Overview of Meaningful Use and Immunization Reporting

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Centers for Medicare and Medicaid Services (CMS) renamed the Electronic Health Record (EHR) Incentive Programs, commonly referred to as Meaningful Use (MU), the Promoting Interoperability Programs in April 2018. For consistency with New York State Meaningful Use Registration for Public Health (MURPH) System, the CIR will continue to refer to the programs as MU.

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 (EHs) were able to begin the incentive program in January 2011.

Beginning 2019, EPs and EHs attesting to MU must be in compliance with Stage 3 requirements, which were updated in the 2019 final rule. All EPs and EHs are required to use 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the MU Programs. For more information on all program requirements, visit the CMS website.

Requirements for Immunization Registry Reporting Measure

Modified Stage 2:

MU Modified Stage 2 ended in 2018. For current requirements, please see the "Stage 3 Requirements" below.

Stage 3 Requirements:

To satisfy the Immunization Registry Reporting measure (under the Public Health Reporting Objective) for MU Stage 3, EPs and EHs located in New York City must be actively engaged with the CIR to submit immunization data and receive immunization forecasts and histories, also referred to as bidirectional data exchange.

EPs and EHs must also have registered intent to submit data within 60 days of the start of the EHR reporting period, which is a continuous, 90-day period within the calendar year that is indicated during attestation, and be in an active engagement stutus with the CIR at the end of the EHR reporting period:

For further details on the Stage 3 submission process and how to actively engage with the CIR, see the Information for NYC Providers section.

Description and Benefits of an HL7 Interface with the CIR

An HL7 interface with the CIR 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 real time 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 bidirectional interface with the CIR’s HL7 Web Service. A unidirectional interface allows providers to report immunizations only; a bidirectional interface allows providers to report immunizations, query the CIR for patients’ immunization histories and clinical decision support, and to store the returned information in their EHR system.

In addition, the HL7 Web Service is the only way for EPs and EHs to report to the CIR in a way that complies with MU requirements.

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
Additional benefits of a bidirectional interface:
  • Avoid duplicate data entry
  • Look up immunizations in the CIR for a patient in <5 seconds, without leaving your EHR workflow
  • Receive clinical decision support for immunizations, included evaluated immunization history and forecasting/recommendations
  • Quick data reconciliation between you EHR and the CIR
  • Avoid missed opportunities for immunization
  • Avoid over-immunizing
  • Increase up-to-date rates

Information for EHR Vendors

Process for establishing an HL7 interface with the CIR

  • Must be 2015 CEHRT for Transmission to Immunization Registries (170.315 (f)(1))
  • Must have the ability to connect to a SOAP Web Service
  • Review specifications document, the CIR HL7 2.5.1 integration guide (Updated October 2017, PDF)
  • Review the MU 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:

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, contact your EHR vendor and put in a requet with them. The vendor will need to work with the CIR to implement a connection with the CIR’s HL7 Web Service. You can also contact the CIR (cir_interop@health.nyc.gov), indicating that you have put in a request with your vendor. Please include your CIR facility code and vendor contact information. The CIR will follow up with the vendor and provide them with all the necessary information for development of the interface.

If you already have an HL7 interface connected to the CIR and would like to attest to MU Stage 3, submit a ticket to your EHR vendor requesting this testing with the CIR.

Stage 3 Process:

  • Ensure that you have a CIR facility code. If you do not, you must register to obtain a CIR facility code.
  • If this is your first time requesting an interface with the CIR, sign and return a copy of the CIR’s health care provider confidentiality statement (PDF).
  • Register your intent to submit immunization data for Meaningful Use on the Health Commerce System (HCS) website by following the directions on the Meaningful Use Public Health Reporting (MURPH) website.
    • If you have already registered for MU, you do not need to re-register your intent. Please avoid duplicate registrations.
    • If you need assistance with MURPH, contact support at MUPublicHealthHELP@health.ny.gov or call 1-877-646-5410 (option 3)
  • Ensure that you are using an a 2015 edition CEHRT product
    • Check if your EHR product has met the 2015 edition certification for transmission to immunization registries (filter your search by the certification status, edition, and criteria)
  • Contact your EHR vendor to request a MU Stage 3 compliant, bidirectional interface with the CIR.
  • For questions about MU testing with the CIR, send the following information to the CIR at MUtracking@health.nyc.gov:
    • Practice Name
    • CIR facility code
    • Primary contact name, e-mail and phone number
    • EHR software name and version number

Active Engagement

To meet the MU Stage 3 Immunization Registry Reporting Measure through active engagement with the CIR, EPs and EHs must have registered their intent to submit data within 60 days of the start of their 90-day EHR reporting period and be in one of the following statuses at the end of their EHR reporting period:

  • Active Engagement Option 1 (Completed Registration to Submit Data)
  • Active Engagement Option 2 (Testing and Validation)
  • Active Engagement Option 3 (Production)

NOTE: Submitting data via the Online Registry and uploading HL7 files to our Web File Repository will not qualify for Meaningful Use Modified Stage 2 or Stage 3.

After registering intent to submit immunization data via the Meaningful Use Registration for Public Health on the Health Commerce System Health Commerce System website, CIR staff will receive the registration data and reach out to providers with one of these requests:

  1. Invitation to Test: If a provider does not have an interface with the CIR’s HL7 Web Service, their EHR vendor will need to connect them.
  2. Request for Action: There are several scenarios associated with this request.
    • Providers who do not have CIR facility codes will be asked to register and obtain a CIR facility code.
    • If a provider’s EHR vendor does not currently have an interface with the CIR, they will be asked to implement the connection.
    • Providers may also receive requests for action if they are connected and reporting via the CIR’s HL7 Web Service, but there is an issue related to the quality or quantity of data that they are submitting.
    • Acknowledgement of Submission of Production Data: If a provider has already connected to the CIR’s HL7 Web Service and established submission of production data, they will be asked to continue submitting immunization data on an ongoing basis.
Providers must respond to all CIR requests in a timely manner in order to be considered in active engagement.

Additional Resources

More Information