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The complexities involved in implementing eCR of STIs can best be understood through delineating the associations between the entities and systems involved. This guidance first clarifies the eCR context and then describes the specific processes and inputs to be implemented for successful eCR.

Context of eCR

Reportable condition case reports represent conditions that must be reported to state and local public health agencies by clinical care and laboratories. Public health case reporting by clinicians is legally mandated by each state. After receiving a report, individual jurisdictions determine if it is a reportable case and if an investigation is needed. Today, the case reports are sent in different formats (e.g., by telephone, fax or web-based data entry systems), and states vary to some extent in the conditions and data elements they require to be reported. eCR is intended to help clinicians meet their reporting requirements while improving public health surveillance.

The Context of Electronic Case Reporting

Illustrative example of eCR case reporting

The figure above can be understood through the following example:

  1. A patient presents at a clinical setting (e.g., hospital, physician’s office, community health center or public health clinic) and meets the screening guidelines for chlamydia or gonorrhea (e.g., female, age 20 years and sexually active). Physical specimens are collected and sent to a laboratory for testing.
  2. After testing, the laboratory sends the test results to the clinic and, if positive, also to the state or local public health agency. (Some states request reporting of negative results also.) Results might be sent electronically by using HL7 standards or another format.
  3. When results are positive, the clinician is also required to send a case report to the state or local public health agency. The case report might be sent by telephone or as a fax, by U.S. Postal Service mail, by manual entry into a web-based system, or by the clinic’s EHR as an eCR.
  4. Finally, each state aggregates the data they receive for each notifiable condition and sends reports on a regular basis to CDC. This is called case notification. Certain large municipalities and territories also send aggregate reports to CDC. CDC then disseminates the data to internal programs (e.g., DSTDP) that use them for planning, research, reporting and intervention development. CDC further makes the data available to the public (e.g., through the Morbidity and Mortality Weekly Report).

The above figure also illustrates that case reporting can be mediated by a health information exchange (HIE) when an HIE organization is operational in a public health agency’s jurisdiction.