eCR Now COVID-19 FHIR App Challenge- Frequently Asked Questions (FAQs)
1. If a potential Challenge participant wants to do electronic case reporting and participate, what information do they need to convey or gather from their EHR vendor regarding the vendor’s eCR capabilities?
EHR vendors are at different stages of maturity regarding the integration of eCR capabilities with their products. The eCR Now FHIR App was developed so that EHRs that support the HL7 FHIR standards can rapidly implement eCR capabilities. The organization needs to know whether the EHR vendor has the capability to implement a FHIR App and should direct the EHR vendor to the eCR Now FHIR App link for the required detailed information.
2. Our healthcare organization has experience with our EHR’s FHIR API and we have several other apps that we have stood-up in front of our EHR. Can we do this with the eCR Now FHIR App and participate in the challenge?
Yes, the healthcare organization can implement the eCR Now FHIR App and participate in the challenge. The eCR Now FHIR App and its source code is freely available to the healthcare organizations and others to implement. Healthcare organizations and third-party organizations will need to engage with their EHR vendor for this effort. More information on the FHIR App can be found here and the requirements for general electronic case reporting can be found here.
3. Can an EHR vendor participate in the Challenge and receive an award?
Yes, an EHR vendor can participate in this challenge and receive an award. Please refer to this link for more information on eligibility and participation criteria.
4. Can a Health Information Exchange (HIE) participate in the Challenge and receive an award?
Yes, a HIE can be a participant in the challenge and receive an award. Please refer to the link for information on eligibility and participation criteria. It is important to note that hosting the backend of the App at an HIE will still allow the App to run in the EHR and meet the eCR requirements.
5. Can a Public Health Agency’s (PHA) clinical services branch, that provides clinical services and receives case reports, participate in the Challenge and receive an award?
Yes, a PHA can participate in this challenge and receive an award. Please refer to this link for more information on eligibility and participation criteria.
6. Can a Health Center Controlled Network (HCCN) participate in the challenge and receive an award?
Yes, a HCCN can participate in this challenge. Please refer to this link for more information on eligibility and participation criteria.
7. As a challenge participant, should a HCCN participant (working with multiple EHRs and multiple health centers) focus on more breadth or depth (implementation of the eCR FHIR app with one EHR candidate without an eCR capability)?
The Challenge Panel will make judgements based on identified judging criteria when making the awards. However, the most relevant criteria in this question are ‘Breadth of Impact’ and ‘Minimizing Provider Burden’ as listed on the information page on judging criteria.
8. Can a healthcare organization with existing eCR capability participate in the Challenge?
Healthcare organizations that introduce new eCR capabilities into organizations or parts of organizations using the eCR Now FHIR App are eligible.
9. Is there a list of EHRs with or without eCR capability?
Many of the EHR vendors are at different stages of maturity regarding the integration of eCR capability with their products. A complete list of the EHR vendors and their current state of eCR capability is not available at this time. We encourage the organization(s) to contact their EHR vendor(s) about the vendor’s capabilities to support implementation of eCR Now FHIR App. More information on the requirements for eCR Now FHIR App implementation can be found here.
10. Is there a cost associated with use of the eCR Now FHIR app?
The eCR Now FHIR App and its source code are freely available to interested implementors of the App. APHL has no commercial interest in the eCR Now FHIR App. Any queries regarding any possible fees or charges from EHR vendors should be addressed to the relevant vendor.
11. Can the eCR Now FHIR App be used for COVID-19 reporting now and later for reporting other reportable conditions? What is the roadmap for eCR?
The eCR Now FHIR App can do electronic case reporting for COVID-19 and more than 89 other reportable conditions. There is a configuration “switch” for the App, to implement just COVID-19 case reporting or full electronic case reporting.
Most provider organizations and PHAs dealing with the pandemic are focusing on COVID-19 case reporting now, but the App can also be implemented to do full electronic case reporting now at the discretion of the healthcare organization and principal PHA. If ‘COVID-19 only’ reporting is immediately implemented, full electronic case reporting can be configured at a later time when the organizations are ready.
12. Is patient consent needed to do electronic case reporting (eCR)?
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 comports with these laws. The 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.
13. Can a local health department receive electronic case report(s)?
At present, all the states and some large local public health agencies (PHAs) directly receive electronic initial case reports (eICRs) from the APHL AIMS platform. Many states then either:
- give access to local health public health agencies for these case reports through their integrated surveillance systems at state level or,
- route the case reports to their local health departments in accordance with their state laws.
14. How are the eCR data used?
Some Public Health Agencies (PHAs) integrate the eCR data into their surveillance system for review and action. Other PHAs can currently use the reports like they would a web page by clicking on the HTML versions that are delivered to them. States and territories also use some of their eCR data, in anonymized form, to send notifications to the Centers for Disease Control and Prevention for national reporting and publishing in the CDC’s MMWR.
15. Will other current practices for reporting COVID-19 cases be replaced by the newly implemented eCR capability when a healthcare organization (e.g., PHA) implements eCR?
In some cases, manual reporting of COVID-19 cases can be turned off as soon as electronic case reporting is implemented. In other cases, there will need to be validation of the reporting data and delivery before manual reporting will no longer be required. In all circumstances the decision for when to release requirements for manual reporting is at the discretion of the principal PHA that is involved.
16. Will all Challenge awards be made?
All Challenge awards will be made conditional to receipt of adequate numbers of fully eligible applications and complete submissions in the different Challenge categories.
17. Is the eCR Now FHIR App validated and sold in all EHR vendors’ App stores?
The eCR Now FHIR App is not being sold through EHR vendor App stores. The App and its source code have been made available, free of charge, to all potential implementors – health systems, EHR vendors, networks, and other third parties. Challenge participants will need to work with their EHR vendors and healthcare organizations to successfully implement the eCR Now FHIR App.
18. If an EHR vendor uses an older version of the FHIR standard, can the eCR Now FHIR App be implemented/integrated?
The eCR Now FHIR App supports DSTU2, which was the initial widely supported FHIR version promoted by the Argonaut Project. EHRs that support FHIR DSTU2 can implement the eCR Now FHIR App and begin reporting for COVID-19. The eCR Now FHIR App also supports Release 4 (R4) of FHIR which is the current version that is named in the recently published CMS and ONC Cares Act regulations.
19. If a potential Challenge participant is an eHealth Exchange member, Carequality implementor, or CommonWell member, is it technically and/or legally easier to integrate the eCR Now FHIR App?
A trust framework needs to be in place to do electronic case reporting. Through partnerships with the eHealth Exchange and Carequality, any member or implementor of these health information networks can do electronic case reporting without any additional legal agreements.
Organizations that are connected to the eHealth Exchange can also do electronic case reporting without any additional legal agreements because of the eHealth Exchange DURSA and participation agreements. Organizations that are connected to Carequality need to agree to the Carequality connection terms with their Carequality implementor, but having done that, do not need to sign any additional legal agreements. CommonWell is a Carequality Implementor.
20. What is the eCR Now FHIR App written in?
The eCR Now FHIR App is written in Java using the Spring Boot framework. It is intended to be a headless App, however, there is a configuration screen to change any configuration requirements, which is written in Angular JS framework.
Said in plain English, the App is intended to start automatically and operate behind the scenes so as to not interrupt the workflow of providers of care.
21. What environment needs to be in place to host the backend of the eCR Now FHIR App?
The backend of the eCR Now FHIR App uses an open-source version of PostgreSQL database. However, any other database, such as Microsoft SQL Server, Oracle, MySQl, or DB2 can also be used. It uses the Hibernate ORM (Object Relational Mapping) framework and can work with any other equivalent technology. For the environment, a typical server with JAVA installed would be appropriate. Since it is a Spring Boot App, no additional container is needed.