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Meaningful Use of Electronic Health Records, CIR, Medicare & Medicaid

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 If you are already registered with CIR and intend to submit immunization data to fulfill Meaningful Use (MU) requirements, please go to the CIR Registration page to register your intent.

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.

Requirements for Immunization Submission
Stage 1:

Eligible Professionals/Hospitals must demonstrate meaningful use by meeting a core set of 15 objectives and also choosing 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 the HL7 version 2.3.1 or 2.5.1 standard protocol fulfills one public health menu objective. View details on the meaningful use stage 1 objective and measure (PDF) to submit data to immunization registries.

Health care providers who are presently sending immunization data to the CIR in a format other than HL7 (i.e. online registry data entry or UPIF files) 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 must first register with the CIR by filling out the form on the CIR registration page. For instructions on the stage I submission process, please see the Information for NYC Providers section.

Stage 2:

Submission of electronic data to immunization registries is a core measure for MU stage II, meaning that all EPs/EHs that provide immunizations and are participating in MU stage II must meet this measure. The stage 2 measure (listed as core measure 16 for EPs, measure 13 for EHs/CAHs) requires that immunizing providers submit data on an ongoing basis to the immunization registry in their jurisdiction. This data must be submitted in HL7 2.5.1 format. View the CMS fact sheet on the meaningful use stage 2 objective and measure (PDF).

For instructions on the stage 2 submission process, please see the Information for NYC Providers section.

 

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:

Prerequisites:

  • Must have the ability to generate an HL7 2.5.1 message
  • Must have the ability to connect to a SOAP Web Service

Steps:

  • Review specifications document, 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
  • Ensure that HL7 ACK (acknowledgement) messages are logged in the EHR so that providers have evidence of ongoing submission.

    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:

  • Sample code in Java and .NET—please e-mail cir@health.nyc.gov to request these code samples
  • CIR required/recommended fields spreadsheet (PDF)
  • CVX code set maintained by the CDC
  • CIR vaccine code list (PDF)
  • soapUI 3.6.1 tool
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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. Your EHR vendor will need to be involved in implementing an HL7 interface with the CIR. If your vendor does not already have an 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 (nycimmunize@health.nyc.gov) 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 Stage 1 Process:

    • 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.

      Meaningful Use Stage 2 Process:

    • Ensure that you are using an EHR that is ONC certified for meaningful use
    • Contact your EHR vendor to request an HL7 version 2.5.1 interface with the CIR
    • Sign and return a copy of the CIR’s healthcare provider confidentiality statement (PDF)
    • Obtain account credentials from CIR staff
    • Work with your EHR vendor to setup an HL7 2.5.1 web service interface connection to the CIR’s test environment and complete the testing process 
    • When testing has been completed, take the interface ‘live’ by moving submissions to the CIR’s production web service
    • Log HL7 acknowledgement (ACK) messages that are sent by the CIR’s HL7 web service in response to each transaction sent by the provider’s EHR.  These ACK messages will serve as evidence that ongoing data transmission was achieved.
    • Registration can be completed online.
    • You must also register your intent on the New York State Department of Health page
    • Send the following information to the CIR (nycimmunize@health.nyc.gov)
      • 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

        Bi-directional interfaces:

      • Office Practicum Connexin
      • MDLand
      • E-Addabbo
      • EZVAC (Columbia Presbyterian Network)
      • Unidirectional interfaces:

      • Quadramed
      • Enable Healthcare, Inc.
      • EPIC
      • AthenaHealth
      • Cerner
      • Nextgen
      • OmniMD
      • Allscripts (Sunrise Clinical Manager only)
      • Criterions
      • Greenway Primesuite
      • 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 (nycimmunize@health.nyc.gov), 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.

        Additional Links

        Meaningful Use FAQs
        CMS Meaningful Use Overview
        CMS Meaningful Use FAQs
        Meaningful EHR Use – Details on the Final Rule (PDF)