Healthcare - Readiness and Implementation Checklist

The below checklist items outline the actions a healthcare organization must take to enable the eCR workflow, once project sponsorship has been secured. Some of the below steps may be performed by your electronic health record (EHR) company, depending on your existing contract and support workflows. Contact the eCR Team via the eCR service desk with any questions that you may have about the process. 

  • Verify eCR Prerequisites are Met 

  • Communicating Intent

  • Confirm Policy Path 

  • Establish Connectivity 

  • Conduct Testing  

  • Go-Live in the Production Environment

√    Verify eCR Prerequisites Are Met

EHR readiness involves (1) elements related to your EHR software and company, (2) the EHR implementation in your 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.

√    Communicating Intent

When you are moving forward with eCR, you will need to communicate your intent to participate to your public health agency (PHA) as well as communicate with the eCR Team via the eCR service desk. Not all PHAs are fully ready to implement eCR, but if your PHA has declared readiness, you should register your intent with that PHA and be able to attest for eCR in the Centers for Medicare and Medicaid Services (CMS) Promoting Interoperability program.

√   Confirm Policy Path 

eCR has created a single point of connection that can be used for reporting, but that single point of connection needs Health Insurance Portability and Accountability Act (HIPAA) business associate authorities, or equivalents, to help support provider organization reporting to all required Public Health Agencies (PHAs). There are several ways that the necessary authorities can be established:

  1. Your organization 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.

  2. Your organization is a Carequality Implementer or uses an EHR Company that is a Carequality Implementer.

  3. Your organization is a CommonWell Health Alliance member or uses an EHR Company that is a CommonWell Health Alliance member.

If your organization is not represented in any of the above options, the Association of Public Health Laboratories (APHL) offers a terms of service agreement that you can sign if your EHR vendor has not already signed it. Additional context is available on the Healthcare – Confirm Policy Path page.

√    Establish Connectivity

eCR connectivity can be implemented from your healthcare organization through almost all Health Information Networks (HINs) or Health Information Exchanges (HIEs). APHL AIMs then connects to all State and Territorial Public Health Agencies (plus some large local PHAs) and they, in turn, connect to local Public Health Agencies. The technical specifics of your reporting will be dependent on the Trust and Legal Connectivity approach you choose above. There are currently two “transport” standards for technical connectivity: XDR and Direct. Soon, FHIR will also be a supported transport standard.

Determine your organization’s technical approach to connect with AIMS: 

  • 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 Health Information Exchange

(For more technical information on connectivity, visit the Healthcare - Establish AIMS Connectivity for Testing page.)

 √    Conduct Testing

Complete the test scenarios using the following COVID-19 Test Package and generate test eICRs using synthetic patient data. Once you send the test eICR, the AIMS eCR platform will send a RR message back.

Download the COVID-19 Test Package (file download)

For each test scenario, make sure to: 

  • Only use the trigger codes specified for each test scenario.   

  • Export the test eICRs and save as XML files with the following naming convention: OrganizationName_Test eICR_YYYYMMDD.

  • Validate the test eICR using the on-line validator ( to upload your eICR XML files and verify the construction. (Synthetic patient data only, no PHI).

  • Submit sample eICR (saved as XML) files for content review. Include at least one sample eICR triggered from an encounter diagnosis/ problem list and at least one triggered from a positive or detected laboratory result. Send an email to with the subject “eCR – {your healthcare organization name} – Sample eICRs for Content Review]. An eCR Onboarding Coordinator will review the files and respond with any required content modifications.  

For any issues, open a ticket by sending an email to [Subject:  eCR – {your healthcare organization name} ]. Include that you sent a test eICR, the time and date of the message. The team will follow up with you to either troubleshoot or confirm next steps. 

For additional testing details, visit the Healthcare - Conduct Testing page. 

√    Go-live in the Production Environment

When the previous readiness and implementation steps have been completed and the EHR implementer supporting details for them are in place, you are ready to go into production. There are technical materials, including support for triggering, eICR creation, RR receipt, and technical readiness testing, available in the EHR Implementers section of this website.

The technical details in the EHR Implementers section of this website provide the specific details necessary to move into production.

When you are ready to onboard, submit a ticket through our eCR service desk.

Contact the eCR Team via the eCR service desk with any questions that you may have about the process.