Electronic Case Reporting (eCR)

Electronic case reporting (eCR) is the generation and transmission of case reports from an electronic health record (EHR) to public health for review and action. eCR allows healthcare providers and facilities to automatically report cases of notifiable diseases to DSHS for further investigation from their EHR. eCR supports earlier notifications to public health and provide more complete and accurate data. eCR is supported by the Centers for Medicare & Medicaid Services (CMS) Promoting Interoperability Program (PIP) regulation. 

Declaration of Readiness 

Texas eCR Onboarding Guidelines

As of September 1, 2023, the Texas Department of State Health Services (DSHS) is ready to accept electronic case reporting (eCR) to fulfill CMS Promoting Interoperability Program (PIP) requirements. All critical access hospitals (CAHs) and eligible hospitals (EHs) are required to submit eCR to DSHS. 

What/When 

The Texas Department of State Health Services (DSHS) will officially declare readiness for electronic case reporting (eCR) on September 1, 2023. DSHS has been accepting eCR messages submitted from hospitals who have completed onboarding and are in full production with the APHL Informatics Messaging Services (AIMS) platform since September 2022. All CAHs and EHs should initiate the eCR process by following the steps to onboard listed below. 

Who 

All Critical Access Hospitals (CAHs) and Eligible Hospitals (EHs) in Texas will be required to onboard with DSHS to submit eCR.  

Why 

DSHS successfully implemented eCR in September 2022. DSHS initially began processing COVID-19 eCRs but has since expanded to processing most reportable disease conditions. DSHS has officially made this declaration to meet grant objectives required by the Centers for Disease Control & Prevention and to ensure alignment with the CMS PIP regulations which support a nationwide data modernization effort to improve public health reporting. Texas has joined 47 other states who have already declared readiness for eCR. eCR is a mutually beneficial effort for both public health and healthcare organizations. 

How/Where 

Steps to Onboarding for eCR with DSHS 

1. Confirm EHR system is eCR conformant 
   CAHs and EHs must confirm having an EHR system that is able to produce a conformant message according to the HL7 Standards Product Brief - HL7 CDA® R2 Implementation Guide: Reportability Response, Release 1, STU Release 1.1 - US Realm | HL7 International. 

2. Register with DSHS to submit eCR 
   Please complete and submit the DSHS eCR registration form. DSHS will provide the healthcare organization with instructions for beginning the process to onboard with DSHS. The items requested by DSHS can be worked on simultaneously while healthcare organizations also begin step 3 below. 

3. Successfully onboard to Production with APHL Informatics Messaging Services (AIMS)  
   EHs and CAHs may begin the eCR process by connecting and onboarding with AIMS at eCR@cdc.gov. This step will be completed when the healthcare organization is able to successfully send production messages via AIMS. Please follow all guidance given by AIMS to complete this step. 

4. Finalize eCR onboarding with DSHS 
   DSHS will prioritize outreach to CAHs and EHs based upon facilities' onboarding completion date with AIMS in Step 3 above. DSHS’s onboarding activities will require registration (if not already completed), completed healthcare facility lists, and final validation assessing data quality and data completeness. When successfully completed, DSHS will approve healthcare organization for eCR production into Texas NEDSS where eCR data will be distributed to local and regional health departments for appropriate follow up. 

5. eCR Parallel Production 
   When an organization has successfully completed onboarding with both AIMS AND DSHS, they will remain in parallel production until explicitly told from DSHS to stop reporting manually. During this time local health departments will review data received manually (e.g., fax, phone, or mail) against data received via eCR messages to identify potential gaps.  

6. Release from Manual Reporting (TBD Criteria still under development) 
   Important note: Unless DSHS explicitly directs your facility to stop submitting manual data, CAHs and EHs must continue to submit all case reports to their public health jurisdictions. DSHS is coordinating with local health departments to determine criteria for releasing facilities from manual reporting to public health. 

All CAHs and EHs in Texas will be required to register and onboard with DSHS. If your facility is located in the city of Houston, please also reference the Houston Electronic Case Reporting website for additional information  from HHD.

Questions on eCR onboarding in Texas should be submitted to TexasECR@dshs.texas.gov.