EHR Integration Of eCR Promotes Public Health Reporting, COVID-19

In the midst of COVID-19, EHR developers have rapidly integrated an automated electronic case reporting solution into their products to promote public health efforts, according to an ONC blog post.

CDC and the Association of Public Health Laboratories created the app, eCR Now, to respond to the growing need for real-time data exchange related to COVID-19’s spread through the country.

“To mitigate and recover from widespread communicable disease, such as COVID-19, government and public health officials need a detailed view of where cases are growing across the country and which patient populations are most affected,” authors Elisabeth Myers and Jeff Smith wrote.

eCR Now automatically sends demographic and clinical information recorded by providers to public health organizations using Health Level 7 (HL7) International Fast Healthcare Interoperability Resources (FHIR) and backend system connection, granting public health officials access to data for case investigation and contact tracing.

All 50 states, the District of Columbia, Puerto Rico, and 13 large local jurisdictions are receiving electronic case reports through the eCR Now shared services platform, according to CDC data.

More than 8,800 healthcare facilities are connected to the ONC-certified health IT platform and public health authorities have received 8.2 million reports for COVID-19 as of May 25, 2021, ONC noted.

“It’s noteworthy that this rapid adoption occurred largely in the last year – during a pandemic – demonstrating the opportunity to rapidly implement health IT solutions by leveraging modern technology standards and specifications,” Myers and Smith continued.

While ONC said the integration of the eCR Now app has been undeniably successful, the agency noted that stakeholders need to ensure it is used by hospitals participating in the Promoting Interoperability Program and clinicians participating in the Promoting Interoperability performance category.

“The FHIR-based eCR Now app may rely on ONC-certified health IT to work, but it is not itself a stand-alone certified ‘Health IT Module,’” Myers and Smith wrote. “It is possible to use eCR Now functionality as part of a certified health IT module to demonstrate conformance with the existing electronic case reporting certification criterion ‘Transmission to public health agencies — electronic case reporting.’”

Therefore, certified health IT developers can contact their ONC-Authorized Certification Bodies (ONC-ACB) and provide documentation to show that their products have integrated the eCR Now app as part of their certified Health IT Module, ONC explained.

“Certified health IT developers who do not already have a certified Health IT Module for electronic case reporting, can contact their ONC-ACB to expand their certification by providing their ONC-ACB documentation that they support eCR Now functionality and meet any other applicable requirements,” Myers and Smith continued.

“The scale and speed of eCR Now adoption has demonstrated the value of leveraging modern, consistent standards, such as FHIR,” Myers and Smith said. “Working together with federal partners at the CDC and CMS, ONC believes this approach can help to support an industry-developed solution that meets a national need.

Nationwide electronic case reporting has been stunted by a lack of implementation of eCR capabilities in EHR products using published eCR standards, since electronic case reporting was only added as an optional measure late in CMS Promoting Interoperability Program, and the number of required public health measures did not change.

Therefore, not many hospitals have opted in to receive Promoting Interoperability credit through the electronic case reporting measure option, ONC explained.

“Consequently, the demand for ONC-certified health IT products with electronic case reporting functionality has been low,” Myers and Smith wrote.

However, CMS recently proposed modifications to its Promoting Interoperability Program that would require hospitals to report on four public health and clinical data exchange measures.

“This proposal is the latest in a series of coordinated steps taken across HHS to leverage data standards and specifications adopted as part of ONC’s Health IT Certification Program to enable nationwide public health reporting,” Myers and Smith noted.