EHR Implementers

EHR Implementers - Reportability Response Receipt & Use

What is a Reportability Response? What is in it? 

The Reportability Response (RR) is a consensus-based Health Level Seven International (HL7) standard developed for use in electronic Case reporting (eCR) based on the HL7 Clinical Document Architecture (CDA). 

It was developed to allow for communication back to healthcare from public health including the following information:

  • The reportability status of conditions identified in an electronic initial case report (eICR).

  • If there are reportable conditions, the jurisdiction(s) that were reported to, along with contact information for the public health agencies (PHAs).

  • Information about reported conditions in the jurisdiction.

  • Necessary follow-up testing or condition management information.

  • Other relevant information (e.g., treatment guidelines, fact sheets).

The RR is a companion standard to the eICR designed to pair one RR created for each eICR. The healthcare organization that created the eICR should receive one RR back. While the RR will also be shared with public health agencies (PHA) if they wish to receive it, the primary audience for the RR is the healthcare provider/reporter in order to communicate information on the status of reportable conditions with succinct next steps they may need to take relative to these conditions and their patients. The CDA Reportability Response Implementation Guide was published in January 2018.

  • HL7 CDA® R2 Implementation Guide: Reportability Response, Release 1, STU Release 1.0 - US Realm, available for download on the HL7 website (external link)

  • Additional XML support files (such as example files, stylesheets, and the Schematron validation files) can be downloaded by clicking the green code button at this GitHub link (external link). There is a specific stylesheet to illustrate the desired format of the rendered RR CDA document

What should clinical care do with the RR upon receipt?

  • For Healthcare Providers: When an RR contains conditions that are “reportable” or “may be reportable,” the healthcare provider and/or appropriate support staff should be notified by one of the following methods:

    • RR is attached to the patient chart.

    • RR is placed in the appropriate healthcare provider/support staff work queue or is communicated to providers through some other internal electronic health record (EHR) communication method.

In general, “reportable” and “may be reportable” communications require healthcare provider or healthcare provider staff attention, but do not need “alerting” and workflow disruption.

  • EHR system administrators should be able to access all returned RRs in order to perform the following tasks (guided by the eICR processing status):
    • To see RR warnings when the eICR was processed, but still needs action:

      • Old/deprecated code is in use and should be addressed.

      • Old version of Electronic Reporting and Surveillance Distribution (eRSD), including the Reportable Conditions Trigger Codes (RCTC), is in use and should be updated.

      • To see RR errors that indicate that an eICR was not successfully processed:

        • To see a full list of errors, see Volume 1 page 14 in the RR Implementation Guide

Creation and management of eCR standards 

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

Comments specifically on the eICR STU Implementation Guide can be made on the HL7 STU Comments site for the eICR (external link)

Comments specifically on the RR STU Implementation guide can be made on the HL7 STU Comments site for the RR (external link).

Other standards for eCR

While the CDA eICR STU 1.1 and RR STU 1.0 documents are currently the only eCR standards in use in production, there are new CDA versions and HL7 FHIR (Fast Healthcare Interoperability Resources) versions that have been balloted and will soon be published.

The eCR Now FHIR App uses the HL7 FHIR R4 to connect to EHRs. The app then produces the same CDA eICR STU 1.1 and receives the RR STU 1.0 documents that are in operations with “native” EHR implementations.

If your organization is interested in piloting FHIR standards or participating in FHIR Connectathons for eCR, contact the eCR Team via the eCR service desk.