Page tree
Skip to end of metadata
Go to start of metadata

Committee Approval Date:

Public Health - 10/1/2020

Publishing Lead:

Nagesh Bashyam and Brett Marquard

Contributing or Reviewing Work Groups:

Public Health and FHIR-I

FHIR Development Project Insight ID:

Approved - 1611

Scope of coverage:

This project will develop a reference architecture to enable clinical data exchange with EHR systems and public health systems, specialized registries, national health care survey systems, and research information systems for multiple conditions. Initially, the reference architecture will be developed using three priority use cases representing infectious diseases, chronic diseases, and healthcare utilization:

  • Hepatitis C Reporting
  • Cancer Reporting
  • Health Care Surveys

Content location:

Proposed IG realm and code:

US Realm (us)


FHIR Core version(s):

FHIR R4.0.1

Maintenance Plan:

CDC intends to provide ongoing support of this implementation guide with FHIR community inputs when adopted. 

Short Description:

Making EHR Data More Available for Research and Public Health (MedMorph) Reference Architecture enables clinical data exchange between EHR systems, public health systems/authorities, data repositories, and research organizations.  This data exchange utilizes if applicable, knowledge repositories and backend services applications (e.g. FHIR APIs) to determine the triggering event(s) for the data exchange, the process for the data exchange, and validation that the data being exchanged meets a set of rules in order to expedite the data exchange. 

Long Description:

The Reference Architecture functions as a framework supporting the MedMorph use cases with a focus on the extensibility to other clinical and research use cases (e.g., Death and Birth Defect reporting). The MedMorph Reference Architecture enables clinical data exchange between EHR systems public health systems, specialized registries, national health care survey systems, and research information systems. It aims to minimize the burden on both the senders and receivers of data by providing a common method for obtaining data for research and public health for multiple conditions or uses. The Reference Architecture explores capabilities enabling the exchange of EHR data without changes to existing workflows and/or increasing provider burden (for e.g requiring more clicks or data entry).  Based on a specified event (trigger event), the Reference Architecture outlines a process by which data is gathered from the EHR during a clinical workflow behind the scenes and does not require the provider to perform extra steps.  In addition, the Reference Architecture outlines capabilities to minimize any added load on EHR systems due to the reporting function.  It further details functionality to minimize sending duplicate reports to public health and/or research for the same patient, for the same episode of care, and from the same clinical care setting.

The Reference Architecture implementation guide aligns with existing standards (HL7 FHIR, CDA ) including HL7 implementation guides for eICR, and regulations (ONC 2015 Edition, 2015 Edition Cures Update, Trusted Exchange Framework and Common Agreement (TEFCA), etc.) while improving the timeliness and completeness of data received by public health and research. The Reference Architecture IG accelerates the development of computable guideline specifications and interventions through an integrated, cross-functional, rapid-cycle (Agile) development process (inclusive of local implementation processes). Additionally, the Reference Architecture IG is developed to promote configurability to allow for customizations in workflows.

For each API used to access and exchange data, the Reference Architecture IG outlines the API mechanisms, inputs, and outputs. The Reference Architecture IG defines the provisioning mechanisms used to trigger the workflows and automation of the reports. The IG describes the trust services such as pseudonymization, anonymization, de-identification, etc., necessary for the use cases. The IG accommodates authorities and policies identified by other workgroups and regulations. The payload for data exchange (e.g. public health and research) as outlined in the reference architecture should be included in future content implementation guides.

Involved parties:

Multiple programs at the CDC

Technical Expert Panel convened by CDC including multiple stakeholder groups such as; federal partners, health IT developers, clinicians/health care organizations, medical societies, public health organizations, evaluation experts, policy experts.

Expected implementations:

Public Health Agencies, CDC


Dynamic Content Group



Cancer of American Pathologists (CAP)

eHealth Exchange

California Cancer Registry - California Department of Public Health

Content sources:


MedMorph working group meetings with external and HL7 stakeholders

Example Scenarios:

The following are example scenarios enabled by the implementation guide

  • Cancer Reporting from clinical care to cancer registries
  • Health Care Survey administration and reporting from clinical care to National Healthcare Surveys organization
  • Hepatitis C Reporting from clinical care to Public Health Agencies
  • Enabling EHRs to populate data marts which are queried by researchers

IG Relationships:

Depend on US Core

eICR FHIR IG, Death and Birth Reporting FHIR IG, MCC eCare Plan IG may depend on this implementation guide.


STU Ballot in January 2021.

FMG Notes