs which are starting the onboarding process contribute data to the CA Site in BioSense.

Contributing to the centralized CA Site supports:

Streamlined onboarding of new facilities and healthcare systems.
Streamlined exchange of standardized data that are comparable across jurisdictions.
The CalSyS team will be better able to provide troubleshooting and help desk support to LHDs.

Additionally in the future, the CalSyS team will advise that LHDs with existing local Sites share their data into the CA Site to inform a more comprehensive picture of syndromic surveillance in CA.

Therefore, creating a local site is not recommended, as it would be an additional administrative burden for the LHD, as well as Hospital IT/vendors, NSSP, and CDPH, to move data to the CA Site. For example, the LHD would need to reconnect with emergency departments/vendors to ensure successful data validation, etc.

7. How should local health departments that currently have local Sites in BioSense proceed?

For LHDs that currently administer their own Site with BioSense, the CalSyS team does not recommend any changes at this time.

The CalSyS team is working with NSSP to determine the best path forward to bring all LHDs into the CA Site to better support the statewide use of syndromic surveillance data.

The CalSyS team is exploring ways to reduce any impact this would have on a jurisdiction’s current surveillance methods.

8. How can local health departments start onboarding emergency departments to BioSense?

As Site Administrator of the CA Site in BioSense, CDPH will be able to support LHDs with onboarding in collaboration with NSSP.

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.gov.

Support – Regardless of whether LHDs/emergency departments have already submitted data to the BioSense Platform or have yet to start, CalSyS will provide support. Reach out to CalSyS with any questions: CalSyS@cdph.ca.gov.

9. Does NSSP support onboarding of urgent cares or other facility types in addition to emergency departments?

Yes. Although NSSP's current priority is emergency care, followed by urgent care, the system does support onboarding for other facility types (e.g., ambulatory, inpatient care).

Healthcare Systems The CalSyS team will consider working directly with large healthcare systems that span many LHDs to onboard them as a system.

Data Interoperability and Exchange

1. What are Data Use Agreements (DUAs)?

The CalSyS team will work to sign DUAs with both LHDs who have and have not started the onboarding process. The DUAs will facilitate syndromic surveillance data sharing and outline related responsibilities for LHDs and CDPH, including the role of CDPH as site administrator of the CA Site in the BioSense Platform. By signing a DUA) and thus providing CDPH access to local level data, LHDs will support the development of the centralized statewide syndromic surveillance program.

2. How will CDPH use syndromic surveillance data?

After de-identified patient data is submitted from medical facilities, local health departments, and Health Information Exchanges to the BioSense Platform, CDPH and local health departments will use the data to detect and monitor public health threats.

CDPH’s initial priority will be managing existing data in BioSense, including:

Accessing existing data from the approximately 25% 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 the BioSense platform.

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

Integrating other data sources to inform a more complete picture of public health in California.

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.

Importing data from the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) within BioSense into a state infrastructure.

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

3. How are emergency department data submitted to the BioSense platform?

Data Exchange in CalSyS

Patients seek care at emergency departments.
Medical facilities send patient data (de-identified to protect privacy) to local health departments or Health Information Exchanges/Organizations (HIEs) or directly to BioSense.

HIEs support the mobilization of health care information electronically across organizations within a region, community or hospital system, for example from hospitals to health departments.

Local health departments and Health Information Exchanges submit the data to BioSense.

The data are transmitted securely and in near real-time using standardized communication protocols such as HL7 to BioSense for further processing and analysis.
Data quality is ensured through guidelines provided by the Public Health Information Network (PHIN), NSSP Syndromic Data Element Prioritization, and the NSSP Data Dictionary, which govern how data is formatted and transmitted accurately and efficiently.

4. How is patient privacy protected in syndromic surveillance?

To protect patient privacy, data submitted by medical facilities to the BioSense Platform is de-identified. The data is stored in secure databases accessible only to authorized users.

5. What is the difference between the BioSense platform and the Data Exchange Framework (DxF)?

BioSense vs Data Exchange Framework

Both the CalHHS Data Exchange Framework (DxF) and the BioSense Platform support secure exchange of health data.

Mode: BioSense is a secure, integrated electronic health information platform. The DxF is “rules of the road,” not technology. According to CalHHS, DxF is not a new technology or centralized data repository; instead, DxF Participants are agreeing to new rules of the road for securely and appropriately exchanging health and social services information to best serve patients. Learn more about the DxF.

Data: BioSense involves de-identified patient line-level data and the DxF involves patient health record data.

Purpose: BioSense facilitates near real-time data exchange of symptom data analyzed at the population level to help public health professionals rapidly detect and respond to emerging public health events. Conversely, the DxF guides the secure and appropriate exchange of health and social services information to improve patient care.

Data Integration: In theory, DxF could provide a framework for integrating syndromic surveillance data from BioSense with other health data sources, such as electronic health records (EHRs) and environmental data. Interoperability standards like Fast Healthcare Interoperability Resources (FHIR) could facilitate the seamless and standardized exchange of syndromic surveillance data alongside other health data sources within DxF, eliminating the need for additional interoperability standards and technological solutions.

Centers for Medicare & Medicaid Services Promoting Interoperability Program (CMS PIP)

1. Has CDPH declared readiness for syndromic surveillance reporting for the CMS Promoting Interoperability Program (CMS PIP)?

No, CDPH has not yet declared readiness for syndromic surveillance reporting for the CMS Promoting Interoperability Program (PIP). CDPH has not yet announced plans to declare readiness.

For the most up to date status, please see the CDPH Health Information Exchange Gateway.
You can also visit the CDPH Health Information Exchange Gateway for help with determining whether your local health department has a syndromic surveillance system that meets the public health reporting measures for the Promoting Interoperability Program (PIP) and Medicare Incentive Payment System (MIPS). If you have questions about this website or would like your jurisdictions information updated, please contact: hiehelp@cdph.ca.gov.

2. What other CDPH programs use hospital data to guide emergency response efforts?

A number of CDPH programs utilize hospital data in their work. The list below includes some examples, but it may not be all-inclusive.

HBEDS The Hospital Bed and Emergency Medical Services Data System provides real-time bed capacity data from healthcare facilities. The system displays that data on a private dashboard accessible to other in-system hospitals, EMS, and governmental partners in California.

CalREDIE The California Reportable Disease Information Exchange (CalREDIE) is a secure system that CDPH has implemented for electronic disease reporting and surveillance. Specified diseases and conditions are mandated by State laws and regulations to be reported by healthcare providers and laboratories to the public health authorities.

Electronic Case Reporting (eCR): Real-time bi-directional flow of reportable disease data from clinical care to public health.

CalREDIE eCR inbox: CalREDIEECR@cdph.ca.gov
eCR Registration

Costs of Participation

1. Are there costs associated with onboarding to the BioSense Platform?

There is no direct financial cost associated with onboarding to the BioSense Platform. The platform offers free surveillance resources and querying tools (e.g., ESSENCE) to state and local health department partners.

2. What may local health departments and facilities need to invest to participate in the statewide program?

Staff Time - The BioSense Platform is free to use, but LHDs may need to allocate staff time for onboarding and data submission tasks.

CDPH will provide needs-based support - The CalSyS team will provide technical and onboarding support in collaboration with NSSP.

3. Will CDPH provide funding for local health departments and facilities to implement and maintain syndromic surveillance programs?

CDPH is not currently providing funding directly to LHDs to hire staff to participate in the CalSyS Program. However, the CalSyS team will support LHDs with guidance, onboarding, and technical assistance for using SyS data and onboarding facilities.

4. Is funding from external sources available?

Hospitals may access financial incentives for participation through the Centers for Medicare and Medicaid Services Promoting Interoperability Program (CMS PIP).

Once the state or local health department declares readiness for syndromic surveillance reporting, participation in syndromic surveillance may help hospitals to meet the CMS PIP requirements.

Hospitals participating in the CMS PIP receive points based on their data reporting. A hospital that doesn't reach the threshold of 60 out of 100 points risks a reduction in their Medicare reimbursement rates for the subsequent year.
A total of 25 points are allocated for public health reporting, including participation in syndromic surveillance, which could help hospitals reach their threshold.
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.

Local health departments may be able to receive funding from other federal programs.

For example, in the past, Public Health Emergency Preparedness (PHEP) funding has been used to support the application of syndromic surveillance in preparedness plans. Other examples of funding mechanisms that counties and states have used in the past to hire syndromic surveillance staff include ELC, data to action funds like OD2A, Emergency Department Surveillance of Nonfatal Suicide-Related Outcomes (SNSRO), and Firearm grants.