Electronic Case Reporting (eCR)

Declaration of Readiness

Montana Department of Health and Human Services (DPHHS) has officially declared readiness to receive electronic case reports (eCRs) to fulfill the CMS Promoting Interoperability Program (PIP) and Merit-Based Incentive Program (MIPS) requirements for eCR within the Public Health and Clinical Data Exchange Objective. 

What is Electronic Case Reporting (eCR)?

Electronic Case Reporting

Electronic Case Reporting (eCR) is the automated generation and transmission of case reports from electronic health records (EHRs) to the appropriate public health agencies (PHAs) for disease tracking, case investigateing, and contact tracing. The reports sent are referred to as electronic initial case reports (eICRs) since some are the first ‘initial’ report sent by providers with diagnoses or suspect diagnoses, and further investigation might be needed before case status is determined by the PHA.  

Exportability Response (RR)

To confirm delivery of eICRs to PHA(s) providers and PHAs will receive a reportability response (RR) with information concerning: (1) condition(s) reported, (2) PHA(s) who received eICR, and (3) optional information from the PHA (i.e., timeframe which reporting is required, whether the eICR was delivered based on the “Patient home address” or “Provider facility address”, treatment information, factsheets, etc.).  

Benefits of eCR

 Fulfills Montana’s mandated provider reporting requirements for reportable diseases and other conditions  

  Improves timeliness of data transmission to public health 

  Reduces the burden of manual care reporting on healthcare providers and public health  

  More complete data (e.g., demographics and social history) 

  Bidirectional data exchange between healthcare providers and public health 

  Streamlines reporting to all applicable jurisdictions automatically 

eCR Requirements

All CMS Promoting Interoperability Program (PIP) and Merit-Based Incentive Program (MIPS) participants are required to register their intent to implement eCR with DPHHS. Please complete the registration form with DPHHS or email MIDIS@mt.gov to inquire about registration status. 

  • Registration is only required once; however, re-registration is required if change in EHR vendor occurs.   

Work with your EHR vendor, CDC eCR Onboarding Team, and APHL to implement eCR within EHR system and connect with AIMS.  

Montana DPHHS Onboarding Materials: 

  • Montana DPHHS eCR Implementation Guide-The Montana eCR Implementation Guide is a comprehensive guide for eCR and is supplemental to the documents and directions provided by your EHRs vendor, CDC eCR Team, and APHL during the onboarding process.  
  • Montana DPHHS eCR Implementation Checklist (see Helpful Tools)

Participating eCR senders are required to utilize APHL Informatics messaging Services (AIMS) platform to transmit eICRs to DPHHS. AIMS is a secure, cloud-based platform that receives, processes, and delivers eICRs to the appropriate jurisdiction(s). All 50 states along with some territories and local jurisdictions have connections with AIMS to receive eICRs. For more information on AIMS and their role in eCR please visit their website.  

AIMS uses a tool called the Reportable Conditions Knowledge Management System (RCKMS) to determine the reportability and appropriate jurisdictions to send eICRs. The trigger codes within the eICR are compared against the reporting specifications authored by PHA jurisdiction to determine reportability and jurisdiction(s) to deliver the eICR.  

“Triggering” is the generation of an eICR document to the AIMS platform. DPHHS encourages all healthcare organizations and eligible providers to implement triggering for all conditions if your EHR vendor is capable.

  • Currently onboarded HCOs should notify the CDC eCR Team and DPHHS about plan to transition to “full triggering” for all conditions if currently triggering for limited conditions.  

 

Healthcare organizations are responsible for routinely updating their Reportable Condition Trigger Codes (RCTC) value set from the Electronic Reporting and Surveillance Distribution (eRSD). For more information on how triggering works in eCR please visit APHL EHR Implementers – EHR Triggering.  

After completion of eCR onboarding and receiving approval from APHL, CDC, and DPHHS eCR Teams the HCO will move into PHA Validation phase with Montana. While production eICRs will be received by DPHHS they will not be ingested into the production environment of our surveillance system while data validations are being conducted. During this phase Montana’s eCR team will conduct data validation and provide feedback on any necessary changes before processing the eICRs into our surveillance production environment.

  • The priority data elements evaluated in the eICRs during the PHA Validation phase are contained in the Priority Data Elements List (see Helpful Tools).  

 

DPHHS will email applicable healthcare organizations/facilities that manual reporting methods can discontinue for specific conditions once: (1) eICRs are being processed into the production environment of our surveillance system, (2) eICR data has been validated, and (3) any identified issues have been addressed/fixed.  

  • Please note that DPHHS will be implementing conditions into the production environment on a rolling basis.   

Latest Updates 

Montana DPHHS has established a connection with AIMS to receive eICRs; however, is currently working on implementing eCR into the production environment of our National Electronic Disease Surveillance System (NEDSS) Base System (NBS). Manual reporting methods for all reportable conditions must continue at this time.  

All interested and capable healthcare organizations and providers are encouraged to implement eCR to eventually replace manual reporting methods.  

 Promoting Interoperability 

The EHR reporting period for CY 2024 runs from January 1st – December 31st, 2024. New this year is the expansion of the required reporting period from 90 consecutive days to 180 consecutive days. For more information about Promoting Interoperability please visit the DPHHS Promoting Interoperability webpage or the CMS Promoting Interoperability webpage. MIPS participants can find more information on electronic case reporting requirements and criteria for exclusions here.  

Starting in 2024 attestation letters can be requested here and letters will be sent out in January 2025 for 2024 participation. Please be aware that Mmontana DPHHS does not provide exclusion letters for PI or MIPS participants. 

Current EHR/ Health IT products approved for general healthcare organization onboarding for eCR according to the CDC: 

  1. Altera Sunrise 
  2. Athenahealth athenaOne (athenaClinicals and athenaHHS) 
  3. Epic 
  4. Flatiron OncoEMR 
  5. Medhost eCR 1.0 
  6. Meditech Expanse 
  7. Oracle Cerner Millennium 
  8. Oracle Cerner Community Works 
  9. Premier Inc. TheraDoc 
  10. Oracle Cerner Ambulatory
  11. Veradigm - Veradigm EHR

For more information about eCR implementation capabilities and options please inquire further with your EHR vendor and visit the CDC eCR website for the most up to date EHR vendor information.

Resources

 

Contact Information

Kristen Merrell, MPH 

eCR Coordinator Epidemiologist 

Kristen.Merrell@mt.gov