eCR General Information

eCR Now FHIR App

The eCR Now App provides electronic case reporting (eCR) capabilities for EHRs that don’t have the current ability to meet eCR requirements and can simplify your EHR onboarding process, enabling eCR rollout to your customers sooner.

The eCR Now App:

  • Handles triggering an eICR
  • Handles trigger code maintenance within an EHR using the eRSD
  • Handles creation of eICRs
  • Handles receipt of the Reportability Response

The eCR Now App allows an EHR that supports FHIR R4 to integrate the app to allow their customers to participate in electronic case reporting to public health. This allows the health care organization (HCO) to implement eCR faster than waiting for development cycles to conduct custom development to build eCR functionality into their EHR’s software. The App is free, and we encourage EHR vendors to adopt it.

Use of the App to perform eCR allows health care organizations to quickly receive credit for sending eCRs to PHAs. 

Benefits of the eCR Now Fast Healthcare Interoperability Resources (FHIR) App for EHRs to automate eCR:

  • Building on the FHIR API and Argonaut work, EHRs can implement the App within EHR versions in use today, allowing their customers to avoid service disruptions from migrations and upgrades often required by custom-developed eCR solutions
  • The App allows automation of eCR reporting, without disruption to provider or staff workflows
  • The App has been provided to EHR companies at no cost for implementation since May 2020 and is successfully sending eICRs to public health agencies today
  • The EHR’s adoption of the App allows HCOs to begin participating in eCR quickly, to comply with CMS rules for the Medicare Promoting Interoperability Program (PI) and Merit-based Incentive Payment System (MIPS) incentives
  • The App allows HCOs to automatically receive reportability responses from public health and integrate them into patient charts or an inbox, as desired
  • The App allows automatic updates to triggers through eRSD, the electronic reporting and surveillance distribution (eRSD) service, to further decrease HCO or EHR team maintenance tasks
  • ONC Certification supplementary guidance identifies the eCR Now FHIR App as a way for EHRs to achieve compliance and then become certified

We encourage health care organizations, providers, and public health to request that their EHR companies adopt the eCR Now FHIR App by submitting a ticket or through their usual procedures.

EHRs respond to their customers’ requests and will appreciate learning of your desire for the App due to the administrative and other benefits to your health care organization.

Other App attributes include:

  • By configuration, the App can do full electronic case reporting.
  • It produces fully validated, outgoing HL7 CDA eICR R1.1 and eICR R3.1 documents.
  • It includes transport out to the AIMS shared services platform:
    • Included support for Direct
    • An interface for XDR and other transport
  • It receives and sorts the returned Reportability Responses to identify those that should be notified to the provider of record and attached to the patient’s chart from those that support EHR system administration needs.
  • It consumes up-to-date trigger codes and reporting parameters from the Electronic Reporting and Distribution (eRSD) system, minimizing health system and EHR trigger code management.
  • It provides local storage of eICRs that have been sent.
  • It supports automated launch possibilities for complete background operations:
    • No user interface SMART on FHIR App launch
    • System API launch when provided with patient ID, encounter ID, FHIR Server URL
  • Can trigger on all of the following:
    • Lab orders
    • Lab result test names
    • Lab result values
    • Conditions in problem list
    • Conditions in diagnosis
    • Medications
eCR Infrastructure


The eCR Now FHIR App is intended to run as a background process during patient encounters and report automatically to appropriate public health jurisdictions and their surveillance systems though the AIMS shared services infrastructure. In this way, it should not burden or disrupt healthcare provider workflows. 

The eCR Now FHIR App can produce an HL7 Clinical Document Architecture (CDA) eICR R1.1 or eICR R3.1. This is the initial case report standard that can be received by the AIMS shared services platform, processed by the Council of State and Territorial Epidemiologists' Reportable Conditions Knowledge Management System, and then integrated into the public health agency surveillance systems or rendered as viewable HTML documents.

Next Steps

  1. Access the App and source code from the GitHub site.
  2. Post any issues or questions to the Zulip chat channel.
  3. Connect with the eCR Team via the eCR service desk early to plan an onboarding and coordination process.

The current version of the App and its source code can be found here:

GitHub App Source Code (external link)

Communication Channels and Resources

eCR Now App Discussion on Zulip (external link)

Electronic Reporting and Surveillance Distribution System (eRSD) (external link)