HIEs and HINs - Supporting Technical Transactions

Electronic case reporting (eCR) begins in electronic health records (EHRs) where the HL7 initial electronic case reports (eICR) are triggered and produced. The eCR project provides a list of trigger codes and reporting parameters to clinical care sites and EHR companies to guide the initiation of automated reporting. Some EHR triggering is oriented to recorded diagnoses and problems, some relates to laboratory results, and some is oriented to state laws about reporting suspicious cases of some highly contagious diseases as identified in an EHR by laboratory orders and prescribed medications.

The eICR is an HL7 Clinical Document Architecture (CDA) standard that uses as many of the same data and templates as HL7 C-CDA documents. It also includes some data that are not in C-CDA documents that are critical to public health. The guidance that is provided to clinical care/EHR companies also defines the timing of eICR creation in EHRs to ensure that reporting can begin during the patient encounter in order to provide timely data for public health needs.

Clinical care providers have long sought relevant information from public health about the status of these conditions in their communities. With eCR, public health is providing a Reportability Response (RR) HL7 CDA document back to clinical care for each eICR that is sent out. The RR provides useful information from public health agencies back to clinical care providers in the context of their patient, the conditions, and the jurisdiction. If no conditions were found to be reportable in the eICR, the RR still serves as a confirmation of connectivity, errors and warnings, and a successful round trip.

Both the eICR and the RR are XML payloads that can be conveyed with many different types of standard store and forward, or synchronous “push” exchange transactions. These include IHE XDR and Direct SMTP transactions, but can also be transported using almost any kind of internal HIE interface engine and routing infrastructure. HIEs can provide eCR services to healthcare provider organizations to move eICRs from EHRs to the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) platform and return response information to the responsible provider of care and their EHR implementer.