eCR Puts the Pedal to the Metal and Expands Nationwide

In March 2022, CDC Director Dr. Rochelle Walensky stood in front of TV cameras and a massive bank of screens in CDC’s Emergency Operations Center being interviewed by Jon LaPook of 60 Minutes. She pointed out a slide created by the electronic case reporting (eCR) team that showed eCR’s impressive nationwide expansion over the course of the COVID-19 pandemic.

Walensky explained that improving the collection and analysis of data has been a top agency priority over the past two years. She noted that before the pandemic, fewer than 200 healthcare facilities could send automated information to public health agencies. Now, thanks to the eCR team, more than 12,500 facilities are sending electronic case reports.

“Boy, did we have to work hard to put the pedal to the metal and create the infrastructure,” Walensky said. “And we have more work to do.”

eCR is the automated, real-time exchange of case report information between electronic health records and jurisdictional public health agencies. It makes case reporting easier for healthcare facilities by eliminating manual data entry, faxing, and phone calls. The fast, accurate, and reliable data that eCR sends to public health agencies allows them to respond quickly to public health threats within their jurisdictions and give immediate feedback to healthcare about possible outbreaks.

eCR Takes Off

At the beginning of 2020, 187 facilities were using eCR for five pilot conditions: pertussis, gonorrhea, chlamydia, salmonellosis, and Zika virus infection. When the COVID-19 pandemic began, the eCR team realized it needed to ramp up quickly. The first eCR for COVID-19 was submitted on February 14, 2020, and the eCR team joined the CDC COVID-19 Emergency Response in June 2020.

Since then, there has been an explosion of implementers. By the end of 2020, 6,500 facilities were using eCR for COVID-19 reporting. Today, there are more than 12,500. All 50 states, Washington, D.C., Puerto Rico, and 13 local public health agencies can receive eCR data. As of June 1, 2022, more than 19.9 million COVID-19 reports have been sent from healthcare facilities to public health agencies. “From a public health perspective, eCR is the single biggest transformation we need to address this pandemic and other public health challenges,” said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, an eCR partner.

eCR received another boost in January 2022 when the Centers for Medicare and Medicaid Services (CMS) started requiring its use in the Promoting Interoperability Program for eligible hospitals and critical access hospitals and the Merit-Based Incentive Payment System (MIPS) Promoting Interoperability Performance Category for eligible clinicians. “We are grateful to CMS for seeing the importance of electronic case reporting for public health surveillance and response readiness and prioritizing it as a requirement in the 2022 promoting interoperability programs,” said Laura Conn, CDC’s eCR program lead. “We are already seeing the uptick in electronic health record vendor and healthcare interest to operationalize eCR.”

What’s Next?

Capitalizing on eCR’s momentum, the eCR team is focused on several important efforts going forward. eCR is a key component of CDC’s Data Modernization Initiative to modernize and accelerate electronic data reporting capabilities in the United States. In addition, the eCR team is focused on expanding eCR beyond COVID-19, helping facilities implement for more than 170 reportable conditions. The team is also working to onboard healthcare facilities and public health agencies serving communities that have been disproportionately affected by COVID-19 and systemic health inequities.