Overview of Meaningful Use and Immunization Reporting
In July 2010, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) published final rules under the American Recovery and Reinvestment Act of 2009 (ARRA) and HITECH Act of 2009, which authorizes incentive payments to healthcare providers and hospitals that demonstrate meaningful use of certified electronic health records (EHRs).
Eligible professionals (EPs) and eligible hospitals were able to begin the incentive program in January 2011. Participants must demonstrate meaningful use by meeting a core set of 15 objectives and also choose 5 of 10 additional “menu” objectives outlined by the CMS and ONC. At least one of the menu objectives selected must be a public health measure. Submitting electronic immunization data to the CIR using HL7 version 2.3.1 standard protocol fulfills one public health menu objective. View details on the meaningful use objective and measure (PDF) to submit data to immunization registries.
Health care providers who are presently sending immunization data to the CIR will need to begin sending immunization data using the HL7 standard protocol. EPs and eligible hospitals who have never reported immunization data to the CIR and would like to send an HL7 standard test message to fulfill Stage I of the meaningful use requirements may contact us by phone: (347) 396-2400, or by email: email@example.com.
Medicare providers can demonstrate meaningful use over any 90 day period during their first year of participation in order to qualify for the first round of incentive payments of up to $18,000 (out of $44,000 over five years). Medicaid providers may begin preparing now for meaningful use, but only need to adopt, implement, or upgrade to a meaningful use-certified EHR in their first year of participation in order to receive the first payment of $21,250 (out of $63,750 over six years). For more details on the qualifications for these payments, please contact: firstname.lastname@example.org.
Description and Benefits of an HL7 Interface with the CIR
The CIR receives all immunization reporting electronically—either via direct data entry into the online registry, the upload of a UPIF (Universal Provider Interface Format) file generated from a billing system or EHR, or real-time HL7 messaging over the HL7 Web Service.
An HL7 interface with the CIR is different from other two methods of reporting electronically to the CIR (online registry and UPIF file upload). The HL7 interface involves a real-time connection to the CIR over a communication framework called a SOAP Web Service. Rather than exchanging immunization information through files, information is exchanged in a real-time fashion through HL7 messages—discrete packets of information containing immunization information for one patient.
EHR vendors have the ability to establish either a unidirectional or a bi-directional interface to the CIR’s HL7 Web Service. A unidirectional interface allows providers to report immunizations only; a bi-directional interface allows providers to report immunizations as well query the CIR for patients’ immunization histories and clinical decision support, and to store the returned information in their EHR.
Benefits of reporting to the CIR via an HL7 interface include the following:
- Eliminates the need for double data entry
- Allows providers to report immunizations in real-time
- Fulfills a meaningful use public health objective
There are additional benefits to a bi-directional interface:
- Allows providers to import immunization histories from the CIR into their EHR
- Delivers clinical decision support in real-time (if this feature is supported by the EHR vendor)
- Can help reduce missed opportunities for vaccination and avoid over-immunization
- Can increase documented immunization coverage rates in your practice, thereby ensuring that your patients are protected from vaccine preventable diseases
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Information for EHR Vendors
Process for establishing an HL7 interface with the CIR:
- Must have the ability to generate an HL7 2.3.1 or 2.5.1 message
- Must have the ability to connect to a SOAP Web Service
- Review one of the following specifications documents, the CIR HL7 2.3.1 integration guide or the CIR HL7 2.5.1 integration guide (PDF)
- Review the implementation checklist (PDF)
- Sign and return the vendor confidentiality agreement (PDF)
- Participate in a kick-off call with CIR staff to review interface requirements
- Connect to the CIR’s HL7 Web Service test environment. You may use the soapUI tool and project files (see below under ‘Other Useful Materials and Links’) to do initial connectivity testing and troubleshoot any issues with connecting to the service.
- Select a pilot site from which to send real immunization data
- Send a large volume of real immunization data through the test environment
- If issues are identified by CIR, make necessary modifications to the interface and send a new load of data to confirm issues have been resolved
- Once the CIR has approved the interface for production use, discuss rollout plans with CIR staff
- Connect clients to the production Web Service for ongoing reporting
The implementation process can take anywhere from one to six months depending on the level of resources a vendor is able to devote to the project.
Other Useful Materials and Links:
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Information for NYC Providers
The CIR will support any provider that would like to establish an HL7 interface with the registry, both for ongoing reporting and for the purpose of performing a meaningful use test. Learn more about the CIR’s HL7 Web Service and the benefits of reporting via this method.
Your EHR vendor will need to be involved in implementing an HL7 interface with the CIR. Some development will be required in order to establish a connection to the HL7 Web Service and testing will need to be performed to ensure that all required data elements are being sent.
If you are interested in establishing an HL7 interface from your EHR to the CIR, you can check to find out whether your EHR vendor has an established HL7 interface with the CIR. If not, you will need to put in a request to your EHR vendor. You can also contact the CIR (email@example.com) indicating that you have put in a request to your vendor for the interface, and including your vendor contact person and contact information. The CIR will follow up with the vendor and provide them with all the necessary information for development of the interface.
Meaningful use testing process (for meaningful use stage I)
- Ensure that you are using an EHR that is ONC certified for meaningful use
- Contact your EHR vendor to request an HL7 interface with the CIR
- If you are not already registered with the CIR, please do so in order to obtain a CIR facility code. Registration can be completed online.
- Send the following information to the CIR (firstname.lastname@example.org)
- Practice Name
- CIR facility code
- Primary contact name, e-mail and phone number
- EHR software name and version number
- Whether you are applying for Meaningful Use under Medicare or Medicaid
- Sign and return the healthcare provider confidentiality statement (PDF)
- You will receive a Web Service account with a username, password and identity key. In most cases, your EHR vendor will assist in configuring your EHR with the authentication information
- Send at least one immunization to the CIR through the HL7 Web Service
- If the test is successful, institute ongoing reporting in accordance with city and state law
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EHR Vendors that have Established HL7 Interfaces with the CIR
- Office Practicum Connexin
- EZVAC (Columbia Presbyterian Network
- Enable Healthcare, Inc.
- Allscripts (Sunrise Clinical Manager only)
If you do not see your EHR vendor on this list, and you would like to have an HL7 interface with the CIR, you will need to put in a request to your EHR vendor. The vendor will need to do some development in order to establish a connection with the CIR’s HL7 Web Service. You can also contact the CIR, indicating that you have put in a request to your vendor for the interface, and including your vendor contact person and contact information. The CIR will follow up with the vendor and provide them with all the necessary information for development of the interface.
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