Within this context, the eCR process depends on public health communicating to clinical care specific requirements for the EHR to identify cases, build reports, and send them to public health, as seen in the figure below. The requirements include (1) case detection logic that evaluates data in the patient record to match to (2) value sets containing specific codes and, when a match is found, builds the case report with (3) specific data elements from the patient record. After a report is sent, the public health agency determines the disposition of the case on the basis of the report, ELR data if available, and possibly, data from contact tracing, partner management or an investigation.

The figure below presents the entire eCR process as taking place within the EHR. Another option is for the case detection logic to reside outside the EHR, which is addressed later in this guide. Regardless of the information technology infrastructure and implementation, the case detection logic and related coded value sets can be used.

Interactions between the Public Health Agency and Clinical Care for eCR

A note on transport standards

This toolkit focuses on implementation of eCR as a direct interaction between a clinical provider and a public health agency. As standards-based systems and processes are adopted by public health and opportunities for participation in shared services like health information exchanges and cloud-based decision support are leveraged, other scenarios are emerging that bring their own implementation caveats to be considered.

Furthermore, this toolkit does not specify transport standards. As standards like HL7 C-CDAs evolve and new ones like Structured Data Capture (SDC) develop, public health must stay informed about the most robust options for data exchange with healthcare.