How eCR Can Cut Clinician Burden, Advance Public Health Surveillance

The implementation of electronic case reporting (eCR) at the Minnesota Department of Health (MDH) has helped improve data accuracy for public health surveillance while cutting clinician burden, according to a study published in JAMIA.

Electronic case reporting (eCR) is the automated generation and transmission of case reports from EHRs to public health agencies.

The researchers explained that MDH took an “incremental approach to enhancement,” which allowed the agency to begin receiving electronic initial case reports (EICRs) for COVID-19 surveillance as the agency expanded its system and staff bandwidth.

The authors noted that switching to eCR has decreased the clinician burden of paper-based reporting while also improving inefficiencies and inaccuracies from phone/fax data entry.

“In addition, eCRs provide the capability for public health to receive case reports from other states for persons in their jurisdictions due to centralized national infrastructure and customized rules authored in RCKMS by public health,” the researchers added.

The authors emphasized that current eCR implementation experience is limited to COVID-19 only. Future challenges may arise when stakeholders expand eCRs to other infectious diseases.

Additionally, they pointed out that all health systems onboarded for eCR in the state are on Epic EHRs.

“Epic EHR is dominant vendor in Minnesota and so current experience will facilitate faster onboarding of future Epic EHR provider sites,” they wrote.

The next steps for MDH’s eCR project will include onboarding other EHR systems and expanding eCRs beyond COVID-19 to comprise all reportable conditions to public health.

“Future phases at MDH will focus on additional data extraction from eCRs (e.g., additional contact info such as phone numbers, current/prior address, medications relevant to reportable condition, vaccinations, occupation, travel, social history) as these data are not available through electronic lab reporting (ELR) and are a value-add to public health surveillance,” the researchers said.

Continued progress will require an ongoing partnership between healthcare providers, EHR vendors, and public health agencies to address current issues such as data quality and future concerns.

“The eCR journey at MDH is being shared to assist other public health agencies as they plan and implement eCRs, and to utilize lessons learned for future eCR enhancements,” the authors wrote.

“Additional details on current eCR implementation (costs, technology, staff expertise) and future eCR enhancements (more EHR vendors, reportable conditions beyond COVID-19, detailed data quality analysis) need to be disseminated and focused research on identified issues is required,” they added.

MDH implemented the technology as part of CDC’s eCR Now for COVID-19 initiative, which provided centralized infrastructure support and technical assistance.

“The eCR Now initiative has been implemented nationally with more than 13,300 facilities (as of June 24, 2022) sending COVID-19 electronic initial case reports to public health agencies,” the study authors wrote.

“The centralized framework and infrastructure along with scalability and a collaborative approach, combined with technical assistance to reporters and receivers have proven to be vital in meeting both provider and public health needs,” they continued.