BACKGROUND: Data and technical standards set consistent expectations using common languages and streamline communication between applications like Electronic Health Records (EHRs) and public health surveillance systems. When exchanging health information, the languages are determined by Health Level Seven International (HL7) “messages” and “documents” and in standardized terminologies such as Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine -- Clinical Terms (SNOMED-CT), and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). These consistent expectations are all brought together and specified in HL7 Implementation Guides (IGs) that indicate what content is to be included and where it is to be located. Lessons learned from immunization registry reporting, electronic laboratory reporting, and syndromic surveillance highlight the importance of using a single, unambiguous, standard for communicating content. As nationwide electronic case reporting (eCR) is implemented, it is also important that common standards are adopted to send information back to clinical care and facilitate seamless bidirectional exchange between public health and health care.
METHODS: In 2016, an electronic case reporting project was initiated in the HL7 Public Health and Emergency Response Workgroup to ballot an IG for the Electronic Initial Case Report (eICR). Based on HL7 Consolidated Clinical Data Architecture (C-CDA) templates – a format with which many health IT developers are familiar and certified – the eICR is intended to provide the core content necessary to initiate a public health investigation. The first version of the eICR included information on the health care provider and organization, patient demographics and contact information, and selected clinical information.
RESULTS: To address comments from stakeholders, the eICR has been updated in 2017 to include data elements that accommodate “meaningful use” certification, update certain fields to more specifically identify information from the EHR, and include additional information relevant to public health investigation. To facilitate bidirectional communication, a second standard document is being developed that will relay the reportability status of the eICR back to health care – was it reportable or not, to which public health agency(s) it was sent, and other relevant information (e.g., treatment recommendations; public health follow-up). This IG is anticipated to be released in mid-2017.
CONCLUSIONS: The standards for initial case reporting and reportability response will make it easier for both health IT developers and public health agencies to implement case reporting, and are the first step to improving electronic exchange between the public health and health care for case reporting.