CDC plans to roll out app in May to speed up COVID-19 case reporting

The Centers for Disease Control and Prevention (CDC) plans to roll out an app in May that will accelerate electronic case reporting of COVID-19 cases.

The app, based on Fast Healthcare Interoperability Resources (FHIR) standards, can be implemented quickly to automate COVID case reporting, said Laura Conn, health scientist and eCR lead in the CDC's Center for Surveillance, Epidemiology, and Laboratory Services.

The app enables healthcare providers that don't have the capability to automatically send case reports from their health IT systems to more efficiently send data to public health agencies.

"The FHIR app can be rapidly implemented to automate COVID-19 electronic case reporting (eCR) in otherwise non-enabled EHRs. The app will connect COVID-19 eCR to existing infrastructure to confirm cases and route to appropriate public health surveillance systems. We are making sure that can be easily used without requiring a software release by the vendors," said Conn during a meeting this week of a Congressional health IT advisory committee (HITAC).

The initial version of the app called eCR Now, will be available on May 1, Conn said.

The eCR Now program, and eventually the app, will enable public health agencies to get accurate, real-time data on COVID-19 cases to support case management and contact tracing efforts, Conn said.

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Public health officials depend on data, particularly from diagnostic testing and hospital case reports, to get a more accurate and timely picture of the COVID-19 pandemic.

Electronic case reporting is an automated sharing of health data from EHRs to public health agencies to track disease trends and identify outbreaks. 

Hospitals and doctor's offices are mandated by state laws to submit reports to public health for conditions deemed reportable, which now includes COVID-19. But there is significant variation from state to state in what conditions are reportable and the data that must be reported, Conn said.

That variation leads to diseases being "significantly underreported," she said.

"The details of cases are front and center with COVID these days. Public health needs to get this individual-level data to support case management investigation, but we also recognize that we can't burden the health care system to manually complete forms and fax them to public health, especially during this crisis," Conn said.

Reporting individual cases to public health can be challenging and burdensome for providers.

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While the CDC has worked to promote electronic case reporting, participation in electronic reporting has been uneven to date, according to Dell Medical School Chief Information Officer Aaron Miri and Robert Wood Johnson Foundation Fellow Daniel O'Neill writing in a Health Affairs blog published this week.

For many providers, case reports still take the form of a PDF file sent to a CDC email address, Miri and O'Neill wrote.

"Large commercial labs (e.g. Quest, LabCorp and BioReference) report electronically, but hospital labs much less so—and the network will have to scale up at least three-fold to capture the million COVID tests per week suggested by epidemiologists," Miri and O'Neill wrote.

CDC extended electronic case reporting for COVID-19 in early January. To date, four healthcare institutions, including Intermountain Healthcare and Houston Methodist Hospital, are sending electronic reports for COVID cases triggered by diagnostic and lab orders.

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Those four organizations have generated 62,000 COVID case reports that have been identified for 16 public health jurisdictions, according to Conn.

Through its eCR Now program, the CDC is working to accelerate electronic case reporting by doctor's offices and hospitals that have EHRs capable of automating reports. The agency is working with an initial cohort in California that includes Sutter Health and the Contra Costa Health Services department to onboard those organizations. The CDC is in the process of signing up organizations for the second cohort.

These efforts also enable more effective reporting of confirmed cases without manual entry, which helps to lower the burden on providers, Conn said.

Organizations interested in joining the eCR program are encouraged to contact Conn at the CDC via email.