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Electronic Case Laboratory Reporting (eCR) Frequently Asked Questions
Q: I am ready to begin eCR. How do I begin?
A: Texas is still in the initial phases of implementing eCR. Pilot phase testing is currently still underway with select facilities. Once pilot phase testing is completed Texas will begin onboarding and validating additional facilities for eCR. Interested organizations may still register at this time at https://app.smartsheet.com/b/form/d9668b3df7a743309af7e46123fd461e.
Q: What constitutes Electronic Case Laboratory Reporting (eCRELR) 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 eCRELR data for Promoting Interoperability?
A: Yes, Texas (DSHS) accepts eCRELR messages from organizations seeking to fulfill their Promoting Interoperability public health requirement. For more information, please visit https://www.cms.gov/files/document/electronic-case-reporting-2019-eh-cah-objective-9-medicare.pdf.
Q: Which entities in Texas should submit ELR messages during Promoting Interoperability Stage 1 and Stage 2?
A: eCR data is accepted from Eligible Providers (EP)s, 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 ELR Provider Registration Form (smartsheet.com).
Q: What notifiable conditions does Texas DSHS accept?
A: Texas Notifiable conditions should be reported according to the implementation guidelines provided above. 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 providers and 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 ELR 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 are available to send eCR to DSHS NEDSS?
A: Secure file transport protocol (sFTP), or FTP, S3, AIMS and/or Public Health Information Network Messaging System (PHIN-MS).
Q: Will new vendor(s) need Data Sharing Agreements?
A:
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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”).
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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.
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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.
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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.
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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.
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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.