eCR FAQs

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Electronic Case Laboratory Reporting (eCR) Frequently Asked Questions

Q: I am ready to begin Electronic Case Reporting (eCR). How do I begin?
A: Texas is still in the last stages of implementing eCR and pilot phase testing is almost completed. If your facility is ready to begin eCR, please start by completing the following: 

1. Complete the Registration Form to Submit Electronic Case Reports (eCR) to Texas DSHS.
2. Contact the CDC AIMS onboarding team at eCR@cdc.gov to learn more about onboarding at CDC.

Q: What constitutes eCR in Texas? 
A: eCR is the generation and transmission of initial case reports from an electronic health record (EHR) to public health for review and action.  eCR allows healthcare providers and facilities to report cases to Texas DSHS for further investigation from their EHR, rather than manually reporting.  

Q: Is the Texas Department of State Health Services (DSHS) accepting eCR data to fulfill the CMS Promoting Interoperability Program objectives? 
A: Yes. Although Texas (DSHS)  has not yet declared readiness, Texas is currently accepting  eCR messages from organizations seeking to fulfill their CMS Promoting Interoperability public health requirement. For more information, please visit Public Health Data Interoperability (cdc.gov). 

Q: Which entities in Texas should submit eCR messages during Promoting Interoperability Stage 1 and Stage 2?
A: eCR data is accepted from Eligible Hospitals (EH)s and Critical Access Hospitals (CAH). If you are interested in reporting data to Texas (DSHS), please complete registration form at the Registration Form to Submit Electronic Case Reports (eCR) to Texas DSHS. If you need to register multiple facilities, please complete the facility bulk registration template and submit through that form during registration.

Q: What notifiable conditions does Texas DSHS accept?
A: Texas Notifiable conditions should be reported according to the HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2 – US Realm the Electronic Initial Case Report (eICR). A list of reportable conditions is available. 

Q: Where do I submit the lab results to after the eCR is generated?
A: The National Electronic Disease Surveillance System (NEDSS) ELR system at DSHS is the single point of contact for eCR and laboratory result reporting indicative of notifiable conditions. For assistance, please contact TexaseCR@dshs.texas.gov. The DSHS eCR staff will provide eligible hospitals (or hospital systems/healthcare organizations) with data format specifications and will schedule technical assistance as needed.

Q: What HL7 versions can DSHS NEDSS ELR currently receive for eCR?
A: For Promoting Interoperability Program (PIP), the acceptable format for DSHS NEDSS ELR is HL7 v3 and CDA messaging following the respective standards and implementation guides. Texas DSHS understands that vendors are implementing processes for generating the eCR standard. Thus, DSHS is prepared to accept either the eCR 1.1CDA standard. For the eCR, facilities are asked to reference the HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2 – US Realm the Electronic Initial Case Report (eICR).

Q: Do you require the use of standard vocabulary?
A: Yes, we require the use of standard clinical vocabulary and value sets, including but not limited to Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine (SNOMED), International Classification of Diseases (ICD)-10 and Unified Code for Unified Measures (UCUM).

Q: What  web-based tools are available to assist me in validating my message structure?
A: DSHS eCR team uses on-line eCR message tools to assist in validation. Examples include the  AIMS Validator (aimsplatform.org) for testing and validating files.   

Q: Are there trigger codes available for eCR?
A: Please check the Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS) for the latest Reportable Conditions Trigger Codes (RCTC) at Electronic Reporting & Surveillance Distribution (eRSD) for the latest published trigger codes.

Q: What transport mechanism is available to send eCR to DSHS NEDSS?
A: Texas DSHS is accepting eCR messages submitted via CDC AIMS platform.

Q: Will new vendor(s) need Data Sharing Agreements?
A:

• There is no Data Usage Agreement (DUA) required for notifiable condition reporting to the Department of State Health Services, as this information is required through regulation.
• Pursuant to Texas state Statute and Federal Regulation, Memorandums of Agreement (MOA) or Memorandums of Understanding (MOU) are not necessary for reporting of notifiable diseases by specified entities to the Department of State Health Services (“Department”).
• Chapter 81, Subchapter C of the Texas Health and Safety Code requires reporting on certain identified diseases to health authorities or the Department. Persons required to report under the statute include, physicians, dentists, veterinarians, local school authorities and individuals in charge of clinical or hospital laboratories. Reporting procedures and notifiable conditions are outlined in Department rule, Texas Administrative Code, Title 25, Chapter 97. Memorandums are not required under this reporting structure.
• The Health Insurance Portability and Accountability Act of 1996’s (HIPAA) Privacy Rule authorizes the disclosure of protected health information (PHI) by covered entities, without individual authorization from the patient, to public health authorities such as the Department for public health purposes including, but not limited to, public health surveillance and investigations. The Electronic Laboratory Reporting program is operated by the Department for public health purposes.
• The Privacy Rule, at 45 CFR 164.512(a), allows covered entities to disclose PHI to public health authorities such as the Department, when required by state laws. Chapter 81 of the Texas Health and Safety Code is the applicable state statute for this type of reporting.
• Covered entities operating in Texas are expected to comply with applicable mandatory reporting requirements in Texas state law and may rely on HIPPA for additional legal basis for disclosing the required information to the Department. This reporting does not require the Department to enter into any legal Memorandums.
• If onboarding via AIMS, an appropriate chain of trust must be established with the Association of Public Health Laboratories (APHL) using the eHealth Exchange, Care quality, or the APHL participation agreement. The APHL AIMS platform operate through Business Associate or equivalent authorities from the clinical care covered entity.