This Composition profile represents an electronic initial case report (eICR). It is based on and further constrains the US Public Health Composition.

This Observation profile represents the patient’s country of nationality.

This Observation profile represents the patient’s country of usual residence.

This Bundle profile represents an eCR Document Bundle. It contains an eICR Composition.

This Encounter profile represents the encounter related to the event.

This Procedure profile defines constraints on the US Core Procedure profile for the eICR use case.

This ServiceRequest profile represents eICR laboratory orders and other diagnostics for the eICR event.

This Observation profile represents whether or not the patient has asserted that they have verifiable vaccine credentials.

This Composition profile represents the Reportability Response that is created in response to an electronic Initial Case Report Composition.

This Bundle profile represents an RR Document Bundle. It contains either an RR Composition.

This profile represents external resources such as a text guidance, link to access forms for additional reporting needs, additional testing and/or laboratory testing needs, treatment and/or prevention resources, Public Health Agency contact information and general additional resources.

This Extension profile represents the eICR processing status.

This Observation profile represents the eICR processing status.

This Observation profile represents, if the incoming eICR was not successfully processed for a determination of reportability, the reason it was not processed.

This profile represents a relevant reportable condition.

This profile represents reportability information based on the PHA in which is located the patient’s home, the provider facility, or both locations.

This Organization profile represents the Responsible Agency which is a PHA to which reporting is legally required.

This Organization profile represents the Routing Entity which is a PHA or other organization identified by the PHA (such as an HIE) to which the eICR and/or the Reportability Response will be provided immediately following the creation of the Reportability Response.

This Organization profile represents the Rules Authoring Agency which is the originator of the rules that are being executed in decision support to determine reportability.

This profile contains a detailed textual description of the reportable condition(s), including actions the provider needs to take, any supplemental information that may be required, and where the initial case report was sent.

This PlanDefinition profile defines the logic and rules around determining: whether or not a condition is reportable to public health, which jurisdiction(s) is/are responsible, which jurisdiction(s) need to be notified, and if the condition is reportable, gives timing information, next steps and condition information to the clinician. The rules for determining reportability described by an eRSD specification involve the use of triggering codes to determine potentially reportable events, and optionally locally evaluated rules for determining suspected reportable events. The final determination of reportability is made by the Public Health Agency or Agencies appropriate for the event, and may be performed by a combination of decisions occurring at various points during the processing of an eICR, as explained in the Reportability Response profile.

Defines the asset-collection library containing the eRSD supplemental assets.

An example library with logic for determining whether or not an event or situation is reportable.

This release includes code updates for the existing conditions and adds codes for Parkinson’s disease and 13 enteric conditions. Medication codes have also been added to this version.

An example eRSD PlanDefinition

An example eRSD PlanDefinition

This Observation profile represents characteristics of the patient’s home environment.

Such characteristics include, but are not limited to, type of residence (trailer, single family home, assisted living), living arrangement (e.g., alone, with parents), and housing status (e.g., evicted, homeless, home owner). Congregate living situations would be represented in this profile - such shared housing includes a broad range of settings, such as apartments, condominiums, student or faculty housing, national and state park staff housing, transitional housing, and domestic violence and abuse shelters.

This Condition profile represents the signs, symptoms, and diagnoses related to a public health event.

It is based on the US Core Condition profile with further restriction of a Must Support constraint on the onset[x] and verificationStatus data elements.

In the case of a condition being mistakenly entered into the system and later corrected:

• verificationStatus of ‘entered-in-error’ must be set

This profile represents the Disability Element defined here: https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status.

The six item set of questions used on ACS and other major surveys to gauge disability is the data standard for survey questions on disability. Note the age thresholds for survey participants for the different disability questions.

Data Standard for Disability Status

1. Are you deaf or do you have serious difficulty hearing?
2. Are you blind or do you have serious difficulty seeing, even when wearing glasses?
3. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions? (5 years old or older)
4. Do you have serious difficulty walking or climbing stairs? (5 years old or older)
5. Do you have difficulty dressing or bathing? (5 years old or older)
6. Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping? (15 years old or older)

This profile represents information that is required during a public health emergency/outbreak. This information can be highly variable, so a generic structure has been chosen to represent it.

This information will be recorded using a question/answer pattern with questions specific to the public health emergency/outbreak.

This Encounter profile represents the encounter related to the event. It is based on the US Core Encounter.

This is the Endpoint Resource profile for the IG used to specify receivers addresses

This Observation profile represents potential patient exposure and contact information and should be used to record information about the patient’s exposure to an agent (exposure source) or to record information about those that the patient could have exposed to an agent (exposure target). Recording of this information could assist/support in contact tracing or other control measures.

This Location profile represents the location/facility in which care was provided.

This Organization profile represents an organization involved in public health. It is based on the US Core Organization profile and establishes the core elements, extensions, vocabularies and value sets for representing organizations for public health.

This Patient profile represents a US Public Health Patient.

It is based on the US Core Patient profile with further restrictions to allow masking of some data elements and the addition of the patient-genderIdentity extension.

For ONC’s USCDI requirements, it adds Must Support constraints to the following:

• contact detail (e.g. a telephone number or an email address)
• a communication language
• a race
• an ethnicity
• a birth sex

This profile represents the postpartum status of a patient.

If the profile is present, the patient is in the postpartum period and further information about the postpartum status is communicated by the code chosen.

The postpartum period, also known as the puerperium, refers to the time after delivery when maternal physiological changes related to pregnancy return to the nonpregnant state. There is consensus that the postpartum period begins upon delivery of the infant. The end is less well defined but is often considered the six to eight weeks after delivery because the effects of pregnancy on many systems have largely returned to the pre-pregnancy state.

This PractitionerRole profile represents the roles and organizations of the practitioner.

It is based on the US Core PractitionerRole profile with a further restriction of a mandatory identifier data element.

This profile represents a result of the pregnancy such as live birth, still birth, miscarriage, etc.

The subject of this profile is the mother. The focus of this profile is the related Pregnancy Status Observation.

The order born in the delivery, live born or fetal death (1st, 2nd, 3rd, 4th, 5th, 6th, 7th, etc.) is contained in Observation.component. All live births and fetal losses are included. If the pregnancy plurality is 1 then this value will also be 1.

There will be one Pregnancy Outcome Observation for each fetus delivered live or dead at any time in the pregnancy, regardless of gestational age or if the fetuses were delivered at different dates in the pregnancy. All live births and fetal losses are included. The order born in the delivery, live born or fetal death is contained in Observation.component.

This profile represents current and/or prior pregnancy statuses and their date ranges, enabling investigators to determine if a patient was pregnant, possibly pregnant, not pregnant or whether the pregnancy status was unknown during a particular date range.

The subject of this profile is the mother.

This profile includes the determination method, determination date, and recorded date of the pregnancy status.

Use the effectivePeriod to indicate the date range over which the patient was pregnant/possibly pregnant/not pregnant/unknown. To record the date that the pregnancy status was recorded, use the date-recorded-extension and to record the date on which the pregnancy status determination was made, use the date-determined-extension. If the effectivePeriod.end is not present it is assumed that the date range over which the pregnancy status is asserted is from effectivePeriod.start to the date in the date-recorded-extension. For example, if the effectivePeriod.start has been recorded as two months prior to the date contained in the date-recorded-extension, and there is no effectivePeriod.end recorded, no assumptions can be made about the pregnancy status after the date contained in the date-recorded-extension.

This Observation profile represents transportation details such as the type of transport (plane, train, ship, etc.) along with any associated information (e.g. name of cruise ship, flight number, airport, seat number, cabin number, etc.).

This Observation profile represents a patient’s travel history.

The following data for a patient can be recorded:

• travel history as a string, an address, or a coded location
• the date or period of time spent in the location (Observation.effectiveTime)
  • it is important to accurately capture the most accurate dates possible
  • the focus should be on date of arrival and date of departure
  • the concepts of dates as related to travel are especially useful for determining need for Federal Public Health Notifications (FPHNs) and these dates are used to alert foreign ministries of health about their residents who may have been contacts of cases, or if a flight that was outbound from the USA had an infectious traveler on it
• most uses will involve a single location (Observation.component), however, it is possible to specify multiple locations (but there is only a single effectiveTime)
  • this allows for cases where a patient cannot remember exact dates of travel (e.g. I traveled to London, Paris, and Berlin in July and August 2016)
• free text describing the travel history details and location (Observation.component.valueCodeableConcept.text element)
• use Observation.component.codeableConcept to record a coded location
• use Observationcomponent.extension to record a specific address
• where a more granular address than state is known (e.g. city, street) it is appropriate to use the extension to record an address rather than using the coded location

This profile constrains the base MedicationAdministration resource. The constraints are based on the requirements laid out in USCDI Level 2 for Medication Administration.

Further constrains the US Core Lab Result Observation to set specimen to Must Support.

This extension represents an US Public Health Alternative Expression

This profile describes the US Public Health CodeSystem.

This Composition profile represents a public health composition.

The computable library profile sets the minimum expectations for a computable CQL library.

Defines a computable value set as one that SHALL have an expression-based definition (i.e. a value set defined intensionally using expressions of the code systems involved) and MAY have an expansion included. The expression-based definition SHALL be represented in only one of three ways; using the compose element, using the expression extension, or using the rules-text extension to provide a step-by-step process for expanding the value set definition

Bundle Resource profile for exchanging public health messages, knowledge artifacts or content.

This Bundle profile represents a Public Health Document Bundle. It contains a US Public Health Composition.

This profile sets the minimum expectations for an executable CQL library. Specifically, the profile requires that the library contain one of ELM XML or JSON content, the compiled representation of the CQL logic.

Defines an executable value set as one that SHALL have an expansion included, as well as a usage warning indicating the expansion is a point-in-time snapshot and must be maintained over time for production usage.

This is the MessageHeader Resource profile for the IG.

This profile describes the US Public Health PlanDefinition.

Bundle Resource profile for exchanging one of public health messages, knowledge artifacts or content.

Defines the asset-collection library containing the US Public Health specification assets.

Defines the asset-collection library containing the US Public Health supplemental assets.

This profile describes the US Public Health Supplemental value set.

Defines the library containing the US Public Health supplemental value sets.

This profile describes the US Public Health Triggering value set.

Defines the library containing the US Public Health triggering value sets.

This profile describes the US Public Health value sets.

Defines the library containing US Public Health value sets.

This MessageHeader profile represents metadata to support the eCR messaging paradigm.

This Extension profile represents where the patient traveled to or visited as an address e.g.: country, state, city, street address (if applicable).

At the least, address must contain the country. State is required if the country is US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies.

A reference to a CodeSystem or ValueSet that establishes the allowable values for a code system property

Indicates whether the data in the content bundle is encrypted or not.

The date a status or observation was determined (date of determination).

The date a status or observation was recorded (recorded date).

This Extension profile represents the determination of reportability.

Reportability is “the quality or state of being reportable or not”. Reportability does not equate to the patient having a condition or meeting a case definition (definitively being a case).

For each condition included in the report and the relevant public health agency(s), this element indicates the determination of whether the condition is reportable to public health.

The values that can be used for the Determination of Reportability are described below.

A possible condition is:

• Reportable - The information provided meets reporting criteria for an associated PHA.

A possible condition:

• May be Reportable - The information provided may meet reporting criteria if additional information is provided. The Reportability Response will also be able to share the information needed to definitively determine reportability.

A possible condition is:

• Not Reportable - The information provided conclusively does not meet reporting criteria.

Some decision support systems may not be able to fully differentiate between possible conditions that are Not Reportable and those that May be Reportable if additional information is provided. In these circumstances there may only be a reportability determination of:

• No Reporting Rule Met - The information provided does not meet reporting criteria or may meet reporting criteria if additional information is provided.

The determination of No Reporting Rule Met may be provided for a possible condition or for all conditions in the report.

This Extension profile represents the reason for the determination of reportability.

This Extension profile represents a rule that led to the determination of reportability.

Supports the definition of expansion parameters for the ValueSet.

This extension represents a US Public Health Information Recipient

This extension contains an explanation for the manual or alternate initiation of the public health report.

If there are multiple distinct reasons for manual or alternate initiation then each reason should be contained in a separate US Public Health Initiation Reason Extension.

The reason may be entered either as:

• free text (string)
• coded value (valueCodeableConcept) (not necessarily initiated by a provider of care but might be “programmed-in” by the EHR implementer for some purpose)

Indicates how systems have to deal with messages in terms of duplicates, lack of responses.

Indicates the types of named events to subscribe to from the EHR.

Indicates the endpoint address where the report has to be sent.

Identifies the input or output of a PlanDefinition Action Input/Output (DataRequirement) so that it can be referenced by other inputs/outputs.

This Extension profile represents an affiliated tribe name and whether or not the patient is an enrolled member

An extra warning about the correct use of the value set.

Supports communicating the FHIR query for a given data requirement. The query is server-specific, and will need to be created as informed by a CapabilityStatement. The $data-requirements operation should be extended to be able to provide an Endpoint or CapabilityStatement to provide this information. If no endpoint or capability statement is provided, the capability statement of the server performing the operation is used. This is not a resolveable URL, and that it will contain 1) No base canonical (so it’s a relative query), and 2) Parameters using tokens that are denoted using double-braces and the context parameters are dependent solely on the subjectType, according to the following: Patient: context.patientId, Practitioner: context.practitionerId, Organization: context.organizationId, Location: context.locationId, Device: context.deviceId

An individual’s personal sense of being a man, woman, boy, girl, nonbinary, or something else. This represents an individual’s identity, ascertained by asking them what that identity is. This is a copy of the draft FHIR individual-genderIdentity extension (http://hl7.org/fhir/StructureDefinition/individual-genderIdentity).

This Extension profile represents that the eICR, was either manually or alternately initiated by the provider.

This Extension profile represents a flag which, if it is present, indicates that the target reference represents a triggering event and caused the eCR to be generated.

This Extension profile represents the date and time of eICR receipt

This Extension profile represents an external resource (DocumentReference) pertaining to the condition such as a text guidance, link to access forms for additional reporting needs, additional testing and/or laboratory testing needs, treatment and/or prevention resources, Public Health Agency contact information and general additional resources.

This Extension profile represents the priority given to the whole composition or one or more external resources.

This Extension profile represents represents a therapeutic response (as opposed to an undesired reaction) to the administration of a medication.

Example of Country of Nationality Observation

Example of Country of Residence Observation

Example of Device Profile (ECMO)

Example of Disability Status Profile (Eve Everywoman)

Example of eICR Composition profile (Eve Everywoman, Pertussis and Zika)

Example of eICR Composition profile (Eve Everywoman, Zika)

Example of eICR Composition profile (Eve Everywoman, Zika, Manual Initiation)

Example of eICR Condition profile (Eve Everywoman: diabetes)

Example of eICR Condition profile (Eve Everywoman: pertussis)

Example of eICR Condition profile (Eve Everywoman: zika)

Example of eICR Condition profile (Eve Everywoman: common cold)

Example of eICR Document Bundle profile (Eve Everywoman, Zika)

Example of eICR Procedure (ECMO)

Example of eICR ServiceRequest profile

Example of eICR ServiceRequest profile (Eve Everywoman - zika

Example of eICR Vaccine Credential Patient Assertion Observation

Example of US Core Immunization profile

Example of Last Menstrual Period (Eve Everywoman)

Example of Location resource (City Football Stadium)

Example of MedicationAdministration resource (Eve Everywoman, azithromycin)

Example of MedicationAdministration resource with Therapeutic Medication Response extension (Eve Everywoman: naloxone response)

Example of ODH Past or Present Job profile (Eve Everywoman)

Example of ODH Usual Work profile (Eve Everywoman)

Example of Travel History Observation profile (Eve Everywoman)

Example of Travel History Observation profile (Eve Everywoman - October 2016)

Example of Travel History Observation profile (Eve Everywoman - January 2018)

Example of US Core Practitioner (Henry Seven)

An example of the US Core Vital Sign Observation profile.

Example of eCR Message Bundle profile (Eve Everywoman, Zika)

Example of ODH Employment Status profile (Eve Everywoman)

Example of RR Summary profile.

Example of Reportability Response Composition - One Condition/One PHA with eICR Validation Output

Example of Reportability Response Composition - One Condition/One PHA

Example RR Document Bundle: One Condition, One PHA

Example of RR DocumentReference profile: Zika follow-up

Example of RR DocumentReference profile: Zika info

Example of RR DocumentReference profile: Additional reporting needs

Example of RR eCIR Processing Status Observation profile

Example of RR eICR Processing Status Reason Observation profile

Example of RR Relevant Reportable Condition Observation profile

Example of RR Reportability Information Observation profile

Example of RR Responsible Agency Organization profile (Health Authority West Responsible Agency)

Example of RR Routing Entity Organization Example profile (Health Authority West Routing Entity)

Example of RR Rules Authoring Agency profile (Health Authority West Rules Authoring Agency)

Packages the contents referenced by an asset-collection library such as a quality program release or version manifest.

An example eRSD Specification Bundle

An example eRSD Supplemental Bundle

This PlanDefinition is a simplified duplicate of the eRSD PlanDefinition Instance created for the purposes of demonstrating by example the usage of the US Public Health Named Event extension.

Description of library

Description of library

Example of Subscription resource (dxtc)

Example of Subscription resource (lotc)

Example of Subscription resource (ostc)

Example of Device resource (YMCA software)

Example of eCR MessageHeader profile (Requested eICR)

Example of Endpoint resource (Salem Medical Center endpoint)

Example of Endpoint resource (YMCA endpoint)

Example of Characteristics of Home Environment profile (Eve Everywoman)

Example of US Public Health PlanDefinition profile

Example of US Public Health Lab Result profile (Eve Everywoman, lymphocytes)

Example of US Public Health Lab Result profile (Eve Everywoman: Pertussis)

Example of US Public Health Encounter profile (Eve Everywoman: completed inpatient)

Example of US Public Health Encounter profile (Eve Everywoman: current inpatient)

Example of US Public Health Encounter profile (Eve Everywoman, external encounter)

Example of US Public Health Encounter profile (Eve Everywoman: external historical)

Example of US Public Health Encounter profile (Eve Everywoman: outpatient)

Example of US Public Health profile (Salem Medical Center)

Example of US Public Health Organization profile (Acme Labs)

Example of US Public Health Organization profile (Health Authority West)

Example of US Public Health Organization profile (Salem Medical Center)

Example of US Public Health Organization profile

Example of US Public Health Patient profile (Eve Everywoman)

Example of US Public Health PractitionerRole profile (Henry Seven)

Example of Emergency Outbreak Information profile (Eve Everywoman)

Example of US Public Health Exposure Contact Information (Football Game)

Example of US Public Health Postpartum Status profile (Eve Everywoman)

Example of US Public Health Pregnancy Outcome Observation profile (Eve Everywoman)

Example of US Public Health Pregnancy Status Observation profile (Eve Everywoman)

Example of the US Public Health Specification Library

Example of the US Public Health Supplemental Library

An example of the US Public Health Supplemental ValueSet Library

Example of US Public Health Transportation Example (Eve Everywoman)

Example of US Public Health ValueSet Library profile

An example of the US Public Health ValueSet Library

The US Public Health Message Types CodeSystem is a ‘starter set’ of codes supported for identifying types of messages being exchanged.

The US Public Health PlanDefinition Actions CodeSystem is a ‘starter set’ of codes supported for identifying actions in PlanDefinition.

The US Public Health TriggerDefinition NamedEvents CodeSystem is a ‘starter set’ of codes supported for identifying named events to subscribe to in clinical workflows.

This code system contains codes that identify the use context of a valueset.

This code system contains codes that identify the use context type of a valueset.

The impact of the content of a message.

The US Public Health Message Types Value Set is a ‘starter set’ of codes for uniquely identifying messages in MessageHeader instances contained within a reporting bundle.

The US Public Health PlanDefinition Action Value Set is a ‘starter set’ of codes for uniquely identifying actions in PlanDefinition instances.

This value set contains codes representing release priority for ValueSets.

This value set contains codes representing pregnancy statuses.

The US Public Health TriggerDefinition NamedEvent Value Set is a ‘starter set’ of codes for identifying named events uniquely in TriggerDefinition instances contained within a PlanDefinition.

This code system contains codes that identify the HL7 FHIR File type.

This code system describes the possible types of jurisdictions that require public health reporting.

This code system contains codes that identify the event a message represents.

This value set contains codes that identify the event an eCR message represents.

This example set of values contains laboratory observations test names that represent that the patient may have a potentially reportable condition - chlamydia.

Set of endpoint connection types specified as being supported by APHL

This code system describes jurisdictions that require public health reporting.

This example set of values contains procedure names for orders that represent that the patient may have a received a procedure or that a procedure has been requested.

This example set of values contains diagnoses or problems that represent that the patient may have a potentially reportable condition regardless of the clinical presentation of the condition

This example set of values contains laboratory observations test names that represent that the patient may have a potentially reportable condition regardless of the clinical presentation of the condition

This example set of values contains laboratory test names for orders that represent that the patient may have a potentially reportable condition regardless of the clinical presentation of the condition

This example set of values contains CVX, RXNORM,and SNOMED medication codes that may represent that the patient may have a potentially reportable condition. These pertain to medications administered and medications prescribed, where the medication, coded in CVX,RXNORM,SNOMED, may be indicative of a reportable condition.

This example set of values contains suspected diagnoses or problems that represent that the patient may have a potentially reportable condition. For example, these may be diagnoses recorded in an EHR problem list and diagnosis codes used for billing for the encounter.

This example set of values contains organism and substance names that represent that the patient may have a potentially reportable condition regardless of the clinical presentation of the condition

This valueset is a simplified duplicate of the eRSD Endpoint Connection Type valueset created for the purposes of demonstraing, by example, the US Public Health Supplemental ValueSet profile.

This value set is an example of the US Public Health Computable ValueSet

This value set is an example of the US Public Health ValueSet

This resource defines the expected capabilities for both client and server participating in eCR exchange

This section describes the expected capabilities of a client consuming eRSD resources including the Reportable Conditions Trigger Codes (RCTC).

Conformance requirements for an eRSD Client

The eRSD Client SHALL:

• Support fetching the eRSD Bundle using the supported RESTful interactions.
• Support processing PlanDefinition and ValueSet resources that are included in the Bundle.

The eRSD Client MAY:

• Support fetching and reading a Person resource.
• Support fetching and reading Subscription resources associated with a Person.

References US SNOMED CT version.