MDH Electronic Case Reporting (eCR)

On this page:
About eCR
Benefits of eCR
Requirements for eCR Onboarding
eCR Implementation
Additional Resources

About eCR

Electronic case reporting (eCR) is the automated generation and transmission of case reports from Electronic Health Records (EHRs) to public health authorities. It allows real-time exchange of critical clinical and demographic data and helps eliminate the need for manual provider reporting. eCR offers several advantages, including reduced administrative burden of reporting and improved timeliness, accuracy, and completeness of data.

eCR is championed through a cooperative effort of the Centers for Disease Control and Prevention (CDC), the Association of Public Health Laboratories (APHL) and the Council of State and Territorial Epidemiologists (CSTE). MDH works collaboratively with these organizations in leading, implementing, and utilizing eCR with health care organizations, EHR vendors, as well as other public health authorities.

MDH declared readiness for Promoting Interoperability for eCR as of January 1, 2022. MDH prioritizes onboarding COVID-19 eCRs and is expanding to other reportable diseases. The state of Minnesota uses the HL7 electronic initial case report (eCR) standards (R1.1 and R3) for eCR and supports the new Centers for Medicare and Medicaid Services (CMS) Promoting Interoperability (PI) and Merit-Based Incentive Payment System (MIPS) regulations for eCR.

Functionally, eCR utilizes a centralized platform which allows multiple systems to securely transfer reportable health data from the EHR automatically. The platform is owned and operated by APHL and is known as AIMS (APHL Informatics Messaging Services). Data entered by a health care provider in the EHR is matched to reportable codes, which in turn trigger the eCR to send to the appropriate public health jurisdictions via AIMS. This critical information is investigated by MDH for public health action.

Benefits of eCR

eCR is advantageous to reporters as well as public health. eCR supports public health surveillance as it enables immediate feedback from public health to health care providers about possible outbreaks and reportable conditions. This immediate exchange of data is vital during public health emergencies. eCR provides quicker, more comprehensive data than manual reporting, including patient and clinical data on demographics, comorbidities, immunizations, medications, and other relevant treatment.

Benefits include:

• Alleviates the time and resource burdens of manual reporting.
• Helps to meet the State of Minnesota reportable disease rule.
• Automates reporting to the appropriate state, tribal, local and territorial public health agencies.
• Enhances data security in transferring patient and clinical information.
• Improves data quality for better disease tracking, case management and contact tracing.
• Provides valuable information back to the provider in the form of the Reportability Response (RR), including disease status, applicable jurisdictions, contact information, and key follow up direction.
• Meets the Centers for Medicare and Medicaid Services’ Promoting Interoperability Program (PIP) and Merit-Based Incentive Payment System (MIPS) reporting requirements:
  • National Archives: Federal Register: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2022 Rates
    Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Changes to Medicaid Provider Enrollment; and Changes to the Medicare Shared Savings Program. A Rule by the Centers for Medicare & Medicaid Services on 08/13/2021.
  • National Archives: Federal Register: Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies
    Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; and Provider and Supplier Prepayment and Post-Payment Medical Review Requirements. A rule by the Centers for Medicare & Medicaid Services on 11/19/2021.

Requirements for eCR onboarding

• eCR is for the reporting requirements of health care practitioners.
• Health care facility must utilize an EHR system.
• EHR system must be able to enable eCR and adhere to HL7 eCR standards.
• Registering for eCR indicates the entire health care facility is seeking to onboard with eCR, and all leadership approvals have been granted.

eCR implementation

1. Determine your EHR system readiness.
   MDH recommends health care organizations interested in implementing eCR communicate with their EHR vendor to learn more about their system’s ability to generate the eCR as well as receive and process a RR. Topics of conversation may be generation of eCR, receiving and processing the RR, and native and FHIR applications.
   More information on eCR readiness and implementation:
   • eCR: What is eCR?
   • eCR: eCR Now FHIR App

2. Connect with MDH.
   Facilities interested in participating are encouraged to complete the MDH Interoperability Checklist (PDF) to document their intent to engage in submission of data and email the completed form to health.interoperability@state.mn.us and health.ElectronicDiseaseReporting@state.mn.us.

   Additional information on promoting interoperability is available on MDH’s Public Health Reporting & Promoting Interoperability website.

3. Plan and establish technical connections and sign participation agreement.
   eCR onboarding is a cooperative process with the health care organization, EHR vendor for the health care organization, CDC, APHL and MDH. There is a technical connection requirement and policy requirement that must be fulfilled once communicated with MDH and CDC readiness to move forward. 
   The technical connection will be to AIMS platform through either of the following:

   • Direct Secure Messaging (DSM) through a Health Information Service Provider (HISP).
   • XDR transaction push through eHealth Exchange Hub to AIMS.

   The participation agreement to meeting policy requirements can be fulfilled by any of the following:

   • Member of Carequality or be associated with as client of ‘EHR' vendor in Carequality.
   • Member of eHealth Exchange path (requires a Data Use and Reciprocal Support Agreement (DURSA)).
   • Sign business agreement with APHL for eCR (eCR Participation Agreement).

Additional resources

• CDC: Electronic case reporting (eCR)
  • CDC: What is eCR?
• CMS: Promoting Interoperability Programs
• eCR - Electronic Case Reporting
  • eCR: eCR Now FHIR App
• Reportable Conditions Knowledge Management System (RCKMS)
• HL7 eICR CDA R2 Implementation Guide & Standard
• National Archives: Federal Register: Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies
• Reportable Disease Rule (Communicable Disease Reporting Rule)
• MDH Interoperability 2022 Webinar Series
  • Presentation: Electronic Case Reporting (eCR) (YouTube)
  • Presentation: Electronic Case Reporting (eCR) (PDF)