Field Notes: eHealth Exchange Collaborates on an eCR Use Case During COVID-19

Field Notes: eHealth Exchange Collaborates on an eCR Use Case During COVID-19

By Jay Nakashima and Kati Odom Bell

eHealth Exchange is among the largest healthcare information networks in the country. Considered a “network of networks,” eHealth Exchange promotes interoperability on a national scale so that multiple types of health organizations (health information networks, health systems, academic institutions, etc.) can join and expand their reach. eHealth Exchange also facilitates data exchange with four federal organizations, including the Veterans Health Administration, Department of Defense, Social Security Administration, and Indian Health Service.

OCHIN, an eHealth Exchange network participant, is a national nonprofit health IT organization with two decades of experience transforming healthcare delivery. OCHIN provides leading-edge technology, data analytics, research, and support services to more than 500 community health care sites, reaching nearly 6 million patients.

The Challenge

Case reporting is used for monitoring disease and condition trends, managing outbreaks, and communicating back to providers about outbreaks and protocols. While case reporting itself is not a new concept, the COVID-19 pandemic emphasized the need for providers to have the capability to electronically report positive COVID-19 tests and diagnoses to local, regional, and federal public agencies quickly and efficiently. Receiving the reported COVID-19 tests and diagnoses in practically real time would allow for public health agencies (PHAs) to better track and report positive infections and pinpoint areas with high or faster growing positive infection rates. With the need for electronic case reporting (eCR) heightened, the eHealth Exchange began to collaborate with its network participants to explore ways to utilize existing functionality and provide a single gateway connection for electronic case reports to be generated and reported.

The Stakeholders

eHealth Exchange collaborated with the Association of Public Health Laboratories (APHL), an eHealth Exchange participant and business associate, utilizing APHL’s Informatics Messaging Services (AIMS) platform that includes the Reportable Condition Knowledge Management System (RCKMS) that has been developed by the Council of State and Territorial Epidemiologists (CSTE) and the Centers for Disease Control and Prevention (CDC). eHealth Exchange and APHL then identified a pilot network participant, OCHIN, to represent the provider side of the use case.

The Plan

With eHealth Exchange, APHL, and OCHIN on board, the three organizations were able to provide a single gateway connection for electronic case reports to be automatically generated in an electronic health record (EHR) and be sent to the appropriate public health agencies and receive responses. The RCKMS code list, which includes COVID-19 tests and diagnoses, triggers an automated message to be sent from the physician’s EHR. That automated message is then routed utilizing the eHealth Exchange Hub to AIMS. Using HL7 electronic initial case reports (eICRs) triggered in EHRs, AIMS and RCKMS determine which PHAs need to receive reports, confirm that potential cases are reportable according to relevant jurisdictional laws, and report the relevant information to the PHA(s). AIMS then sends a reportability response via the eHealth Exchange Hub to the submitting provider. That response allows the physician to see, among other things, if the diagnosis was considered reportable, and, if so, which PHA the diagnosis was reported to. The three involved organizations were able to collaborate and utilize predominately existing functionality and successfully roll out the implementation in August 2020.

Results and Next Steps

OCHIN began to send hundreds of thousands—and soon millions—of COVID-19 electronic case reports a month to APHL and the respective PHAs while paying no additional fees. Following this successful pilot, the new eHealth Exchange eCR capability was made available to all network participants, and dozens of eHealth Exchange members immediately signed up to begin to share data with APHL in this way. eHealth Exchange participants found this to be a stable connection as they send millions of COVID-19 reports. The eHealth Exchange does not charge any additional fees for unlimited eCR conditions, often providing significant cost savings for the 60+ state and regional health information exchanges and thousands of hospitals participating. Previously, those sending electronic case reports at all were sending via a health information service provider (HISP), which often charge based on transaction volumes. The APHL-eHealth Exchange connection will also be used for more than 99 other reportable diseases and conditions. The underlying eHealth Exchange network’s single gateway connection and common agreement, which already supports more than a dozen use cases, enabled the fast implementation of the new eCR COVID-19 use case and will easily support expansion for the other reportable diseases as providers are ready.

Lessons Learned

Collaboration was critical during this project. eHealth Exchange and APHL continue to partner while onboarding additional organizations to utilize the eCR use case. The goal is to onboard all relevant eHealth Exchange network participants to better support our national and local response to the pandemic, to streamline eCR for other conditions, as well as ease the manual workload of our providers sending these case reports. Improvements are constantly being made to streamline the onboarding and testing process and allow users faster access to eCR. With each implementation, the process improves for the next organization.


Jay Nakashima is the executive director of eHealth Exchange.

Kati Odom Bell is the program manager of eHealth Exchange.

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