EHR Vendor Cerner Develops National eCR Public Health Solution

The Association of Public Health Laboratories (APHL) recently named EHR vendor Cerner the hospital category winner of its 2021 Electronic Case Reporting (eCR) Now COVID-19 FHIR App Challenge for its public health eCR solution, a development that has been years in the making.

Bob Harmon, MD, MPH, lead physician executive of Cerner Government Services, told EHRIntelligence in an interview that more streamlined case reporting has been a priority of the CDC and state public health agencies for a long time.

Manual case reporting delivery processes such as fax are time consuming, burdensome for providers, and often result in incomplete data reports. To develop a national standard case reporting system, the CDC created the Public Health Community Platform in 2014, which led to the Digital Bridge Coalition National Coalition in 2016, Harmon explained.

The coalitions decided that eCR was the best way to improve case reporting to public health agencies. 

“That has led to successful pilot projects and a big expansion of electronic case reporting for COVID starting in 2020 and eventually it will include more than a hundred conditions,” Harmon said. “It's very exciting and a big improvement over what has been the situation in the past.”

The goal was to create a system that would allow data to flow directly from the provider’s EHR system to state public health agencies through a national platform.

Now, that goal has become a reality.

At the center of Cerner’s eCR solution is AIMS, a CDC-funded, cloud-based national information messaging platform developed by the Digital Bridge National Coalition and maintained by the Association of Public Health Laboratories (APHL).

AIMS contains the decision support engine for trigger codes of more than a hundred conditions determined by the coalition, as well as the reporting requirements of all the state public health agencies.

If a patient is found to have evidence of one of the conditions, an Electronic Initial Case Report (eICR) document is created and sent to the AIMS platform. Then, with decision support, the platform decides if the data is reportable or not. If it is, the report is routed to appropriate public health agencies, and a reportability response goes back to the provider.

“It's bi-directional,” Harmon explained. “For the first time, the delivery system, the clinic, the hospital, and the infection control division will see if something was reportable.”

For instance, if the physician or nurse wants to know if data was reported, they can go into the report section of the EHR.

This health IT solution is an exciting step forward, Harmon asserted, as it will automate previously burdensome reporting processes, giving providers more time to spend delivering patient care.

“The physician workflow will not be interrupted because this is automatic,” Harmon continued. “Physicians or their nurses don't need to file a report, so it's a huge step forward.”

Harmon explained that high-priority billable items and critical medical care improvements often push interoperability to the end of healthcare stakeholders’ list of priorities.

However, the new eCR FHIR application will help support national interoperability for critical public health reporting.

“Often, public health gets left behind the list of priorities, as does interoperability; things that benefit the greater good,” Harmon noted. “eCR will provide public health with much more complete, comprehensive, fast, electronic reports.”

“It will also allow public health to improve its hardware and software systems, such as their surveillance system that would receive these case reports and put them into contact tracing and tracking software systems,” Harmon continued.

He explained that public health agencies have long lacked the money and resources to support these health IT investments.

“Public health agencies have been lagging behind hospitals and physician offices in their health IT resources,” Harmon said. “Now with COVID funding, they will be able to catch up and implement electronic case reporting along with some of the other required systems, such as electronic lab reporting, syndromic surveillance, and electronic immunization registry reporting.”

“This is a once-in-a-lifetime opportunity as well as a challenge because we're well aware that COVID is having another surge,” Harmon added. “We desperately need these tools and now we're starting to have them. It's a big step forward for connecting public health to a healthcare delivery system that has been needed for a long time.”

Because the eCR Now initiative is so important, the vendor has made its solution available to the broader healthcare market by equipping the app for widespread adoption by Cerner clients, non-Cerner clients, and other EHR systems.

Harmon noted that over the next 10 months or so, the vendor will fully implement the more than 100 conditions within the eCR Now FHIR application.

“This will greatly benefit not only our clients but other electronic health record clients and state public health agencies,” he said. “It's an example of open interoperability benefiting many people.”

The Digital Bridge Coalition and its public health partners like APHL and the Council of State and Territorial Epidemiologists decided which conditions would be included in the system and when they'll be implemented, Harmon explained.

“The number one leading candidate for the next use case is cancer registry reporting, which is required by most states to be reported but is often incomplete, and yet it's not an infectious disease but it's a major killer,” he said. “So, that’s an example of the future potential of this eCR infrastructure.”