Pew Calls for Electronic Case Reporting for Potential Pandemics

Pew Charitable Trusts, the Council of State and Territorial Epidemiologists (CSTE), and the American Medical Informatics Association (AMIA) recommended the Department of Health and Human Services (HHS) prioritize electronic case reporting (eCR) to protect public health during COVID-19 and beyond, according to a letter obtained by EHRInteligence.

eCR is the automated production and submission of reportable diseases and conditions from the EHR to public health agencies, according to the Centers for Disease Control and Prevention (CDC).

eCR is made up of data from The Association of Public Health Laboratories (APHL), the Council of State and Territorial Epidemiologists (CSTE), and the CDC. Those organizations work with providers, public health agencies, and eCR vendors to report certain conditions.

Although public health agencies see the importance of a clinical direct messaging service that enables safe and secure eCR transmission, industry leaders haven’t adopted those tools yet.

“These data help authorities follow up with individuals directly to conduct case investigations, identify outbreaks within communities, evaluate disease control programs, set critical policy to protect the most vulnerable, and connect people to other health services or treatments,” explained the authors. “However, gaps in the data available to public health authorities have hindered the exact actions that could help the country emerge from the COVID-19 pandemic, save lives, and restart the economy.”

The three groups recommended four key case reporting challenges for HHS to address.

The authors suggested an update to the CMS payment programs to incentivize and require providers to require eCR. The authors said CMS should update the Promoting Interoperability program and/or conditions of participation in Medicare to require eCR as soon as possible.

EHR systems cannot often digitally send case reports to public health officials. To fix this issue, the authors said ONC should update EHR certification provisions to make eCR support mandatory as an EHR base definition and require adherence to both Health Level Seven (HL7) eCR standards and implementation guides.  

“Requiring eCR as part of EHR certification will ensure that public health agencies get the data they need, in a standard way, from health care providers and facilities in real time,” explained the authors.

The authors recommended ONC ensures all EHRs make specific public health data available through updates to the United States Core Data for Interoperability (USCDI).

Those data elements should include existing “problems” data classes, “specimen” data classes, “travel information” data classes, “work information” data classes, “observations” data classes, and death dates for public health officials.

“Including data needed for public health as part of the USCDI will ensure that all EHRs are able to document and exchange this information in a standard manner, particularly with public health agencies,” wrote the authors.

Lastly, the authors recommended ONC require all EHRs to make data available to public health officials free of charge, similar to how patients can access data through application programming interfaces (APIs).

“Removing fees that hamper the use of APIs for public health reporting would eliminate a cost barrier to providers who are sending public health officials needed information,” the authors wrote. “Through this change, entire communities would benefit; this approach would also align with existing policies that allow patients to access data for free given the societal benefits involved.”

The authors recommended ONC should update API fee regulations to eradicate API-based public health reporting costs.

“Thank you for prioritizing the urgent need to implement eCR to improve the public health response to COVID-19,” concluded the authors. “Broad implementation of eCR will transform public health reporting and responses beyond COVID-19, and serve as a longstanding infrastructure investment that will improve the ability of public health to address other disease threats.”