Public Health Agencies

Resources, Tools, & Capabilities for PHAs 

The Association of Public Health Laboratories (APHL) Direct Support Team for electronic case reporting (eCR) engages with public health agencies (PHAs) to deliver tailored solutions and enable the implementation of eCR resources, tools, and capabilities (RTCs) to state, Tribal, local, and territorial PHAs. RTCs are subsequently made available to all PHAs (via direct download from our eCR Knowledge Management Space for PHAs) or assisted implementation through Direct Support. There are two models of Direct Support:  

Full Direct Support 

The Direct Support Team engages with a PHA to define the business needs and technical requirements, then develops a solution that promotes longevity and extensibility specific to the PHA. This may result in adapting or implementing an existing RTC or developing a new solution.  

Targeted Direct Support 

The Direct Support Team engages with a PHA to deliver a pre-developed RTC in an accelerated or tailored format. 

If you would like to learn more about the RTCs, Direct Support, and/or acquiring access to the eCR Knowledge Management Space for PHAs, please reach out to us through the eCR Service Desk.

 

eCR Resource, Tool, and Capability (RTC) Functionality 

Grouping and Filtering 

Tools that enable prioritization and filtering of content within eICRs based on the condition being reported and the public health needs. Grouping and filtering certain content in eICRs can aid in adapting clinical information for public health use and enable programs to use data received through eCR more efficiently. 

Associated RTCs:  

Terminology Management 

Tools and resources for managing eCR terminology. 

Associated RTCs:  

Data Quality 

Tools for validating eICR data and assessing data against PHA data quality standards and eCR requirements. 

Associated RTCs:  

Data Routing 

RTCs for routing case reports to the appropriate environment or PHA program(s) based on the condition being reported and other factors. 

Associated RTCs:  

Data Transformation 

RTCs for transforming data from one format to another, such as from CDA to FHIR, to facilitate data exchange and interoperability. 

Associated RTCs:  

Feed Monitoring 

RTCs used to monitor existing HCO and EHR eCR feeds, ensuring operational efficiency and providing timely alerts for outage response. 

Associated RTCs:  

Data Formatting 

RTCs for formatting data for presentation or analysis, such as by applying stylesheets to XML documents to generate human-readable HTML reports or handling variabilities in the structure or layout of content within the eICR that may differ by sender. 

Associated RTCs:  

 

Overview of RTCs for PHAs 

eCR Document Splitter and Filter

Functionality: Grouping and Filtering 

The eCR Document Splitter & Filter has been developed as part of Direct Support for select conditions, with the potential for expanding to all conditions. It provides grouping and filtering functionality that delivers condition-prioritized electronic Initial Case Reports (eICRs) and Reportability Responses (RRs) to the receiving surveillance system. 

One of the key functionalities of the eCR Document Splitter & Filter is its ability to map display names for undefined codes. This function can assist PHAs in managing and interpreting data effectively, even when dealing with non-standard codes. 

In addition, the design will allow for integration with the Terminology Exchange Service (TES), currently under development. This integration is intended to simplify the tool's expansion to all conditions and streamline maintenance activities, making the tool more effective and reducing the burden on PHA staff. 

Availability 

The eCR Document Splitter and Filter is available now for PHAs as part of a Direct Support request.  

 

Electronic Message Staging Area (EMSA3) 

Functionality: Grouping and Filtering, Vocabulary Management, Data Transformation 

The Electronic Message Staging Area (EMSA3) is a project that the eCR Team is collaborating with the EpiTrax Consortium to deliver, with the goal of expanding EMSA3's functionality to integrate with multiple surveillance systems. This expansion aims to provide jurisdictions with a platform to collaborate and contribute to a cohesive solution that advances public health surveillance. 

EMSA3 includes a user interface for terminology management, allowing for efficient mapping and maintenance of terminologies. The interface also allows for the implementation of robust condition-specific rules on coded values and is designed to facilitate the grouping and filtering of content to populate prioritized information into a surveillance system. 

Similar to the eCR Document Splitter & Filter, EMSA3 provides grouping and filtering functionality that delivers condition-prioritized eICRs and RRs to the spectrum of receiving surveillance systems. 

EMSA3 also enables the ability to map data variability, both in terms of data and structure, across Health Care Organizations (HCOs) and Electronic Health Records (EHRs). This feature is made accessible through a user-friendly interface. 

Availability 

EMSA3 is currently under development and expected to be completed Q4 2024. It will be integrated with the Terminology Exchange Service (TES) for vocabulary management and maintenance activities. 

 

Terminology Exchange Service (TES) 

Functionality: Vocabulary Management 

The TES has two main components aimed at supporting PHAs. The first component centralizes the curation of condition-associated codes, such as the Reportable Conditions Knowledge Management System (RCKMS) value sets, the electronic Reporting and Surveillance Distribution (eRSD), and other sources, making them readily accessible to PHAs through an API and a user interface. The second component of the TES is its capacity for customization. This feature is designed to meet the unique needs of public health and facilitate integration within PHA infrastructure. 

The TES offers condition-curated value sets for codes that both identify and contextualize a given condition, such as lab results and symptoms, to help ensure that data is relevant and actionable. It also streamlines vocabulary management by centralizing and curating relevant codes, reducing duplication of effort across PHAs. 

In addition, the TES provides narrative description look-ups for value sets captured within this tool and keeps users informed of content and value set updates.

Availability 

Users can register, sign-in, and search the web application by going to https://tes.tools.aimsplatform.org/ or tailor the TES content for integration within their PHA surveillance system infrastructure via the API or with the eCR Document Splitter and Filter tool. The TES can also be integrated with version 3 of the Electronic Message Staging Area (EMSA3) once it is released.

 

Text-to-Code Project 

Functionality: Vocabulary Management, Data Quality 

The Text-to-Code Project enables PHAs to receive enriched eICR documents with enhanced coded data by converting non-standard and narrative text into standard codes for critical data elements, thereby enhancing the quality of coded data and improving the processing and utility of eCR data. 

The improvements introduced by the Text-to-Code Project are expected to impact several areas of public health reporting: 

  • Enhance the accuracy of reportability determination for the Reportable Conditions Knowledge Management System (RCKMS). By ensuring that data aligns with standard codes, the system can more accurately determine which cases need to be reported. 
  • Reduce the vocabulary management burden on PHAs. The mapping of non-standard content to standard codes simplifies the process of managing and interpreting data. 
  • Streamline the grouping and filtering functionality at PHAs. With standardized codes, the process of grouping and filtering data becomes more efficient and reliable. 

It's important to note that PHAs have the option to receive the original eICR, an augmented eICR, or both. All original content will be preserved within the eICR, with augmented content clearly indicated to ensure that PHAs have access to the full data even as the Text-to-Code Project works to standardize and enhance it. 

Availability

The Text-to-Code Project is currently under development. It will be implemented on the AIMS platform and made available to all jurisdictions via a user interface and API. 

 

Implementation Guide Schematron 

Functionality: Data Quality 

The eCR Implementation Guide Schematron is a tool designed to assess the schema of eICRs based on the HL7 CDA Implementation Guides for public health case reports. Its primary purpose is to ensure that eICRs conform to the standards set in the Implementation Guide. 

While the eCR Implementation Guide Schematron focuses on evaluating eICR's adherence to HL7 CDA Implementation Guide standards, it's important to note that it does not assess the quality or completeness of the data within the eICRs. Its role is strictly to verify schema compliance, ensuring that the structure of the eICRs aligns with the guidelines provided by the Implementation Guide. 

In both testing and production, eICR documents go through an inline validation process on the AIMS platform using the Implementation Guide Schematron. Inline validation primarily serves to identify messages with fatal errors, to prevent further processing of those messages, and to notify the sender HCO of the fatal errors(s) via the RR. Inline validation also identifies eCR documents with severe warnings, errors, and warnings. However, unlike those with fatal errors, these eICRs and RRs are processed by AIMS. 

Additionally, the AIMS online validator provides a tool for ad hoc checking of test messages against the same inline validation artifacts. The eCR testing team also uses specialized XML software (e.g., Oxygen XML, etc.) with the Implementation Guide Schematron to review Schematron outputs from test documents on an individual and manual basis. 

Availability 

While the Implementation Guide Schematron is already in use on the AIMS platform and its functionality serves as one component of the broader AIMS architecture, this tool is also available, along with the Data Quality Schematron, to provide PHAs with a suite of capabilities to assess both data quality and eICR schema compliance with the CDA eICR Implementation Guide standard. 

 

eCR Data Quality Schematron & Associated Tools 

Functionality: Data Quality 

The eCR Data Quality (DQ) Schematron & Associated Tools is a comprehensive tool designed to evaluate data quality metrics for eICRs. It contains all the rules outlined in the Implementation Guide Schematron and introduces new rules for a more robust data quality assessment. 

The DQ Schematron is intended to be used alongside a data store. This allows for quality assurance outputs to be maintained for aggregate analysis, providing a holistic view of data quality over time. It is designed for use within the PHA's local environment, enabling jurisdictions to add customized assertions based on their unique needs and circumstances.  

The DQ Schematron is also utilized during the EHR product preparation and HCO onboarding processes for eCR. 

Availability 

The DQ Schematron & associated tools are available now for PHAs implement independently or as part of a Direct Support request. It is available for both Mirth and Rhapsody implementations. 

 

eCR Feed Splitter 

Functionality: Data Routing 

The eCR Feed Splitter is a tool that PHAs can utilize to split the production feed from AIMS into different environments, such as a test, stage, and/or production environment. This allows jurisdictions to manage and monitor their data flows and ensure that the right data gets to the right environment at the right time. 

The splitting process can be based on the condition and/or sending organization, which enables PHAs to manage onboarding activities for independent conditions before routing them to production. 

Availability 

The eCR Feed Splitter is available now for PHAs implement independently or as part of a Direct Support request. It is available for both Mirth and Rhapsody implementations. 

 

eCR Mapper 

Functionality: Data Transformation 

The eCR Mapper creates a Simplified XML file, composed of data elements from both the RR and the eICR. The structure and content of both the RR and eICR source files are standardized Clinical Document Architecture (CDA) XML documents. The eCR Simplified XML Output is a flattened, less cumbersome, XML schema where many of the CDA templates and organizers are removed.  

PHAs and HCOs can incorporate this into their system via Rhapsody or Mirth. The resulting XML file makes it easier to find and map eICR and RR data elements for integration within downstream surveillance systems. 

Availability 

The eCR Mapper is available now for PHAs implement independently or as part of a Direct Support request. PHAs and HCOs can incorporate this into their system via Rhapsody or Mirth.  

 

PHA eCR Monitoring Dashboard 

Functionality: Feed Monitoring 

The PHA eCR Monitoring Dashboard is a comprehensive tool that enables Public Health Agencies (PHAs) to track near real-time analytics of their jurisdiction's eCR feeds. This high-level dashboard helps in identifying outages and trends, and includes the following information: 

  • eICR document count (within a designated time period) 
  • Encounter count (within a designated time period) 
  • eICR documents received over time 
  • Outage alerts 
  • eICR document count by: 
    • Sending organization 
    • Condition 
    • Route 
    • Transport method 

Availability 

The PHA eCR Monitoring Dashboard is available now. Jurisdiction’s eCR leads can request access to their dashboard via the eCR service desk. 

 

XSL Stylesheets 

Functionality: Data Formatting 

The XSL Stylesheets is a tool that can be utilized to transform XML files into human-readable HTML files. This allows the files to be easily opened and viewed in a web browser, facilitating a more straightforward user experience. 

This tool has been implemented in multiple jurisdictions, enabling the platform to use XSL stylesheets to deliver HTML eICRs to public health agencies (PHAs). This delivery can be done in conjunction with the XML, depending on the preferences of the PHA. 

Availability 

Available now for PHAs implement independently or as part of a Direct Support request. This stylesheet is also used to generate the HTML file that PHAs can request to receive from the AIMS platform alongside the XML file.