eCR Now FHIR App

Introduction

An initial version of the eCR Now FHIR “App” and its source code is now available for download. The app is intended for a very specific purpose, is different from many commercial apps in both its attributes and its provisioning, and has integration points that will require close teaming between the eCR Now technical team and EHR vendors and other implementors that choose to use it. This page provides some context and then lays out the planned process and communication channels for teaming to meet the critical electronic case reporting need in the COVID-19 pandemic.

GitHub App Source Code

HL7 FHIR Connectathon eCR Now FHIR App Webinar
Tuesday, May 5th, 2020  1:00 PM ET

Presentation Recording May 5, 2020

Presentation Slides May 5, 2020

 

Context

Electronic case reporting (eCR) involves “the automated identification of reportable health events in electronic health records and their transmission to state and local public health authorities for review and action.” Reporting is a legal requirement for COVID-19 and many other conditions, but the specific laws vary by state. Triggering case reports out of EHRs does not, by itself, definitively establish that something is reportable or which public health agencies should receive it if it is.

To address the complexity of reporting requirements, the Centers for Disease Control and Prevention (CDC), the Council of State and Territorial Epidemiologists (CSTE), and the Association of Public Health Laboratories (APHL) have implemented shared eCR services on the APHL AIMS platform including provisioning, decision support, routing, and delivery infrastructure to provide electronic case reports to public health agencies for integration into their surveillance systems. The eCR Now App is constructed to connect to, and take advantage of, this existing infrastructure to support appropriate reporting even though neither it, nor public health agencies, currently support production HL7 FHIR services.

Integration Points

The eCR Now App is intended to run as a background process during patient encounters, report automatically to appropriate public health jurisdictions though the APHL AIMS shared service infrastructure, and not disrupt healthcare provider workflows. On the EHR side, the App is built to leverage the work of the Argonaut Project, HL7, and ONC that has implemented a level of FHIR API that is now in implemented EHRs. As such, the App is both enabled and restricted by the status of that API. The areas of:

  1. obtaining patient and encounter context;
  2. launching the background app process;
  3. obtaining up-to-date trigger codes and parameters from the electronic Reporting and Distribution (eRSD) system;
  4. implementing specific trigger and loading queries;
  5. transporting electronic Initial Case Reports (eICRs) out to the APHL AIMS platform;
  6. local storage of eICRs that have been sent;
  7. receipt, processing, and local storage of the Reportability Response that comes back to the EHR for each eICR that has been sent;

all require consideration as integration points with other EHR infrastructure.

Some of these integration points are well developed and essentially complete in the App that is being developed such as accessing up-to-date trigger codes from the eRSD system and some of them will require additional EHR activities and teaming with the eCR Now team.

Teaming and Release Process

The eCR Now App is being developed with the intent of sharing, with its source code, for implementation by EHR vendors and other implementors. The planned schedule represents phased delivery and hand-off to implementors over the course of May 2020. The following draft schedule may be subject to change in accordance with shared refinement and development priorities:

eCR Now App Schedule

  • First Release (Pre-Alpha) - May 1, 2020
  • Second Release (Alpha-Pre-Connectathon) - May 8, 2020
  • Implementor testing in HL7 Connectathon Public Health Track – May 13-15, 2020
  • Third Release (Post-Connectathon) – by May 29, 2020

Next Steps

  1. EHR companies should access the App source code from the Github site
  2. Download and Implement the app in your local development sandbox following instruction on the GitHub site
  3. Verify that the app runs successfully in your local development sandbox
  4. Post any issues encountered to the Zulip chat channel
  5. Add COVID-19 data into your development sandbox EHR for testing purposes
  6. Consider the “Integration Points” in the context of your EHR implementation
  7. Post technical questions you have to Zulip chat stream for discussion
  8. Access the second release on May, 8th
  9. Get the second App release up and running in your sandbox for Connectathon testing using your COVID-19 patients
  10. Sign-up for the Public Health Track at the HL7 Connectathon
  11. Test your implementation with the eCR Now team in the Connectathon
  12. Provide feedback through the Connectathon process
  13. Access and implement the May 29th release

Communication Channels and Resources

eCR Now App Discussion on Zulip

electronic Reporting and Surveillance Distribution System (eRSD)

HL7 FHIR Connectathon Public Health Track Page

GitHub App Source Code