State reporting systems were advocated early in the patient safety movement as a way to enable learning from errors. This analysis of 27 state-level reporting programs highlights that while adverse event reporting has become more sophisticated since the previous survey, only one new program has launched since then. The authors emphasize the value of partnership, collaboration, and transparency in the work of the participating states. An AHRQ WebM&M perspective spotlights state reporting programs as mechanisms to augment patient safety.