EHR Implementers

Triggering of eICRs

Triggering is the set of actions in an Electronic Health Record (EHR) that initiates the creation and transmission of an Electronic Initial Case Report (eICR) to the AIMS platform. When certain data in the EHR are recorded or updated they are checked against a series of codes that have been distributed to the EHR. If a code matches, there is a likely reportable condition that needs to be processed by decision support for confirmation.  If the timing parameters for reporting have been met then the eICR should be “triggered” and transmitted to the AIMS platform. This should all be done automatically behind the scenes and without disrupting healthcare providers’ workflow.

Triggering is based on reporting parameters and trigger code value sets in XML or JSON form that are distributed through the Electronic Reporting and Surveillance Distribution (eRSD). The eRSD contains these value sets, referred to as the Reportable Conditions Trigger Codes (RCTC). The trigger codes (RCTC) in the eRSD were collaboratively developed by the Council of State and Territorial Epidemiologists (CSTE), the Centers for Disease Control and Prevention (CDC), and the Association of Public Health Laboratories (APHL). EHR Implementers can register and subscribe at no cost to the eRSD service to receive notification and distribution of routine and emergent updates. Each update will include an effective start date, which is the date the set of codes should be implemented and in use by reporters.  For scheduled releases, this will typically be 4-6 months from the release date (see schedule below).

Item

Full Description

Access

Release Date

eRSD

Electronic Reporting and Surveillance Distribution (includes RCTC value sets)

eRSD Service

Available

RCTC Spreadsheet 

Reportable Condition Trigger Codes

Download

July 9, 2020

RCTC Change Log

A change log of updates to the RCTC file since the previous release

Download

July 9, 2020

EHR implementers requested the more consumable version of the RCTC than the excel spreadsheet so the eRSD service has been developed and is built on the HL7 FHIR standard, but its XML or JSON distribution can be used, just like other XML and JSON, by EHRs that do not yet implement FHIR. In addition to trigger codes (RCTC), the distribution contains report timing guidance and metadata important for consistent public health reporting.

Routine Release Schedule for Triggers for Reportable Conditions

Release Date

Effective Date

Number of New Conditions

Total Conditions Included

December 2018

April 1, 2019

6

  6

June 2019

November 1, 2019

14

  20

January 2020

June 1, 2020

23

  43

June 2020

December 1, 2020

41

  84

January 2021

June 1, 2021

10

  94

Predicted June 2021

Predicted December 2021

TBD

 

Ongoing Routine Updates

Ongoing Routine Updates

Ongoing Routine Updates

 

How the eRSD is used to trigger an eICR

An eICR is “triggered” or generated and sent to the AIMS platform for confirmation of reportability when a diagnosis, a laboratory order (for conditions reportable based on suspicion), a laboratory test, a laboratory result code, or a medication is matched to one of the specific trigger code sets in the eRSD. There are 5 primary triggering scenarios that EHRs need to account for by matching data recorded in the EHR against the RCTC within the eRSD.

Diagnosis (SNOMED, ICD-10 CM)

An eICR will be triggered when a diagnosis is recorded in the EHR that matches a value within the eRSD/RCTC “Diagnosis_Problem” value set. These codes could be held in problem list or diagnosis fields.

Lab Results (SNOMED)

An eICR will be triggered when a laboratory result report is received by the EHR where the laboratory result matches a value within the eRSD/RCTC “Organism_Substance” value set.

Lab Result Test Name (LOINC)

An eICR will be triggered when a laboratory result report is received by the EHR where the laboratory test name matches a value within the eRSD/RCTC “Lab Observation Test Name” value set.

Lab Orders (LOINC)

An eICR will be triggered when a laboratory order is placed where the lab order matches a value within the eRSD/RCTC “Lab Order Test Name” value set. Note: this trigger should occur before lab results are available.

Medication

(CVX,RXNORM,SNOMED)

An eICR will be triggered when a medication is administered or prescribed and matches a value within the eRSD/RCTC “Medication” value set.

eRSD Preparation and Maintenance

It’s important to implement and utilize the latest version of the eRSD within EHRs as doing otherwise may adversely impact public health reporting, resulting in reports of public health interest going undetected and not being sent to public health. The eRSD includes RCTC value sets that will continue to evolve with more refined codes and additional conditions reportable to public health. It may also include new codes for rapid implementation in a public health emergency setting. It is important to be able to accommodate routine and emergent eRSD updates.

In some cases, a healthcare provider may use local codes that are not specified in the eRSD/RCTC.  Most major labs deliver results to EHRs with the nationally accepted SNOMED and LOINC terminologies. Not all EHRs record these values on receipt. EHRs using local codes may need to map those codes into the nationally accepted SNOMED and LOINC terminologies to trigger properly. This mapping may be unique to individual healthcare providers, and it is encouraged that the healthcare provider, EHR implementer, and EHR work collaboratively to determine this need.

Trigger Timing

Because of variability in accumulation of data at the start of a patient encounter, the EHR implementer should implement a time-based delay in generating and sending the eICR to allow time for required data to be captured within the patient encounter. This will ensure the eICR is more populated before sending, and minimize the number of case reports that are sent for a single patient encounter.  Full triggering timing can be described using the three suggested parameters below.

Parameter A – The time from the start of the patient encounter to when the first eICR is constructed and sent.  May contain multiple trigger events before eICR is populated.

  • Example - 1 hour after the encounter begins

Parameter B - The time period from the send of an initial eICR to the send of an update during a long-term stay.

  • Example - 24 hours after the last eICR was sent

Parameter C – Time period after the encounter ends when a final eICR is constructed and sent

  • Example - 24 hours after the encounter ends

For any questions or feedback regarding the eRSD (including the RCTC), please submit a ticket using the link below.

RCKMS Ticketing system