​Background

On August 28, 2024, the Federal Register published interim final rule CMS-1808-F, requiring GACHs and CAHs to report data to DHHS in accordance with Title 42 CFR sections 482.42(e) and 485.640(d), respectively. During the COVID-19 Public Health Emergency (PHE), collecting hospital data was pivotal in providing situational awareness around the impact of respiratory disease on hospitals. Hospital data was collected through previous reporting requirements during the COVID-19 PHE and through the first respiratory virus season after the PHE declaration expired. These data are critical to help with public health coordination and keeping patients safe by informing strategic planning and coordination of public health responses, enhancing disease surveillance and early warning systems by helping identify trends and patterns of disease spread, and improving healthcare delivery and patient outcomes through patient-centered care.

In addition, CDPH is working to implement hospital data reporting systems using automated processes that take advantage of existing infrastructure, such as the following Health Information Exchanges (HIEs):

• eCR will automate required reporting of individual case data for communicable diseases.
• HBEDS will help automate and satisfy some of the Centers for Medicare and Medicaid Services (CMS) reporting requirements currently reported into the NHSN.
• CalSyS through the national BioSense Platform will provide public health officials with a near real-time system for detecting, understanding, and monitoring health threats.​
  

NHSN Reporting Requirements

Effective November 1, 2024, GACHs and CAHs must electronically report data on COVID-19, influenza, and RSV weekly via the CDC's National Healthcare Safety Network (NHSN) system. Reporting will include the following data elements:

• Confirmed infections for a limited set of respiratory illnesses, including but not limited to flu, COVID-19, and RSV, among newly admitted and hospitalized patients
• Total bed census and capacity, both overall and by hospital setting and population groups
• Limited patient demographic information, including age
• Hospital personal protective equipment (PPE) and supply information (optional)

Additionally, in the event of a declared national, state, or local PHE for an acute infectious illness, the Secretary of HHS may also require reporting on the following additional data elements:

• Facility structure and infrastructure operational status
• Emergency department diversion status
• Staffing shortages
• Supply inventory shortages (e.g., equipment, blood products, gases)
• Relevant medical countermeasures and therapeutics
• Other demographic factors
  

For additional information on respiratory data reporting requirements, see the CDC's NHSN Hospital Respiratory Data (HRD) Reporting (PDF). ​

eCR

eCR is a nationwide initiative led by the CDC, the Association of Public Health Laboratories (APHL), and the Council of State and Territorial Epidemiologists (CSTE). eCR is the process of automatically generating and transmitting case reports from a healthcare organization's electronic health record (EHR) system to public health agencies for review and action. Once fully implemented, eCR will meet Title 17 CCR section 2500, requiring health care providers to report certain diseases and conditions to public health authorities. It will ultimately replace manual reporting, which currently occurs through manual data entry into CalREDIE (California's electronic reportable disease reporting system) or sending information to local health jurisdictions. The CMS Promoting Interoperability Program requires eCR for eligible hospitals, CAHs, and eligible clinicians.

CDPH instituted eCR for COVID-19 in August 2022. Starting in June 2024, CDPH expanded to additional conditions and currently accepts eCRs for 16 conditions, with additional conditions added monthly. CDPH intends to continue eCR disease expansion through 2025.

Hospitals can begin onboarding to eCR by working with their EHR vendor and the CDC onboarding team. CDPH receives eCRs through the APHL Informatics Messaging Services (AIMS), based on California's specific reporting criteria. To onboard to eCR, please contact CalREDIEeCR@cdph.ca.gov.

More information can also be found on the CDPH CalREDIE eCR webpage or through the CDC eCR webpage.​

HBEDS

HBEDS displays real-time staffed bed availability by bed type of participating hospitals on a private dashboard that is accessible to participating hospitals, as well as local and state government officials. HBEDS does not include any Protected Health Information and is automated using one-way data feeds from hospital EHR or staffing systems as opposed to the current bed-polling systems used throughout the state that require manual data entry.

The purpose of HBEDS is to increase visibility of bed capacity across the healthcare system to facilitate the healthcare system's existing procedures for patient transfers and responses to medical surge events. HBEDS data is reported to CDC's NHSN, which also helps provide visibility into healthcare and surge capacity.

On September 30, 2024, Governor Newsom signed Assembly Bill (AB) 177 (Chapter 999, Statutes of 2024), which authorizes CDPH, in conjunction with the Department of Health Care Services, to collect bed capacity information from specified facilities, including GACHs. Healthcare facilities will be made aware of any required deadlines for participation. In the meantime, hospitals are welcome to begin the enrollment process now.​

To enroll in HBEDS or to learn more, facilities can contact HBEDS@cdph.ca.gov.

CalSyS

CDPH has launched a new statewide syndromic surveillance program called CalSyS. On July 1, 2024, Senate Bill (SB) 159 (Chapter 40, Statutes of 2024) took effect, authorizing CDPH to develop and administer a statewide syndromic surveillance program. This bill also requires GACHs with emergency departments to submit syndromic data to either: 1) CDPH, or 2) the local health department (LHD) of the jurisdiction where the hospital is located but only if the LHD operates its own syndromic surveillance system AND the LHD will have capacity to transmit data to CDPH by July 1, 2027.

Efforts are currently underway to develop state regulations for hospitals and LHDs in support of SB 159. Until regulations are finalized, there is no immediate action required of hospitals or LHDs; however, CDPH encourages hospitals to continue to onboard to the BioSense Platform. Continued onboarding to BioSense will support CalSyS efforts to build a statewide centralized syndromic surveillance system and satisfy SB 159 requirements.

To onboard, please contact CalSyS@cdph.ca.gov. More information on CalSyS can be found on the CDPH CalSyS webpage.​

Questions

If you have any questions about reporting, please contact NHSN@cdc.gov.

Sincerely,

Original signed by Chelsea Driscoll

Chelsea Driscoll

Acting Deputy Director

Resources:

• CDC Updated Hospital Reporting Requirements for Respiratory Viruses
• CDC Hospital Respiratory Data
• NHSN Hospital Respiratory Data (HRD) Reporting (PDF)
• CMS FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule – CMS-1808-F Fact Sheet
• CDPH CalREDIE eCR webpage
• CDC eCR webpage
• CDPH CalSyS webpage​