- The Centers for Disease Control and Prevention is working to automate generation and transmission of COVID-19 case reports to deliver data put in provider EHRs directly to public health agencies.
- For providers that don't have EHRs with the ability to electronically send case reports, CDC is creating a FHIR-based app to connect COVID-19 electronic case reporting (eCR) to existing health IT infrastructure to confirm cases and route the data to appropriate end users. The goal is to give public health officials a more accurate, timely picture of the pandemic.
- The initial version of the app, called eCR Now, will be available May 1, Laura Conn, eCR lead in the CDC's Center for Surveillance, Epidemiology, and Laboratory Services, said Wednesday at a virtual meeting of health IT congressional advisory group HITAC.
Electronic case reporting is automated sharing of health information between EHRs and public health agencies for earlier disease detection and intervention. CDC first extended electronic case reporting to COVID-19 in early January, but has seen piecemeal uptake in providers so far.
Health IT experts have called for the Trump administration to impose mandatory electronic lab and case reporting requirements to track and manage the epidemic and help inform decisions about when to reopen the economy. Large commercial labs like Quest and LabCorp report electronically, but hospital labs rarely do. Many providers' case reports are in the form of a PDF file sent to a CDC email address, Dell Medical School Chief Information Officer Aaron Miri and Robert Wood Johnson Foundation Fellow Daniel O'Neill wrote in a recent Health Affairs blog.
Due to widespread community spread of the coronavirus, SARS-CoV-2, it's challenging for providers to report all cases to public health authorities. Additionally, state law mandates hospitals and doctor's offices submit reports to public health agencies, but there's significant variation in what conditions states deem to be reportable and what datasets states request.
That patchwork of requirements creates a lot of confusion and leads to disease cases being "significantly underreported," Conn said.
"Public health needs to get this individual level data to support case management investigation, but we also recognize that we can't burden the health care system to manually complete forms and fax them to public health, especially during this crisis," Conn said.
The new app is meant to give public health agencies access to COVID-19 data in real-time, bolstering case management and contract tracing efforts, while lowering the reporting burden on providers.
CDC already runs a program for digital case reporting called Digital Bridge but only seven public health departments were participating in the program as of 2018 — California, Houston, Kansas, Massachusetts, Michigan, New York City and Utah — and only five reportable conditions are being shared — chlamydia, gonorrhea, pertussis, salmonella and the Zika virus.
The network relies on a family of data standards, called C-CDA templates, built into many EHRs. Most EHRs have this capability, but many facilities haven't implemented the standards.
CDC is also working to accelerate eCR implementation in provider organizations that have capable EHRs. The agency is working to take an initial cohort in California with the Contra Costa Health Services department live and is signing organizations up for the second wave now, Conn said.