Stream: eCR Now FHIR App
Topic: stream events
Notification Bot (Apr 30 2020 at 17:39):
Stream created by Nagesh Bashyam.
Grahame Grieve (Apr 30 2020 at 22:54):
thanks @Nagesh Bashyam I presume you'll notify this stream when the source is released?
Nagesh Bashyam (May 01 2020 at 12:11):
Yes, very soon.
John Loonsk (May 02 2020 at 20:43):
eCR Now FHIR App
May 1st, 2020
The eCR Now team has released an initial version of the eCR Now FHIR App for testing. The App seeks to provide automated electronic case reporting (eCR) for COVID-19 to operational EHRs that do not have currently have eCR capabilities. This initial release will be followed by a pre-Connectathon release on May 8th and then by testing in the HL7 Virtual Connectathon May 13-15th.
More information about the release of the App including a link to the App source code and information on a pre-Connectathon Webinar can be found here: https://ecr.aimsplatform.org/ecr-now-fhir-app
Thank you for your interest in the App. We hope it can get us more eCR Now to battle COVID-19!
John Loonsk (May 04 2020 at 14:42):
Electronic Case Reporting
Electronic case reporting (eCR) is a key component of the data strategy for COVID-19 and other outbreak management needs. With patient identity, demographic information, race and ethnicity, and clinical diagnoses, it presents the necessary case data needed for state, local, and federal public health agencies (PHAs) to manage cases, provide patient situational awareness, support reporting, enable contact tracing, as well as to coordinate isolation and other response measures. eCR can contain point of care and local lab results from clinical care sites as well as connect with electronic laboratory results when they arrive at PHAs.
Trigger codes and case definitions to support eCR have been authored by state and local PHA staff and are being rapidly updated as they change during the course of the outbreak. In addition to automatic reporting without disruption of provider workflow when a diagnosis or problem list item is recorded, eCR can be triggered from laboratory and medication orders. As such, while eCR is faster and more complete than ELR natively, cases can also be generated on suspicion before a result is even achieved.
John Loonsk (May 04 2020 at 14:43):
eCR Now
When COVID-19 presented, eCR was just beginning operationalization by the CSTE, APHL, and the CDC. eCR was in operation in a limited number of sites because only a limited number of EHR vendors had implemented technical eCR solutions. The eCR team developed a strategy, eCR Now, for immediate and rapid deployment. eCR Now includes the following elements:
-
Cohort-based COVID-19 rapid eCR implementations for provider sites that have eCR enabled EHRs
Cohort implementation has been streamlined to 3 days
Early cohorts have successfully implemented and new cohorts are forming now
Aside from commitment by healthcare organizations to implement, there is no limit to the number of concurrent cohorts -
eCR Now FHIR app that non-eCR enabled EHRs can rapidly implement to automate COVID-19 eCR
Because of the Argonaut work and the FHIR API, an app can be quickly developed that can be implemented in EHRs in place now.
The app supports automated COVID-19 (and full eCR) reporting
The app will be provided to EHR companies and others for implementation and testing in their test environments by May 1st.
With the app, cohorts for any EHR vendor on-boarding is possible -
Extension of the existing eHealth Exchange policy framework through a developing Carequality eCR implementation guide
eHealth exchange participants can already do eCR without any new legal agreements
Carequality is accelerating the development and approval of an eCR implementation guide meaning that their expanded list of participants can as well
With solutions for all EHR vendors and the ability to scale onboarding without limits, the obstacle to making these critical data available is the leadership to focus on its advancement.
John Loonsk (May 04 2020 at 14:45):
Introduction
An initial version of the eCR Now FHIR “App” and its source code is now available for download. The app is intended for a very specific purpose, is different from many commercial apps in both its attributes and its provisioning, and has integration points that will require close teaming between the eCR Now technical team and EHR vendors and other implementors that choose to use it. This page provides some context and then lays out the planned process and communication channels for teaming to meet the critical electronic case reporting need in the COVID-19 pandemic.
John Loonsk (May 04 2020 at 14:46):
HL7 FHIR Connectathon eCR Now FHIR App Webinar
Tuesday, May 5th, 2020 1:00 PM ET
Join Zoom Meeting: https://aphl.zoom.us/j/91312462801
Meeting ID: 913 1246 2801
+16468769923,,91312462801# US (New York)
+13017158592,,91312462801# US (Germantown)
John Loonsk (May 04 2020 at 14:46):
Context
Electronic case reporting (eCR) involves “the automated identification of reportable health events in electronic health records and their transmission to state and local public health authorities for review and action.” Reporting is a legal requirement for COVID-19 and many other conditions, but the specific laws vary by state. Triggering case reports out of EHRs does not, by itself, definitively establish that something is reportable or which public health agencies should receive it if it is.
To address the complexity of reporting requirements, the Centers for Disease Control and Prevention (CDC), the Council of State and Territorial Epidemiologists (CSTE), and the Association of Public Health Laboratories (APHL) have implemented shared eCR services on the APHL AIMS platform including provisioning, decision support, routing, and delivery infrastructure to provide electronic case reports to public health agencies for integration into their surveillance systems. The eCR Now App is constructed to connect to, and take advantage of, this existing infrastructure to support appropriate reporting even though neither it, nor public health agencies, currently support production HL7 FHIR services.
John Loonsk (May 04 2020 at 14:46):
Integration Points
The eCR Now App is intended to run as a background process during patient encounters, report automatically to appropriate public health jurisdictions though the APHL AIMS shared service infrastructure, and not disrupt healthcare provider workflows. On the EHR side, the App is built to leverage the work of the Argonaut Project, HL7, and ONC that has implemented a level of FHIR API that is now in implemented EHRs. As such, the App is both enabled and restricted by the status of that API. The areas of:
obtaining patient and encounter context;
launching the background app process;
obtaining up-to-date trigger codes and parameters from the electronic Reporting and Distribution (eRSD) system;
implementing specific trigger and loading queries;
transporting electronic Initial Case Reports (eICRs) out to the APHL AIMS platform;
local storage of eICRs that have been sent;
receipt, processing, and local storage of the Reportability Response that comes back to the EHR for each eICR that has been sent;
all require consideration as integration points with other EHR infrastructure.
Some of these integration points are well developed and essentially complete in the App that is being developed such as accessing up-to-date trigger codes from the eRSD system and some of them will require additional EHR activities and teaming with the eCR Now team.
Teaming and Release Process
The eCR Now App is being developed with the intent of sharing, with its source code, for implementation by EHR vendors and other implementors. The planned schedule represents phased delivery and hand-off to implementors over the course of May 2020. The following draft schedule may be subject to change in accordance with shared refinement and development priorities:
eCR Now App Schedule
First Release (Pre-Alpha) - May 1, 2020
Second Release (Alpha-Pre-Connectathon) - May 8, 2020
Implementor testing in HL7 Connectathon Public Health Track – May 13-15, 2020
Third Release (Post-Connectathon) – by May 29, 2020
John Loonsk (May 04 2020 at 14:46):
Next Steps
EHR companies should access the App source code from the Github site
Download and Implement the app in your local development sandbox following instruction on the GitHub site
Verify that the app runs successfully in your local development sandbox
Post any issues encountered to the Zulip chat channel
Add COVID-19 data into your development sandbox EHR for testing purposes
Consider the “Integration Points” in the context of your EHR implementation
Post technical questions you have to Zulip chat stream for discussion
Access the second release on May, 8th
Get the second App release up and running in your sandbox for Connectathon testing using your COVID-19 patients
Sign-up for the Public Health Track at the HL7 Connectathon
Test your implementation with the eCR Now team in the Connectathon
Provide feedback through the Connectathon process
Access and implement the May 29th release
John Loonsk (May 04 2020 at 14:48):
We have added (above) some of the content from the eCR website because folks were having issues accessing the content from outside of the U.S.
Grahame Grieve (May 04 2020 at 20:07):
http://histalk2.com/2020/05/04/curbside-consult-with-dr-jayne-5-4-20/
Last updated: Apr 12 2022 at 19:14 UTC
