EHR Implementers

What is an eICR document? What does it include? 

The Electronic Initial Case Report (eICR) is a consensus-based HL7 standard developed for use in Electronic Case Reporting (eCR). It was constructed in the HL7 Clinical Document Architecture (CDA) almost entirely from C-CDA templates that are certified to be already used by Electronic Health Records (EHRs) for other purposes. 

The data in the eICR were identified by a Council of State and Territorial Epidemiologists (CSTE) task force as the “minimum necessary” data needed for public health case reporting. The CDA eICR R1.1 Implementation Guide was published in January 2017, and there is an update planned for the May 2019 HL7 ballot cycle. An updated version will be made available by the end of 2019.

  • HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2: the Electronic Initial Case Report (eICR), Release 1, STU Release 1.1 - US Realm, available for download here on the HL7 Website

How / when should an eICR document be created?

When specific patient encounter data match one of the trigger codes in the electronic Reporting and Surveillance Distribution (eRSD) reportable condition trigger codes and the encounter timing is as specified in the eRSD, an eICR should be created and sent. An eICR can also be manually initiated by a clinician if they suspect the presence of a reportable condition. If manually initiated, the clinician should record the reason for sending the eICR for public health awareness. While an eICR can be created and sent directly from an EHR system, it can also be created in an EHR and sent through a designee of clinical care, such as a Health Information Exchange (HIE).

How to validate an eICR document?

Validation during eICR development

It is important while developing the eICR document to ensure it follows both Schema and Schematron validation specifications. APHL has made a customized on-line validation tool for this purpose. Users can upload eICR files to test validation here. This validation tool is specific to the eICR and the eICR’s underlying CDA Schema. The tool produces very specific information to refine the creation of the eICR document. 

Validation is also performed on all incoming eICRs in production. Some of the validation information will also be placed in the Reportability Response that is returned to healthcare, when production reports have issues that need to be addressed.

Additional informative XML support files (such as example files and the Schematron validation files) can be downloaded from this GForge link. Please see the “_readme.txt” file included in the STU document download for more details.

Validation in production on AIMS platform

Within the production eCR workflow, validation also occurs on the eCR platform before the eICR is passed to the decision support service. This validation step will allow for more detailed error and warning information in specific circumstances to be conveyed in the Reportability Response. 

Reportability Response “warnings” indicate that the eICR was received and was processed, but that there is some issue to be addressed by an EHR system administrator. Such warnings may include that the EHR is using an outdated version of the eRSD and trigger codes or that a minor issue exists in the relevant eICR.

Reportability Response “errors” indicate that the relevant eICR was not successfully processed, that the EHR administrator needs to determine what caused the issue (the validation errors should be available in the Reportability Response to help diagnose the problem), and that the provider of care may need to be notified that required reporting has not been done.

Creation and management of eCR standards 

The eICR and Reportability Response were developed through the HL7 consensus-based standard development process. Participation included stakeholders from across the industry (clinical care, public health, EHR vendors). We would encourage participation in the HL7 process for these standards in the HL7 Public Health Workgroup.

Comments specifically on the eICR STU Implementation Guide can be made here.

Comments specifically on the Reportability Response STU Implementation guide can be made here.

Other standards for eCR

While the CDA eICR and Reportability Response documents are currently the only eCR standards available for use in production, there are ongoing efforts to expand into FHIR.  An eCR FHIR Implementation Guide has been balloted and will soon be published. If your organization is interested in prototyping FHIR standards or participating in FHIR Connectathons for eCR please contact us at: