Successful completion of this challenge will fulfill the following:

1. CMS Promoting Interoperability / MIPS requirements for electronic case reporting (eCR).
2. The Cures Act eCR related USCDI V3 requirements.
3. The ONC HTI-1 certification criteria for electronic health records (EHRs). Recent updates to the Certification Program’s standards, criteria, and requirements include using HL7® Consolidated Document Architecture (CDA) Implementation Guides or HL7 Fast Healthcare Interoperability Resources (FHIR ®)-based specifications for eCR.
4. The ONC USCDI V3 certification requirements for ‘occupation’ and ‘occupation industry’ (job occupation and job industry, respectively) in the HTI-1 Final Rule.

A complete submission is an entry that fulfills “The Challenge Requirements” and provides evidence thereof prior to the submission deadline, as detailed on the Challenge web page – https://ecr.aimsplatform.org/ecr-data-challenge. Note: The “Judging Criteria” and the “Additional Challenge Data” will also be considered in terms of developing a participant’s ultimate score.

Participation in this challenge does not require reporting for all conditions. The supplemental funding for silicosis reporting does require more than COVID reporting, including the reporting of silicosis cases. Trigger codes for silicosis are included in all eCR eRSD trigger code distributions. Participants may need to determine if silicosis reporting is required in a particular jurisdiction and is authored in RCKMS.

EHRs that implement the eCR Now FHIR App are fully eligible to participate in the Challenge.

All Challenge awards will be made conditional to receipt of adequate numbers of fully eligible applications and complete submissions.

Yes! You can view the kick-off call here: https://www.youtube.com/watch?v=HFOfY0XsafA.

EHR companies can participate in this challenge and receive an award if their team meets all requirements, including having a participating healthcare organization that is originating the eICRs.

An HIE can be a participant in the challenge and receive an award if their team meets all requirements, including having a participating healthcare organization that is originating the eICRs.

Yes, if your jurisdictional PHA does not currently ingest occupational data, your organization will still be eligible for the awards provided all of the challenge requirements are met. See the Challenge Requirements section for details on challenge requirements. Participants are encouraged to reach out to their jurisdictional PHAs to encourage them to implement the eICR R3.1 standard.

All decisions will be final on the basis of the panel evaluation. The panel will consider:

• Data Completeness: Evidence of collection of all required challenge data using the value sets and codes specified in the eICR R3.1 standard.
  • The percentage or count of the documents sent that include the required challenge data including analysis of correct and incorrect coding.
  • Evidence of collecting and sending additional challenge data can improve the participant’s score. The number of these elements included and the frequency of their presence using the specified value sets will contribute to scoring.
• Policy and Technical Compliance: Evidence of successful eCR processing through the APHL AIMS Platform using the eICR R3.1 standard.
• Communication/Collaboration with the Relevant PHA(s): Evidence of communication / collaboration with the eCR and occupational health programs’ points-of-contact, if applicable.
• Breadth of Impact: Evidence of using ODH to implement collection of patients’ work information in one or more healthcare facilities. The size of your HCO will not impact your score.

Although these data elements are not required for the Challenge, including them (using the value sets identified in the eICR R3.1 standard and correctly mapped into the R3.1 template) will increase your score based on both the number of these data elements implemented and the percentage of sent documents that include them.

For additional challenge data to be considered in scoring, it must be implemented using the value sets identified in the eICR R3.1 standard and correctly mapped into the R3.1 template. ODH data must be implemented in the OHD templates. Value sets are available for most ODH data elements; for downloadable files, see the ODH Hot Topics tab. Occupation and industry concepts are supported by large value sets that enable keyword searches using common terms. A Guide to Collection of Occupational Data for Health (ODH): Tips for Health IT Developers (“The ODH Collection Guide”) provides valuable suggestions for collecting the ODH data elements, particularly occupation and industry values. ODH interoperability templates enable adding ODH topics into broader implementation guides (HL7 CDA, IHE CDA, FHIR, V2). The Past or Present Job and Usual Work templates are included in the eICR 3.1 standard.

Additional challenge data are not required to participate in the challenge or be eligible for awards. See the Challenge Requirements section for details on challenge requirements.

The parent, guardian, or other household member’s job occupation and industry can be implemented in the HL7 CDA eICR R3.1. Such implementation is acceptable to meet the challenge requirements.

Please see the following NIOSH (The National Institute for Occupational Safety and Health) publication: A Guide to the Collection of Occupational Data for Health: Tips for Health IT System Developers for general information about implementing Occupational Data for Health.

We recommend using the downloadable files under the PHIN VADS Hot Topics section for the ODH vocabulary. These files provide additional information, such as Spanish translations.

The clinical setting and the EHR being used will determine the implementation workflow for capturing data.

The ODH framework includes work information for household members of a minor; however, the patient does not necessarily have to be a minor to collect this information. These data elements are designed to provide work information about people residing in the household of the patient and possible take-home hazards. Information on guardianship or legal roles related to the patient are not included. A Guide to Collection of Occupational Data for Health (ODH): Tips for Health IT Developers (“The ODH Collection Guide”) provides valuable suggestions for collecting the ODH data elements, including work information for household members.

Only participants within jurisdictions where silicosis case reporting is required by law are eligible to receive the supplemental award. Participants are encouraged to reach out to their jurisdictional PHAs to determine if silicosis is a reportable condition.

The code sets for these elements can be found in the HL7 CDA® R2 Implementation Guide: Public Health Case Report – the Electronic Initial Case Report (eICR) Release 2, STU Release 3.1 - US Realm.

For example, the value set for “Employment Status” can be found in table 131 (Employment Status ODH) of the guide.

Table 131: Employment Status ODH

eCR targets current data based on a patient’s self-reported employment status. The “specified time period” described in the employment status definition is the current data documented as the employment status start date and the employment status end data.

“A History of Employment Status Observation Entry is a clinical statement about a person's relationship to working for pay, family earnings, or training (e.g., having one or more jobs, searching for work, etc.). A person’s ODH Employment Status is independent of Job characteristics, e.g., not “full-time work,” “part-time work,” "self-employed," because many people have more than one job. A History of Employment Status Observation Entry is a clinical statement about the subject’s state of being employed during the time period specified in the observation effectiveTime. Generally, employment status refers to whether or not a person has a job (e.g., employed, unemployed, not in labor force). In a healthcare setting employment status may be used to determine appropriate probing questions for occupational hazards and occupational history. For example, someone who is unemployed or has chosen not to work may be prompted to provide information about previous jobs. Employment status is not the same as work classification, which describes characteristics of a given job such as self-employed.”¹

Yes, participating healthcare organizations can use the NIOCCS Web API to code occupation and industry data fields to the less-detailed North American Industry Classification System (NAICS) and the Standard Occupational Coding (SOC) system.

Yes, if new ODH value sets are made available, for example through PHIN VADS or VSAC, using these updated value sets would fulfill the Challenge requirements.

Job occupation and job industry refer to the occupation and industry associated with a patient’s past or present job. Many people work multiple jobs; it is recommended to be able to collect data elements for at least two current jobs. It is also recommended that it be possible to collect a history of current and past jobs. Usual occupation and usual industry refer to the occupation and industry associated with the work a patient has done for the longest amount of time, which can span multiple jobs. Values for usual (longest held) work can be auto-populated based on the patient’s history of current and past jobs, as determined by the length of time in a single type of occupation.

The HL7 CDA eICR R3.1 standard is the most current standard for eICR from HL7. The HL7 CDA eICR R3.1 Implementation Guide can be found on the HL7 website, here: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=436 with additional information about the standard.¹

The EHR vendor must, in the end, produce a compliant HL7 CDA eICR R3.1 document using a vendor-developed system or the eCR Now FHIR App and submit it for reporting. There is validation available for testing HL7 CDA eICR 3.1 documents here: https://validator.aimsplatform.org/. (Under version, select "eICR 3.1" from the drop-down list.)

Public Health case reporting is required by law in every state and territory in the United States. Patient consent is not required to do electronic case reporting that complies with these laws. eCR supports the requirements for case reporting and the relevant laws through the use of the HL7 eICR standard and the RCKMS decision support engine on the APHL AIMS platform. The rules in this decision support engine are authored by the relevant public health agencies to represent their reporting laws and requirements.

All eICRs that are determined to be reportable for a jurisdiction(s) are transmitted in the format received by the AIMS platform to those jurisdictions. All reportable conditions will be routed to relevant PHAs without change. Any other eICRs are deleted.

Generally, it is expected for PHAs to declare readiness prior to participation in the Challenge. But, with the jurisdictional PHA’s approval, an HCO may participate even if readiness has not yet been declared.

eCR is a requirement in Promoting Interoperability and the MIPS incentive programs. See the following webpage on MIPS eligibility: How MIPS Eligibility is Determined PY 2022 (cms.gov).  Successful participants will meet CMS Promoting Interoperability requirements for eCR and Challenge data elements support the Cures Act and U.S. Core Data for Interoperability (USCDI) V3 requirements.