HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm
2.1.1 - STU 2.1.1 United States of America flag

HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/case-reporting/ and changes regularly. See the Directory of published versions

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Official URL: http://hl7.org/fhir/us/ecr/ImplementationGuide/hl7.fhir.us.ecr Version: 2.1.1
Active as of 2024-06-18 Computable Name: ElectronicCaseReporting


Introduction and Purpose

With the adoption and maturing of Electronic Health Records (EHRs) there are opportunities to better support public health surveillance as well as to better support the delivery of relevant public health information to clinical care. Electronic Case Reporting (eCR) can provide more complete and timely case data, support disease / condition monitoring, and assist in outbreak management and control. It can also improve bidirectional communications through the delivery of public health information in the context of a patient’s condition and local disease trends and by facilitating ad hoc communications. eCR will also reduce healthcare provider burden by automating the completion of legal reporting requirements.

With the advent of FHIR standards, there is a need for FHIR implementation guidance to specify appropriate resources and transactions needed for the eCR process. FHIR offers opportunities to further enable automated triggering and reporting of cases from EHRs, to ease implementation and integration, to support the acquisition of public health investigation supplemental data, and to connect public health information (e.g., guidelines) with clinical workflows. Over time, FHIR may also support the distribution of reporting rules to clinical care to better align data authorities and make broader clinical data available to public health decision support services inside the clinical care environment.

For more supporting information, use cases, and other background context and material, see Volume 1 of both the HL7 CDA R2 Electronic Initial Case Report (eICR) Standard for Trial Use (STU) IG (see the link under “STU Documents” for STU Release 3) and the HL7 CDA R2 Reportability Response (RR) STU IG.

For Clinical Safety Information please refer to the FHIR Implementer’s Safety Checklist.




Electronic Health Record (EHR) / 

Electronic Medical Record (EMR) 

The electronic health record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518657/. For purposes of this IG, EHR can also be interpreted to refer to applications that some vendors may call an electronic medical record (EMR).

Healthcare Provider

Any supplier of a healthcare service, i.e., a person or organization that furnishes, bills, or is paid for healthcare in the normal course of business. Includes physicians and healthcare provider staff, as well as ancillary healthcare personnel (e.g., laboratory personnel).

Health IT Vendor

A vendor or supplier is a company/consortium that provides health information technology products and/or services, in this case, for supporting health or healthcare.


An organization that is in the information flow between a healthcare organization and a PHA regarding case reporting. An intermediary may be acting on behalf of either the healthcare organization as a business associate or public health as an authorized agent. Examples include a Health Information Exchange (HIE) organization, a clinical trust and exchange network, or a shared infrastructure and routing platform.


The laboratory is a producer of laboratory test results (filler or, at times, placer of a laboratory order).

Laboratory Information System (LIS)

An application to streamline the management of laboratory processes including data collection, workflow management, and report generation. May provide an automatic interface to laboratory analytical instruments to transfer verified results to nurse stations, chart carts, and remote physician offices. Also referred to as a Laboratory Information Management System.

Public Health Agency (PHA)

For the purposes of this IG, a PHA is a governmental entity at the federal, state, territorial, local, or tribal level that is legally entitled to establish public health case reporting requirements and receive case reports. 

Public Health Decision Support (PHDS)

For the purposes on this IG, PHDS provides clinicians, staff, and public health practitioners with knowledge about reporting cases to public health and information about the condition that has been identified. 

Public Health System 

Jurisdictional information systems that may, among other things, receive public health case reports.

Standards Development Organization 

An organization that identifies the need for, locates interested parties, and writes specifications that all parties in a particular field of human endeavor can use to their mutual benefit. For the purpose of this document, the field is health or health interoperability and recognition by the American National Standards Institute (ANSI) or the International Standards Organization (ISO) is accepted as evidence that a particular organization is a standards development organization. 


Name Email/URL
HL7 International - Public Health http://www.hl7.org/Special/committees/pher