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.

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 organizations to report initial cases to DSHS and other local public health entities across Texas for further investigation from their EHR.  

Texas (DSHS) will officially declare readiness for eCR on September 1, 2023. Texas is currently accepting eCR messages from organizations seeking to fulfill their CMS Promoting Interoperability public health requirement. For more information, visit Public Health Data Interoperability (cdc.gov). 

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.

Texas Notifiable conditions should be reported according to the HL7 Standards Product Brief - HL7 CDA® R2 Implementation Guide: Reportability Response, Release 1, STU Release 1.1 - US Realm | HL7 International). Texas can accept all conditions currently published via the Reportable Conditions Knowledge Management System (RCKMS). For reference, a list of Texas Notifiable conditions is also available. 

All facilities conducting testing of notifiable conditions in Texas should already be onboarded and reporting to the Texas National Electronic Disease Surveillance System (NEDSS). Please contact IDI@dshs.texas.gov with any questions regarding reporting ELRs. The DSHS ELR staff will provide data format specifications and will schedule technical assistance as needed.

For Promoting Interoperability Program (PIP), the acceptable format for DSHS NEDSS ELR is HL7 v2 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 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).

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).

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.   

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.

Texas DSHS is accepting eCR messages submitted via CDC AIMS platform.

Note the following:

• 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.
• Chapter 81, Subchapter C of the Texas Health and Safety Code requires reporting on certain notifiable disease conditions to health authorities or to DSHS. 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 the Texas Administrative Code, Title 25, Chapter 97. Memorandums are not mandatory under these rules and reporting structure.

Applicability under HIPAA

• 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 DSHS for public health purposes including, but not limited to, public health surveillance and investigations.
• The Privacy Rule, at 45 CFR 164.512(a), allows covered entities to disclose PHI to public health authorities such as DSHS, 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 DSHS.
• If onboarding via the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS), an appropriate chain of trust must be established with the APHL using the eHealth Exchange, Care quality, or the APHL participation agreement. The AIMS platform operates through Business Associate or equivalent authorities from the clinical care covered entity.