Healthcare Organizations

The Texas Department of State Health Services (DSHS) initially began processing eCR on October 1, 2022. On September 1, 2023, DSHS declared readiness to accept eCR and fulfill the Centers for Medicare & Medicaid Services Promoting Interoperability Program requirements.

Purpose

DSHS has been accepting eCR messages submitted from hospitals that have completed onboarding and are in full production with the APHL Informatics Messaging Services (AIMS) platform since September 2022. All healthcare organizations (HCOs) should initiate the eCR process by following the steps to onboard listed below.

Eligibility

CMS requires all Critical Access Hospitals (CAHs) and Eligible Hospitals (EHs) to onboard with state health departments to submit eCR.

Steps to Onboarding for Electronic Case Reporting (eCR) with DSHS

Confirm electronic health record (EHR) system is eCR conformant 
Critical access hospitals (CAHs) and eligible hospitals (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. CAHs and EHs can also verify if their EHR product is eCR ready by visiting AIMS page.
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.
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.
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.
eCR Parallel Production 
When an organization has successfully completed onboarding with both AIMS and DSHS, they will remain in parallel production until explicitly told by 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. 
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 are required to register and onboard with DSHS. HCOs who complete eCR onboarding to production who are not currently submitting all reportable conditions should move toward sending all conditions. In order to send all conditions, HCOs should abide by the Electronic Reporting & Surveillance Distribution (eRSD) and ensure they are up to date with all trigger codes for eCR.