Current Initiatives and Requirements
In 2009 Congress passed the American Recovery and Reinvestment Act (Public Law 111-5), which included the Health
Information Technology for Economic and Clinical Health
Act (HITECH), meant to promote the adoption and use of
interoperable health information technology (health IT).
Under HITECH, the “meaningful use” EHR Incentive Program—now known as Promoting Interoperability—was
developed to incentivize eligible providers and hospitals
to make the transition to EHRs. The Centers for Medicare
and Medicaid Services (CMS) and the Office of the National
Coordinator for Health IT (ONC) collaborated to develop reporting requirements, which included eCR. The reporting
option was initially published in 2015. In 2017, ONC modified the technical requirements in preparation for Stage 3 of
the meaningful use program. Initial conditions to be evaluated included chlamydia, gonorrhea, pertussis, salmonella,
and the Zika virus.
Seeing a continued need for public health agencies to rely
on healthcare providers to share relevant and timely information regarding reportable incidents, a forum was created
to bring together key decision-makers in health IT, healthcare delivery entities, public health organizations, and
other committed industry leaders. This forum is called the
According to an article from the Journal of Law, Medicine
and Ethics, “The Digital Bridge initiative is a public-private
national effort involving federal and state public health
agencies, providers systems, and EHR vendors to accelerate
these innovative electronic surveillance methods. Digital
Bridge creates a forum for these organizations to collaborate on technical solutions for a nationally standardized,
sustainable approach to exchanging and using electronic
health data.” 4 Digital Bridge works to leverage a standards-based approach to bidirectional information exchange
among healthcare stakeholders to ease administrative burden as well as enable better informed clinicians regarding
population health, environmental risks, and outbreaks. The
Digital Bridge’s first project was to design a nationally scalable, multi-jurisdictional approach to eCR that would help
identify and address the disparate reporting capabilities
at the national, state, and local levels. 5 The Digital Bridge
developed a data and decision flow (see Figure 1 on page
20) for successfully managing case reporting through electronic means. Documenting an accurate trigger code from
one of the vocabulary sets is imperative for launching the
reportability of a potential case to a surveillance system
and, ultimately, the CDC.
Achieving Comprehensive eCR in the US
The current eCR landscape reflects ad hoc pilots and siloed
well-intentioned initiatives. Collaboration and careful plan-
ning will be necessary to move forward with comprehensive
eCR. This approach will ensure that data is collected in a time-
ly manner, leverages the correct standards, is accurate, and is
comparable throughout the public health ecosystem.
To achieve this goal, it is important that HIM professionals:
Build relationships with providers and community part-
ners: Developing purposeful relationships that help to
build trust among providers and community stakehold-
ers that understand the unique needs of public health is
critical to the success of eCR implementation.
Maintain consistent standards: The ability to commu-
nicate between public health agencies and healthcare
providers is reliant upon the development of consistent
data, technical, and messaging standards that support
interoperability for the exchange of health information.
A lack of consistency in these areas significantly reduces
the ability to transmit data seamlessly, ultimately creat-
ing more work.
Adhere to data-driven decision-making: At all levels of
care, including public health, data must form the basis for
the assessments and informed decision-making at both
the individual and community level. A more complete data
set of the patient will provide a more accurate and com-
prehensive understanding of the public health burden. A
more complete representation of the potential situation
will enable better resource allocation and timely support.
Educate policymakers and legislatures about the ben-
efits: Improving the infrastructure and implementing
the workforce training needed for eCR success requires
funding. To allocate and support funding for eCR, poli-
cymakers and legislative bodies first need to understand
the ways in which eCR is critical for dealing with public
health emergencies and potential disease outbreaks. 6 Ul-
timately, eCR data has the potential to help shape changes
in public health policy for the better. ¢
1. Hamilton, Janet et al. “Electronic Case Reporting (eCR).”
Technical report 16-SI-02. Council of State and Territorial Epidemiologists, 2016. https://cdn.ymaws.com/www.
3. ASTHO. “Leading Public Health Practice Though Health
Informatics and Technology.” 2019. https://www.astho.
4. Black, Jennifer et al. “Public Health Surveillance: Electronic Reporting as a Point of Reference.” Public Health
and the Law 47 S2 (2019): 19-22. https://mihin.org/wp-
6. ASTHO. “Leading Public Health Practice Though Health
Informatics and Technology.”
Allison Viola ( email@example.com) is director at Guidehouse.
Making the Electronic Case