eCR might be implemented in various ways depending on the presence or absence of any intermediaries like HIEs in a public health jurisdiction.

Provider to public health

Although public health has legal authority for receiving case reports by whatever means is available to the clinical provider, implementing eCR will involve collaborating with clinical entities in their jurisdiction and asking them to work with their EHR vendors to implement eCR. The clinical entities might not immediately understand the value of expending the time and financial costs necessary to implement eCR.

Public health agencies should be prepared to make the value case from the perspective of the clinical entities. eCR creates opportunities for public health to report back to clinical care about risks and exposures of their patient population.

Provider to intermediary to public health

Increasingly, public health agencies are participating in data exchange with clinical entities through such intermediaries as HIE organizations. At a national level, CDC, CSTE, ASTHO and APHL are working toward cloud-based services supporting data exchange between health care and public health.

These opportunities can increase access to eCR for public health agencies and can reduce costs through increased efficiencies for health care and public health alike. Intermediary technologies for health information exchange and public health reporting have legal implications for what data can be accessed by whom and when. Although many data security concerns have been addressed technologically, the public’s trust needs to be built and maintained.

Because eCR promises more complete reporting, the volume of data to be received (particularly for chlamydia and gonorrhea) must be considered. Using case detection logic that yields a specific result with few false-positives can reduce the burden of data volume on technology and the persons involved alike.