Public health agencies collect information related to communicable diseases as part of their function to ensure the general health of the population. This information helps public health agencies prevent the spread of disease by both detecting occurrences of specific conditions and managing those occurrences when they happen. A fundamental building block of disease surveillance is accurate and timely diagnosis. Different state and local jurisdictions define in their local law or policy the set of “reportable conditions” that providers need to submit to public health, in some cases when they are evensuspected let alone confirmed, in a process know as Electronic Case Reporting (eCR) when the submission is done in an automated manner. In turn, the CDC requests that jurisdictions submit a set of “notifiable conditions” to CDC. While Electronic Lab Reporting (ELR) may be a key component of eCR, other types of data can also be transmitted, including lab test orders (the order itself may be reason to alert public health as it indicates that clinician suspects something that may be significant) and other clinical observations.
The National Electronic Disease Surveillance System (NEDSS) is an Internet-based infrastructure for public health surveillance data exchange. Rather than being a single, monolithic application, NEDSS is a system of interoperable subsystems, components and systems modules that include software applications developed and implemented by the CDC; those developed and implemented by State and Local health departments and those created by commercial services and vendors. Critical to the long-term success of NEDSS is the quick and efficient transmission of critical data from clinical systems to the appropriate local, state, and Federal public health agencies. The exact path of this data differs from state to state, as do the specific reporting requirements for individual conditions or suspected conditions. Consult with your state public health agency for specific requirements.
eCR is not required until Stage 3 Meaningful Use beginning in 2018. The standards are not yet mature enough and are expected to be identified by ONC as the time approaches. The core work flow expected for eCR is also still under development, but likely will involve the “triggering” of an eCR report by an EHR based on the presence of clinical data in the patient’s record that matches a particular set of coded values (trigger codes). The structure of the Electronic Initial Case Report (eICR) itself is a clinical document (C-CDA) that is part of the Meaningful Use standards. This case report will be sent to the Reportable Condition Knowledge Management System (RCKMS), a clinical decision support system that determines if the condition is reportable to one or more jurisdictions and if so how.