Healthcare Providers - Readiness and Implementation Checklist

√    EHR Readiness

Electronic health record (EHR) readiness involves (1) elements related to your EHR software and vendor, (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 state public health agency (PHA) as well as communicate with the eCR Support Team via the eCR general information 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.

√    Planning Connectivity

There are two major elements of connecting your clinical care site to public health for eCR: Policy/trust agreements and technical exchange. The two elements are interrelated, but also require different staff to put into operation.

  1. Trust and Legal Connectivity

  • 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 to help support your organization in appropriate reporting to all required PHAs (For more information, visit the Healthcare Providers - eCR Data Sharing Overview page.). There are two ways to implement the necessary data sharing agreements:
    • Have your organization sign an Electronic Case Reporting Participation Agreement (file download) with the Association of Public Health Laboratories (APHL) that was designed for this purpose. 

    • Use the agreements that are in place for up-to-date participants in the eHealth Exchange Health Information Network (HIN). If your organization is a member directly or through a representative, like a Health Information Exchange (HIE), and you are current with membership agreements, you should already be able to participate without needing any other agreements or signatures.

  • Access a list of current eHealth Exchange participants. (external link) If your organization is not already a member of the eHealth Exchange, the eHealth Exchange is offering no-charge memberships for eCR only participants. More information on all of these possibilities is available on this site in the HIEs & HINs section, and you can also contact the eCR general information desk at

  2. Technical Connectivity

  • eCR can be implemented through a direct connection from your healthcare organization to the APHL Informatics Messaging Services (AIMS) platform or through most HIEs and HINs. The technical specifics of your reporting will be dependent on the Trust and Legal Connectivity approach you choose above. (For more technical information on connectivity, visit the EHR Implementers - eCR Exchange and Transport page.)

Help for both of these steps can be received by connecting with the eCR general information desk at

√    Onboarding and Production

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 helpdesk ticket with the eCR Support Team by emailing and include “eCR” in the subject line to ensure proper triage and routing.

Contact the eCR general information desk at with any questions that you may have about the process.