Healthcare - Conduct Testing
During the eCR onboarding process, healthcare organizations (HCOs) will complete testing activities in coordination with their electronic health record (EHR) company. This includes scenario testing activities and soft go-live testing.
Note: testing and soft go-live activities detailed below only refer to the CDC eCR onboarding process. Organizations should expect to complete additional validation activities with public health agencies (PHAs).
Scenario Testing
When developing the eICR document, it is important to ensure it follows the appropriate standards and specifications. HCOs, in coordination with their EHR, can use test scenarios to generate test electronic initial case reports (eICRs) using synthetic patient data. These test eICRs can be validated using the AIMS Online Validator (external link).
AIMS Online Validator
The AIMS Online Validator is a tool specific to the eICR and its underlying schema which produces error and warning information that can help refine the creation of the eICR document.
HCOs, EHR companies, and PHAs can upload eICR documents without PHI to validate eICR against the following:
- CDA eICR R3.1 (CDA® R2 Implementation Guide: Public Health Case Report - the Electronic Initial Case Report Release 2, STU Release 3.1 - US Realm)
- CDA eICR R1.1 (CDA® R2 Implementation Guide: Public Health Case Report Release 2: the Electronic Initial Case Report Release 1, STU Release 1.1 - US Realm standard)
- eCR Data Quality Schematron v2.0
Note: PHAs may also leverage this tool to investigate specific errors they are seeing and reference the output when troubleshooting specific issues with HCOs and EHRs.
Soft Go-Live
Overview
At this stage EHRs—with HCOs, PHAs, and the eCR Team—will conduct testing and soft go-lives. EHRs will finalize their customer-facing eCR implementation documentation, respond to PHA questions following eICR document reviews, and utilize the Data Quality Monitoring Report to identify and resolve issues. This report, which aggregates outputs from the Data Quality Schematron, will be shared with EHRs by the eCR Team.
The eCR Team will support this process by documenting any issues and anticipated resolution timelines, sharing Data Quality Monitoring Reports and any preliminary known issues with PHAs.
Soft Go-Live Process
- The eCR Onboarding Team will coordinate soft go-live start dates with the eCR Testing Team to confirm capacity and AIMS technical setup. Once confirmed, the Onboarding Team will provide the next steps to the HCO and EHR.
- The HCO will initiate production triggers on the approved date and continue until there are enough eICR documents to analyze. (Note: documents are not transmitted to PHAs during this step unless the PHA opts-in to receive eICRs. HCOs will receive Reportability Responses (RRs) for each eICR sent to the AIMS Platform during soft go-live.)
- The Onboarding Team will ensure PHAs receive updates on the implementation status for the HCO and PHAs may share feedback or requests prior to the HCO going into the PHA Validation stage. The Onboarding Team will support the HCO and EHR in accomplishing PHA requests, as applicable.
HCOs will need PHA approval to move from soft go-live to the PHA Validation stage.
Test Packages
The test packages below can be used by HCOs to conduct testing. Additionally, EHRs will make supplemental eCR testing materials available to HCOs during the onboarding process (as described above).
eICR Creation
This test package can help to confirm that electronic initial case reports (eICRs) generated by EHR systems are correctly constructed, are populated with standard codes, and conform to the standard specification. The instructions in this test package outline the available resources for testing the eICR creation process. These resources apply to both new development and implementation of eCR features within an existing EHR system. Learn more about eICR creation on the EHR Implementers - eICR Creation, Validation, & Standards page.
Download the eICR Test Package (file download)
Triggering
This test package can help to confirm that eICRs are triggered correctly based on trigger code value sets (Reportable Conditions Trigger Codes (RCTC)) found in the Electronic Reporting and Surveillance Distribution (eRSD). This test suite is focused specifically on triggering, and not eICR creation or delivery.
Note: these tests are limited to trigger code matching and exclude any functionality related to timing of triggering and/or eICR creation. Learn more about triggering on the EHR Implementers - EHR Triggering page.
Download the Triggering Test Package (file download)
RR Processing
This test package can help to confirm which Reportability Responses (RRs) have reportable, may be reportable, not reportable, or no rule met eICRs. “Reportable” and “may be reportable” should be attached to the patient chart, placed in the appropriate provider/support staff work queue, or communicated to them through some other internal EHR communications. However, when an eICR does not meet reporting requirements, providers should not be burdened with those RRs at all. The “not reportable” and “no rule met” RRs are only for the EHR system administrators use to confirm that reporting is functioning and to be notified of errors and warnings. Learn more about the RR on the EHR Implementers - Reportability Response Receipt & Use page.
Download the RR Test Package (file download)
Connection Testing
This test package builds on the other testing resources above and requires the sending healthcare facility to include an address for its location to properly test rules based on provider location. This test package should only be started after the previous test packages have been successfully completed. (Personally identifiable information should still not be included in this testing step). Information on facility and patient data requirements, as well as potential RR examples, are provided. Learn more about AIMS connectivity on the EHR Implementers - eCR Exchange and Transport page.
