eCR Now for COVID-19 Reporting
Electronic Case Reporting
Electronic case reporting (eCR) is a key component of the data strategy for COVID-19 and other outbreak management needs. With patient identity, demographic information, race and ethnicity, and clinical diagnoses, it presents the necessary case data needed for state, local, and federal public health agencies (PHAs) to manage cases, provide patient situational awareness, support reporting, enable contact tracing, and coordinate isolation and other response measures. eCR can contain point-of-care and local lab results from clinical care sites, as well as connect with electronic laboratory results when they arrive at PHAs.
Trigger codes and case definitions to support eCR have been authored by state and local PHA staff and are being rapidly updated as they change during the course of the outbreak. In addition to automatic reporting without disruption of the provider workflow when a diagnosis or problem list item is recorded, eCR can be triggered from laboratory and medication orders. As such, while eCR is faster and more complete than electronic laboratory reporting natively, cases can also be generated on suspicion before a result is even achieved.
When COVID-19 presented, eCR was just beginning to be operationalized by the Council of State and Territorial Epidemiologists, Association of Public Health Laboratories, and Centers for Disease Control and Prevention. eCR was in operation in a limited number of sites because only a limited number of electronic health record (EHR) vendors had implemented technical eCR solutions. The eCR team developed a strategy, eCR Now, for immediate and rapid deployment. eCR Now includes the following elements:
1. Cohort-based COVID-19 rapid eCR implementations for provider sites that have eCR-enabled EHRs:
- Cohort implementation has been streamlined to 3 days.
- Early cohorts have successfully implemented, and new cohorts are forming now.
- Aside from commitment by healthcare organizations to implement, there is no limit to the number of concurrent cohorts.
2. eCR Now Fast Healthcare Interoperability Resources (FHIR) app that non-eCR-enabled EHRs can rapidly implement to automate COVID-19 eCR:
- Because of the Argonaut work and the FHIR API, an app can be quickly developed that can be implemented in EHRs in place now.
- The app supports automated COVID-19 (and full eCR) reporting.
- The app was provided to EHR companies and others for implementation and testing in their test environments in May 2020.
- With the app, cohorts for any EHR vendor onboarding is possible.
3. Extension of the existing eHealth Exchange policy framework through a developing Carequality eCR implementation guide:
- eHealth exchange participants can already do eCR without any new legal agreements.
- Carequality is accelerating the development and approval of an eCR implementation guide, meaning that their expanded list of participants can, as well.
With solutions for all EHR vendors and the ability to scale onboarding without limits, the obstacle to making these critical data available is the leadership to focus on its advancement.