Healthcare Readiness and Implementation Checklist
The below checklist items outline the actions a healthcare organization (HCO) must take to enable the eCR workflow. Some of these steps may be performed by the provider’s electronic health record (EHR) company, depending on their existing contract and support workflows. HCOs can contact their EHR vendor with any questions about the process.
eCR Prerequisites
√ Verify EHR readiness to implement eCR.
EHR readiness involves (1) elements related to the EHR software and company, (2) the EHR implementation in a particular healthcare setting, (3) the ability to send the electronic initial case report (eICR), and (4) the ability to receive a Reportability Response (RR) back. HCOs should work with their EHR to ensure they meet the prerequisites for implementing eCR.
For more information on EHR readiness, see the EHR Implementers – Readiness and Implementation Checklist page.
√ Verify EHR/Health IT product is ready for general HCO onboarding.
HCOs should review the list of EHR/Heath IT Products to ensure their EHR is ready for General HCO Onboarding: Getting Started with eCR | CDC (external link).
If their EHR is not listed, HCOs should continue to check this list periodically and/or contact their EHR for more information.
√ Register intent with public health agency.
To move forward with eCR, the HCO may need to register their intent to participate with their jurisdictional public health agency (PHA).
HCOs that participate in the Centers for Medicare and Medicaid Services (CMS) Promoting Interoperability Program should register intent with the appropriate PHA once the PHA has declared readiness to receive eCR data. After registering intent to participate, the HCO may be able to attest for the eCR measure.
Note: Some PHAs require registration from all HCOs doing eCR, including providers not participating in CMS programs.
See this page for a list of PHAs: Appendix IV - State and Local Public Health Readiness for Interoperability | Interoperability Standards Advisory (ISA) (healthit.gov) (external link)
√ Express interest in eCR onboarding.
After an HCO has verified their EHR is ready for general HCO onboarding, they should communicate their organization’s interest in eCR Onboarding by contacting their EHR company’s eCR contact to begin completing necessary prerequisites. The EHR will coordinate with the eCR Onboarding Team for implementation.
Implementation Planning
√ Review introductory onboarding materials.
After the HCO completes all eCR prerequisites and are ready to initiate onboarding, the eCR Onboarding Team or their EHR vendor will provide introductory materials. Key personnel should review all introductory materials.
Watch the Introduction to eCR for Healthcare Organizations video (external link).
√ Confirm policy path.
eCR has created a single point of connection for reporting, but that single point of connection needs Health Insurance Portability and Accountability Act (HIPAA) business associate authorities, or equivalents, to help support the provider organization reporting to all required Public Health Agencies (PHAs). There are several ways that the necessary authorities can be established.
HCOs should coordinate with their EHR to determine their organization’s policy path from the options below:
- The HCO is an eHealth Exchange member or is a member of a Health Information Exchange (HIE) or other organization that is a member of the eHealth Exchange.
- The HCO is a Carequality Implementer or uses an EHR Company that is a Carequality Implementer.
- The HCO is a CommonWell Health Alliance member or uses an EHR Company that is a CommonWell Health Alliance member.
- If the HCO is not represented in any of the above options, the Association of Public Health Laboratories (APHL) offers a terms of service agreement that the HCO can sign if their EHR vendor has not already signed it. HCOs should verify this first with their EHR company prior to signing the APHL eCR Participation Agreement.
Additional context is available on the Healthcare – Confirm Policy Path page.
√ Coordinate with jurisdictional PHA.
Jurisdictional PHAs engage with HCOs throughout the eCR onboarding process.
Once an HCO has initiated the onboarding process, they (or their EHR vendor) should notify their jurisdictional PHA of planned implementation and continue to include them on communications. At this stage, the PHA will then notify the HCO of any PHA-specific testing or requirements for their organization.
Configuration
√ Establish connectivity.
Determine technical approach for establishing connectivity.
Connectivity for eCR can be implemented from a HCO through almost all Health Information Networks (HINs) or Health Information Exchanges (HIEs). The APHL AIMS Platform then connects directly to all State PHAs, as well as some Tribal, local, and territorial PHAs. The technical specifics of HCO reporting will be dependent on the policy path chosen above. There are currently two “transport” standards for technical connectivity: XDR and Direct Secure Messaging. Soon, FHIR will also be a supported transport standard.
HCOs should determine their technical approach to connect with the AIMS platform from the following options:
- XDR via the eHealth Exchange Hub (the Hub is used for XDR connections either via eHealth Exchange members or Carequality Implementers)
- DirectTrust using a Health Information Service Provider (HISP) - DirectTrust technical connections also need the policy framework of the eHealth Exchange, Carequality and/or Commonwell
- Through a HIE
For more technical information on connectivity, visit the Healthcare - Establish AIMS Connectivity for Testing page.
Complete technical prerequisites for secure transport.
HCOs should work in collaboration with their EHR and/or HIE/HIN (as needed) to ensure their organization completes the prerequisites for connecting to the AIMS platform based on the secure transport option.
Visit the Healthcare - Establish AIMS Connectivity for Testing page to see the prerequisites for each secure transport option.
Note: Specific setup prerequisites and configurations steps will be outlined in your EHR’s documentation.
If, on the basis of the HCOs policy/network membership determinations, they intend to use a HIE or HIN to connect, the HCO may need the HIE/HIN to contact the eCR Support Team to ensure that their connection to the AIMS platform is in place.
Follow the steps for establishing a connection to the AIMS platform.
HCOs should follow the steps defined for their selected secure transport option. These are available on the Healthcare - Establish AIMS Connectivity for Testing page.
Connectivity Testing
√ Test connection to the AIMS platform.
HCOs should work in collaboration with their EHR (as appropriate) to confirm they are able to successfully:
- Trigger and send an eICR to the AIMS Platform,
- Receive the RR in return, and
- Render the RR visible to responsible healthcare providers and system administrators.
During this stage, the EHR and eCR Onboarding teams may define additional testing needs that inform the following step.
Content Review & Soft Go-Live
√ Conduct testing.
At this stage, HCOs will complete testing activities with their EHR as well as any recommended PHA-specific testing needs and/or complete a soft go-live.
Scenario Testing
HCOs can use test scenarios to generate test eICRs using synthetic patient data. These test eICRs can then be validated using the AIMS Online Validator.
To learn more about scenario testing, download test packages, or find additional information on the AIMS Online Validator, visit the Healthcare - Conduct Testing page.
Soft Go-Live
The eCR Testing Team will review the HCOs eICR documents during the soft go-live with real patient data to identify common data quality and structural issues.
Note: The HCO’s eCR Policy Path must be in place prior to any testing with production data.
For additional testing details, visit the Healthcare - Conduct Testing page.
√ Work with EHR and the eCR Onboarding Team to resolve issues.
After the completion of a soft go-live using real patient data, the eCR Data Quality Monitoring Report will be shared with the HCO, EHR, and PHA. This report will outline issues that should be reviewed and resolved in coordination with the EHR product team.
Note: The PHA may provide additional data quality feedback not found in the eCR Data Quality Monitoring Report that must be addressed.
√ Go live in the Production environment.
The EHR Implementers section of this website provides specific details necessary to move into production, including technical materials on triggering, eICR creation, RR receipt, and technical readiness testing.
PHA Validation
√ Maintain manual case reporting processes alongside eCR until sign-off by PHA.
Each PHA will review, validate, and analyze the HCOs eICR data to ensure it meets public health reporting requirements for each reportable condition. They will provide ongoing feedback on data quality directly to the HCO and EHR.
Note: These activities will likely not occur for all conditions at the same time.
The HCO will maintain current manual case reporting processes alongside eCR until notified otherwise by the PHA.
Production and Maintenance
PHAs, as the ultimate authority, determine when HCOs are in the CMS Promoting Interoperability “Validated Data Production” stage for eCR. They will notify your organization when you can end manual reporting.
Note: Manual reporting for all conditions will likely not end at the same time.
During production and maintenance, the HCO will continue to respond to PHA inquiries and improve data quality, as needed. HCOs may be required by their jurisdictional PHA to return to the PHA validation stage if data quality no longer meets the PHA-specific requirements.
√ Maintain eCR implementation standards.
HCOs (in collaboration with EHRs, as appropriate) establish and implement a process to maintain Electronic Reporting and Surveillance Distribution (eRSD) trigger codes immediately upon release at new updates.
For more technical information on eRSD trigger codes, visit the EHR Implementers - EHR Triggering page.
At least annually, HCOs will submit an updated facility list and their eRSD version to CDC and appropriate PHA(s).
Contact your EHR or submit a ticket through our eCR service desk with any questions that you may have about the process.
