PROTECTING, MAINTAINING AND IMPROVING THE HEALTH OF ALL MINNESOTANS
MDH Interoperability Webinar Series:
Electronic Case Reporting (eCR)
Ann Kayser, Jacqueline Cassman, Melinda Hanson
January 20, 2022
MDH Overall Data Strategy
Join any or all MDH Interoperability Webinars in this Series:
Date Public Health Reporting Use Case
January 20 Electronic Case Reporting (eCR) *
January 27 Laboratory Orders/Results – Infectious Disease Lab (IDL)
February 3 Laboratory Orders/Results – Newborn Screening Blood Spot (NBS)
▪ For past Webinar materials, including recordings:
DSI website (https://www.health.state.mn.us/data/interoperability/webinar.html)
▪ Further questions: health.dsi@state.mn.us
* Denotes CMS required public health reporting for Medicare payments
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Webinar providing information towards:
Reducing your reporting administrative burden
Meeting the CMS public health reporting requirements
Improving data quality so information shared with MDH can
better address future emerging threats and address population
health issues
Learning how you, your organization, and your patients benefit
from improved public health
reporting
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MDH Interoperability Strategy: Overall
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MDH Request of External Partners
Schedule meeting with DSI to discuss more details related to health system needs
▪ Determine your organizations’ public health reporting priorities for implementation and
share with DSI (checklist)
▪ Discuss any barriers or opportunities for electronic implementation with MDH
▪ Consider Participation Agreement with Koble (https://3b54d489-fb07-4eda-b01d-
8169cc695bc4.filesusr.com/ugd/64a972_dddba6a5436949e5952abe8094b9c778.pdf)
▪ Plan and coordinate MDH public health reporting improvements through DSI and
provide feedback to processes
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Electronic Case Reporting (eCR)
What is eCR?
Electronic case reporting (eCR)
is the automated, real-time exchange of case
report information between electronic health
records (EHRs) and public health agencies
eCR aims to eliminate the burden of manual
reporting for health care providers
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Current State of Disease Reporting
Many infectious diseases are
required to be reported to the
Minnesota Department of Health
[MN Rules 4605.7000 to 4605.7900]
Disease report card (yellow card) is
used for most reportable infectious
diseases; some diseases require
separate form with additional details
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Minnesota Electronic Disease Surveillance System (MEDSS)
Main information system to support public health disease surveillance in Minnesota
Person-centric system and consolidates data receives from various sources for an individual
Supports case management, contact tracing and outbreak investigations
Receives lab data on reportable conditions; mostly as electronic laboratory reporting (ELR)
Receives paper/manual case reports currently; expanding electronic case reporting (eCR)
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Current Data Flow from Provider to Public Health Programs for
Infectious Disease Surveillance
Case reports are paper/phone/fax/manual web entry – lag in reporting and timeliness issue
ELRs considered an initial feed and public health requires case report for surveillance needs
ELRs can be delayed with reporting lag (some are daily feeds & not real-time): timeliness issue
ELRs from some reference labs have minimal info & lack key data elements: completeness issue
Public Health perspective
Significant resources are spent to track down additional needed information
Provider and Health systems perspective
Significant resources are spent to track down additional needed information to report to
public health + possibility of under-reporting due to manual process
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Promise of Electronic Case Reporting (eCR)
Critical need of timely & complete data has been brought to forefront in context of COVID-19
ELRs a success (thanks to Meaningful Use) and is an essential notification for public
health action and much needed lab confirmation of infectious pathogens
eCR from electronic health records provides critical clinical and demographic data not
included in lab report
eCR will provide contextual information on cases and the value-proposition extends
well beyond COVID-19 to all reportable conditions
Resources can be reallocated to other essential services by both public health and the
providers/health systems
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Disease Reporting Data Flow
Clinical System
MDH PHL
MDH MEDSS
3. Cas e report data (eCR)
Lab
RCKMS/AIMS
HUB
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Current state
Preferred Future State
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eCR Overview
• eCR is a national initiative and collaborative effort of
Centers for Disease Control and Prevention (CDC)
Association of Public Health Laboratories (APHL)
Council of State and Territorial Epidemiologists (CSTE)
• All healthcare providers are required to report certain infectious diseases to the public health agency
responsible for their jurisdiction
• Currently the reporting occurs in various formats
phone, fax, web-data entry and non-standard electronic flat files
• eCR supports data delivery to public health in real time
uses standard codes to automatically trigger the eCR
transfers relevant, clinical data to a shared services platform for reporting
• These transactions are standards-based
major step towards interoperability in healthcare ecosystem
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Acronyms / Alphabet Soup
• CDC – Centers for Disease Control and Prevention
• APHL – Association of Public Health Laboratories
• CSTE – Council of State and Territorial Epidemiologists
• MDH – Minnesota Department of Health
• EHRs – Electronic Health Records
• AIMS – APHL Informatics Messaging Services
• RCKMS – Reportable Condition Knowledge Management System
• MEDSS – Minnesota Electronic Disease Surveillance System
• eRSD – Electronic Reporting and Surveillance Distribution System
• eCR – Electronic Case Reporting
• RCTC – Reportable Condition Trigger Codes
• eICR – Electronic Initial Case Report
• RR – Reportability Response
• ELR Electronic Laboratory Reporting
Entities
Services and Systems
Electronic Transactions
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eCR Infrastructure
Source: eCR Team at CDC and AIMS
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• Exchange standard
HL7 document
HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2 - US Realm - the Electronic
Initial Case Report (eICR)
• Vocabulary standards
Diagnosis (SNOMED, ICD-10 CM)
Lab Orders (LOINC)
Lab Results (SNOMED)
Lab Result Test Name (LOINC)
Medication (CVX, RXNORM, SNOMED)
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eCR Standards
eCR COVID-19: Location of Reporting Facilities
Source: eCR Team at CDC and AIMS
As of December 10, 2021,
more than 10,100 facilities
are sending COVID-19
electronic initial case reports
to public health using eCR
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eCR @ MDH – Current Status
Connected to AIMS platform and have been receiving COVID-19 data daily
Receiving daily eCR data from 3 FQHCs and 4 major health systems (for COVID-19)
3 more health systems have expressed interest
As of
Jan 2022
eCR thru AIMS is currently the only option supported by MDH to streamline data input
Receive data from other states connected to eCR-AIMS for COVID-19 cases
who are MN residents
Incoming electronic eCR data, followed by automatic upload of file into
surveillance system since Aug 2020; working on parsing of priority eCR data
Currently doing outreach to health systems in MN to facilitate eCR on-boarding
Declared readiness for eCRs for all reportable conditions
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eCR Reports @ MDH for COVID-19
Additional MN submitters
added:
-Jan, 2021 and Dec, 2021
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eCR Data Flow
Minnesota Department of Health (MDH)
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Key Clarifications to Get from your EHR Vendor
• EHR ability to implement trigger codes for COVID and all reportable
conditions
• Cost and timeline for implementation
• Ability to receive and review RR in a meaningful way
▪ When eCR goes out, an RR is always returned whether it was sent to MDH or no
report was required
▪ May have additional follow-up information – send specimen to MDH
▪ Identify a process to know which patients to still report manually
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eCR Onboarding Process with AIMS
• MEDSS eCR team works with health systems and providers in MN along with CDC/AIMS
colleagues to elicit interest
• CDC/AIMS eCR Onboarding Team will guide the implementation process
• Cohort-based implementation for Epic EHRs
• Legal/Policy – 3 approaches for healthcare sites to engage the Association of Public
Health Laboratories (APHL) with an appropriate HIPAA legal agreement
• Technical process:
• Establish AIMS Connectivity for Testing
• Testing
• Production go-live process
• MDH eCR team will be involved all along for support as needed
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APHL Expectations for eCR Onboarding*
1) Technical Requirement: a technical connection to AIMS platform: A or B below
A. Direct Secure Messaging (DSM) through a Health Information Service Provider (HISP)
B. XDR transaction push through eHealth Exchange Hub to AIMS.
2) Policy Requirement: one method for documenting participation agreement: A, B or C below
A. Member of Carequality or be associated with as client of ‘EHR’ vendor in Carequality
B. Member of eHealth Exchange path (requires DURSA)
C. Sign Business Agreement with APHL for eCR (eCR Participation Agreement)
*National eCR onboarding team will provide guidance during initial call
and regular on-boarding calls once an entity expresses interest in eCR
1/20/2022
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eCR Readiness
MDH has declared readiness to receive all reportable
diseases
COVID only receiving presently
Epic EHRs have FastTrack process as part of national
onboarding strategy
Other EHRs are under consideration as well
Providers can consider using eCR Now FHIR App for
EHRs that are not eCR enabled
For more
info: https://ecr.aimsplatform.org/general/ecr-
now-fhir-app
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Next Steps
Fast track interest in eCR
▪ Email [email protected] with interest to onboard eCR for your organization
Include the MDH eCR team in CC field:
Ann Kayser, Ann.Kayser@state.mn.us
Jacqueline Cassman, Jacqueline.Cassman@state.mn.us
Priya Rajamani, Priya.Rajamani@state.mn.us
Melinda Hanson, Melinda.Hanson@state.mn.us
▪ Connect with EHR Vendor on eCR capabilities – plan to start implement with COVID eCR and then move to
all reportables
▪ Use the
DSI checklist to continue to determine your organizations’ public health reporting priorities for
implementation and share with DSI
(
https://www.health.state.mn.us/data/interoperability/docs/checklist.pdf)
▪ Discuss any barriers or opportunities for electronic implementation with MDH
▪ Plan and coordinate MDH public health reporting improvements through DSI and provide feedback to
processes
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Additional Information: eCR Use Case
Electronic Case Reporting (eCR) (https://www.cdc.gov/ecr/index.html)
COVID-19 Electronic Case Reporting for Public Health Agencies
(https://www.cdc.gov/coronavirus/2019-ncov/php/electronic-case-reporting.html)
What is eCR? (https://ecr.aimsplatform.org/)
eCR Now for COVID-19 (https://ecr.aimsplatform.org/ecr-for-covid-19-reporting/)
MDH Electronic Case Reporting (eCR)
(https://www.health.state.mn.us/diseases/reportable/medss/ecr.html)
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Q & A
