CDC FHIR® IG: Anonymized Electronic Initial Case Reporting (eICR)
1.0.1 - release

CDC FHIR® IG: Anonymized Electronic Initial Case Reporting (eICR) - Local Development build (v1.0.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Downloads

Full Implementation Guide

The entire implementation guide (including the HTML files, definitions, validation information, etc.) may be downloaded here.

In addition there are format specific definitions files.

- XML
- JSON
- TTL

Examples: all the examples that are used in this Implementation Guide available for download:

- XML
- JSON
- TTl

#### Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (ecr.fhir.us.anonymized-eicr.r4) and R4B (ecr.fhir.us.anonymized-eicr.r4b) are available.

#### Dependency Table

IG | Package | FHIR | Comment
--- | --- | --- | ---
CDC FHIR® IG: Anonymized Electronic Initial Case Reporting (eICR) | ecr.fhir.us.anonymized-eicr#1.0.1 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.2.0 | R4 | Automatically added as a dependency - all IGs depend on HL7 Terminology
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.2.0 | R4 | Automatically added as a dependency - all IGs depend on the HL7 Extension Pack
HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm | hl7.fhir.us.ecr#2.1.2 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.0.2 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.1.0 | R4 |
US Core Implementation Guide | hl7.fhir.us.core#4.0.0 | R4 |
FHIR Bulk Data Access | hl7.fhir.uv.bulkdata#1.0.1 | R4 |
VSAC | us.nlm.vsac#0.3.0 | R4 |
VSAC | us.nlm.vsac#0.19.0 | R4 |
PHINVads | us.cdc.phinvads#0.12.0 | R4 |
Vital Records Common Profiles Library | hl7.fhir.us.vr-common-library#1.0.0 | R4 |
PHINVads | us.cdc.phinvads#0.7.0 | R4 |
HL7 FHIR Profile: Occupational Data for Health (ODH), Release 1, STU 1.1 (Standard for Trial Use) | hl7.fhir.us.odh#1.1.0 | R4 |
US Core | hl7.fhir.us.core#3.1.1 | R4 |
Bulk Data Access IG | hl7.fhir.uv.bulkdata#1.1.0 | R4 |
VSAC | us.nlm.vsac#0.21.0 | R4 |

Package hl7.fhir.uv.extensions.r4#5.2.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00)

Package hl7.fhir.uv.extensions.r4#5.1.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Package hl7.fhir.us.core#4.0.0 The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Mon, Jun 28, 2021 19:09+0000+00:00)

Package hl7.fhir.us.vr-common-library#1.0.0 The purpose of this project is to create an HL7 Fast Healthcare Interoperability Resources (FHIR) Library standard to support the needs of multiple Vital Records Implementation Guides. This guide is a FHIR Resources (FHIR) Library to support the needs of multiple Vital Records Implementation Guides. It does not provide any use case or scenario specific content or additional guidance on how to use these artifacts, but serves as a source for a standard set of profiles for reuse in multiple use case specific implementation guides focusing on the exchange of Vital Records information. Implementation details such as how and when to use a given artifact will be supplied in these guides. ### Background After evaluation and analysis of two separate FHIR IG projects - Birth Defects Reporting and Birth and Fetal Death Reporting, it was determined that there are many common data elements between the two IGs. The short-term scope of this common profiles library will include data elements common to the above-mentioned FHIR IGs and will define a US Realm specific framework that defines common elements for the implementation guides. The longer-term scope of this profiles library will include analysis and possible inclusion of data elements from other Vital Records projects (such as Vital Records Mortality and Morbidity Reporting FHIR IG). To avoid defining the same profiles multiple times, this IG contains a US Realm focused profile library for use by Vital Records and other FHIR standards development efforts to define the appropriate FHIR profiles, value sets, etc., once and allow them to be referenced by each of the specific implementation guides. This profile library will provide a standard framework for inclusion in multiple use case specific implementation guides focused on the exchange of Vital Records information to support interoperability among public health systems and reduce provider and implementer burden. This FHIR implementation guide uses the US Core profiles. Where this FHIR implementation guide is unable to use a US Core profile, we have followed the Cross Group Projects WG's variance request process, and have provided the US Realm Steering Committee an approved rationale for deviation in the implementation guide. For Clinical Safety Information please refer to the FHIR Implementer’s Safety Checklist. ### How to Read This Guide This Guide is divided into several pages which are listed at the top of each page in the menu bar. Home: The home page provides the introduction and background for HL7 FHIR® Vital Records Common Profiles Library. Terminology: This page provides a listing of the value sets used in this guide. Downloads: This page provides links to downloadable artifacts. Artifact Index: This page provides a list of the FHIR artifacts (profiles, examples, and value sets) defined as part of this guide. (built Tue, Oct 12, 2021 12:37+0000+00:00)

Package hl7.fhir.us.odh#1.1.0 HL7 FHIR Profile: Occupational Data for Health (ODH), Release 1.1 (Standard for Trial Use) This Implementation Guide is a reconciled version, containing changes in response to comments received in the Sept. 2018 ballot. It has been updated to FHIR R4.0.1. Introduction and Guidance This Implementation Guide (IG) contains profiles to implement support for Occupational Data for Health (ODH). ODH describes structured work information primarily designed to facilitate clinical care, including population health and value-based care. ODH also can be used to support public health reporting. ODH is not designed to support billing activities. This set of FHIR profiles is specified as a composition resource, but it is not intended to be used as a stand-alone composition. Rather, the desired content should be included in broader IGs and available as a response to requests for ODH information. Some use cases may leverage only a subset of the ODH profiles, and these should be specified within those work products. For instance, in the Vital Records Death Reporting (VRDR) IG, the data requirements for work information are limited to those in the Usual Work profile. While this profile is specified for the US Realm, the design is intended to also support international needs. Three of the referenced value sets—Occupation, Industry, and Supervisory Level— are necessarily US specific. The remaining three value sets—Work Schedule, Employment Status, and Work Classification—use international concepts. Input is requested regarding whether these should be specified as ‘extensible’, ‘required’ (using ‘text only’ where a concept does not yet exist such as a new occupation), or as an ‘example’ for those US specific concepts. Background The majority of adults in the U.S. spend more than half their waking hours at work. Therefore, health and work are inextricably inter-related. For example, the management of chronic conditions requires taking the patient’s work environment into consideration. Work-related conditions are often first brought to the attention of a primary care provider. Some conditions related to exposure to hazards in the workplace can have a long latency, requiring knowledge of a person’s work history for recognition, diagnosis, and treatment. The recognition of new conditions related to previously unknown workplace hazards has often come from astute clinicians, which requires knowledge of the patient’s work. ONC has indicated recognition of the value of work information for health care. The incorporation of ODH into Electronic Health Records (EHRs) and other health IT systems presents an opportunity to improve health in relation to work. ODH provides a structure and standardization for work information that can be used across systems to take advantage of system tools for clinical decision support, population health, and public health. Research has been conducted and guidance is available to support clinicians, and the use of ODH by health IT systems can support identification of patients that would benefit the most from this knowledge. Scope The Occupational Data for Health (ODH) FHIR IG covers information about a patient’s work, including some voluntary work, or a patient’s household members’ work. ODH is designed for the social history section of a medical record, to facilitate clinical care in multiple disciplines and delivery environments. ODH can be used for clinical decision support, population health activities and value-based care, and public health reporting. The scope of the work information in ODH includes: • Employment Status • Retirement Date • Combat Zone Period • Past or Present Job for the patient or a household member, which includes:
    	o	Past or Present Job Occupation

    	o	Past or Present Job Industry

    	o	Work Classification

    	o	Work Schedule, which includes:

    			- Weekly Work Days

    			- Daily Work Hours

    	o	Job Duty

    	o	Occupational Hazard

    	o	Employer name

    	o	Employer address

    	o	Related Subject (when it is Past or Present Job of a household member of the person)

    	o	Start/End Dates
• Usual Work of the patient or a household member, which includes:
    	o	Usual Occupation

    	o	Usual Industry

    	o	Usual Occupation Duration

    	o	Related Subject (when it is Usual Work of a household member of the person)

    	o	Start Date
Known Issues and Limitations This IG includes more extensive occupational data than typically collected in current systems. The content and structure of this IG is intended to inform clinical care, support population health, and contribute to public health activities. While there may be some overlap with administrative and billing information maintained by some systems, the information in this IG is not designed to support billing and administrative needs. While multiple retirement dates are supported, the retirement date is not linked to any specific job, or usual occupation. Credits Co-Editor: Lori Reed-Fourquet e-HealthSign, LLC lfourquet@ehealthsign.com Co-Editor: Rob Hausam Hausam Consulting rob@hausamconsulting.com Co-Editor: Mark Kramer MITRE Corporation mkramer@mitre.org This set of FHIR profiles was produced and developed through the efforts of a project of the National Institute of Occupational Safety and Health (NIOSH), the U.S. federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is a part of the U.S. Centers for Disease Control and Prevention (CDC). NIOSH consulted stakeholders in clinical care, public health, health IT, health informatics and U.S. government agencies to develop ODH. The HL7® Public Health and Emergency Response Work Group sponsored development of this set of FHIR profiles. Co-sponsoring HL7® Work Groups were Orders and Observations (OO), Patient Administration (PA), and Clinical Quality Initiative (CQI). The following individuals provided subject matter expertise for this set of FHIR profiles: Genevieve Barkocy Luensman, NIOSH; Eileen Storey, Professional Services Partners, formerly NIOSH; Margaret S. Filios, NIOSH; Christina Socias-Morales, NIOSH; Lauren Brewer, NIOSH; Barbara Wallace, Professional Services Partners. Authors Name Email/URL HL7 International - Public Health http://www.hl7.org/Special/committees/pher (built Mon, Jul 12, 2021 17:46+0000+00:00)

Package hl7.fhir.uv.bulkdata#1.1.0 FHIR based approach for exporting large data sets from a FHIR server to a client application (built Fri, Apr 16, 2021 11:36+1000+10:00)

Package hl7.fhir.us.ecr#2.1.2 # 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](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=436) (see the link under "STU Documents" for STU 2.0) and the [HL7 CDA R2 Reportability Response (RR) STU IG](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=470). For Clinical Safety Information please refer to the [FHIR Implementer’s Safety Checklist](http://hl7.org/fhir/safety.html). Known Issue: The following issue is related to a publication tooling issue. A technical correction is planned once the tooling issue has been addressed. FHIR-30477: Resolution errors for FHIRHelpers and FHIR-ModelInfo. # Stakeholders * Regulatory Agencies * Standards Development Organizations * Vendors: EHR, PHR; Health Care IT; Clinical Decision Support Systems, Public Health Surveillance Systems * Providers: Ambulatory and Healthcare Institutions (hospitals, long term care, mental health) * Local, State, Tribal and Federal Public Health Agencies (built Wed, Oct 30, 2024 20:32+0000+00:00)

#### Globals Table

There are no Global profiles defined

#### IP Statements

This publication includes IP covered under the following statements.

- ISO maintains the copyright on the country codes, and controls its use carefully. For further details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
  Show Usage
  - ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: Bundle/bundle-document-zika-anon, EICRAnonymized... Show 13 more, EICRAnonymizedCalculatedAge, EICRAnonymizedComposition, EICRAnonymizedDocumentBundle, EICRAnonymizedEncounter, EICRAnonymizedImmunization, EICRAnonymizedOrganization, EICRAnonymizedPastOrPresentJob, EICRAnonymizedPatient, EICRAnonymizedPractitioner, EICRAnonymizedPractitionerRole, EICRAnonymizedRelatedPerson, Observation/observation-country-of-nationality-anon and Observation/observation-country-of-residence-anon
- Most of the information on the CDC and ATSDR websites is not subject to copyright, is in the public domain, and may be freely used or reproduced without obtaining copyright permission. For information and exceptions regarding use of CDC material please see https://www.cdc.gov/other/agencymaterials.html
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  - Vaccine Administered Code Set (CVX): Bundle/bundle-document-zika-anon and Immunization/immunization-pneumo-anon
- The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
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  - Unified Code for Units of Measure (UCUM): Bundle/bundle-document-zika-anon, EICRAnonymizedCalculatedAge... Show 5 more, MedicationAdministration/medicationadministration-naloxone-response-anon, Observation/observation-blood-pressure-anon, Observation/observation-calculated-age-anon, Observation/observation-lab-result-lymphocytes-anon and Observation/observation-rr-reportability-information-anon
- This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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  - LOINC: Bundle/bundle-document-zika-anon, Composition/composition-zika-anon... Show 16 more, DocumentReference/documentreference-add-reporting-needs-pdf, DocumentReference/documentreference-zika-follow-up-pdf, DocumentReference/documentreference-zika-info-pdf, EICRAnonymizedCalculatedAge, EICRAnonymizedComposition, Observation/observation-blood-pressure-anon, Observation/observation-calculated-age-anon, Observation/observation-country-of-residence-anon, Observation/observation-disability-status-anon, Observation/observation-lab-result-lymphocytes-anon, Observation/observation-odh-usual-work-anon, Observation/observation-past-or-present-job-anon, Observation/observation-pregnancy-status-anon, Observation/observation-rr-relevant-reportable-condition-anon, Observation/observation-vaccine-credential-assertion-anon and ServiceRequest/servicerequest-zika-anon
- This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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  - SNOMED Clinical Terms&reg; (SNOMED CT&reg;): Bundle/bundle-document-zika-anon, City Football Stadium... Show 14 more, Composition/composition-zika-anon, Condition/condition-common-cold-anon, Condition/condition-zika-anon, Device/device-ecmo-anon, Encounter/encounter-outpatient-anon, MedicationAdministration/medicationadministration-azithromycin-anon, MedicationAdministration/medicationadministration-naloxone-response-anon, Observation/observation-country-of-nationality-anon, Observation/observation-pregnancy-status-anon, Observation/observation-rr-relevant-reportable-condition-anon, Observation/observation-travel-history-201801-anon, PractitionerRole/practitionerrole-anon, Procedure/procedure-ecmo-anon and ServiceRequest/servicerequest-zika-anon
- This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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  - Condition Category Codes: Bundle/bundle-document-zika-anon, Condition/condition-common-cold-anon and Condition/condition-zika-anon
  - Observation Category Codes: Bundle/bundle-document-zika-anon, Observation/observation-blood-pressure-anon and Observation/observation-lab-result-lymphocytes-anon
  - identifierType: Bundle/bundle-document-zika-anon, Patient/patient-anon and Patient/patient-anon-not
  - expandedYes-NoIndicator: Bundle/bundle-document-zika-anon and Observation/observation-vaccine-credential-assertion-anon
  - ActCode: Bundle/bundle-document-zika-anon and Encounter/encounter-outpatient-anon
  - NullFlavor: Bundle/bundle-document-zika-anon, Patient/patient-anon and Patient/patient-anon-not
  - ObservationInterpretation: Bundle/bundle-document-zika-anon and Observation/observation-lab-result-lymphocytes-anon
  - ParticipationType: Bundle/bundle-document-zika-anon, EICRAnonymizedEncounter, Encounter/encounter-outpatient-anon and Observation/observation-travel-history-201801-anon
  - RoleClass: Bundle/bundle-document-zika-anon, Patient/patient-anon and Patient/patient-anon-not
  - RoleCode: Acme Labs, Bundle/bundle-document-zika-anon, Clinic Bldg A, Salem Medical Center and RelatedPerson/relatedperson-anon
  - TribalEntityUS: Bundle/bundle-document-zika-anon, Patient/patient-anon and Patient/patient-anon-not
  - Orderable Drug Form: Bundle/bundle-document-zika-anon and MedicationAdministration/medicationadministration-azithromycin-anon
- Used by permission of HL7 International, all rights reserved Creative Commons License
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  - Race & Ethnicity - CDC: Bundle/bundle-document-zika-anon, Patient/patient-anon and Patient/patient-anon-not
- Using RxNorm codes of type SAB=RXNORM as this specification describes does not require a UMLS license. Access to the full set of RxNorm definitions, and/or additional use of other RxNorm structures and information requires a UMLS license. The use of RxNorm in this specification is pursuant to HL7's status as a licensee of the NLM UMLS. HL7's license does not convey the right to use RxNorm to any users of this specification; implementers must acquire a license to use RxNorm in their own right.
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  - RxNorm: Bundle/bundle-document-zika-anon, MedicationAdministration/medicationadministration-azithromycin-anon and MedicationAdministration/medicationadministration-naloxone-response-anon