PACER, or Public Health Automated Case Event Reporting, is a system that augments electronic laboratory reporting using FHIR (Fast Healthcare Interoperability Resources). The PACER model supports targeted queries from public health to the appropriate healthcare system to collect relevant data to support public health case investigation and follow-up.


…builds on electronic laboratory reporting infrastructure.

The U.S. federal government and state, tribal, local and territorial public health agencies have invested heavily in developing electronic laboratory reporting (ELR) capacity for reportable diseases. As a result, ELRs are an increasingly reliable, robust and widely adopted method of reporting notifiable conditions to public health agencies. PACER builds and expands upon existing ELR infrastructure by using a reported test result as a trigger for agencies to query additional information from healthcare, resulting in more complete data for an individual case report. Case reporting from providers’ clinical systems can have complex triggering criteria, with external dependencies such as specific clinical provider workflows and EHR vendor specifications. Leveraging ELR as the trigger to obtain clinical data eliminates these complications.

PACER pilot

PHII, in partnership with CDC, is leading a pilot of the innovative PACER model. The collaborative body of pilot sites is implementing the PACER architecture in the public health and clinical setting to test how the FHIR-based querying capabilities can be used to improve data collection on STI cases, and ultimately aid in public health case investigation and follow-up of gonorrhea and chlamydia cases.

…leverages FHIR-based architectures.

PACER uses FHIR-based queries to extract data on a reportable case from clinical EHRs. This includes predetermined filters implemented with Health Level 7 industry standards and the FHIR-based electronic case reporting (eCR) format. By using FHIR, PACER provides compatibility with a wide array of commercial EHR vendors and aligns to emerging data modernization initiatives. The information contained in the eCR is often richer and more detailed than ELRs, while being in a familiar format that health departments can parse and ingest. PACER serves as a vanguard and feasibility test for nuance disease-based eCR using FHIR, and will continue to inform future CDC initiatives.

…preserves patient privacy.

PACER architecture includes privacy filters embedded behind the health system’s firewall. This ensures that only predetermined information pertinent to the notifiable encounter is extracted from the EHR. This filtering authority lies entirely with the clinical providers, offering them complete control over the information shared with public health.

…uses the same architecture for multiple conditions.

PACER’s architecture has modular trigger logic (any test result) and data queries that can be readily configured for any reportable condition. A provider’s PACER implementation can be mapped to local codes and used for any number of notifiable conditions, including emerging outbreaks such as COVID-19.