Overview of Meaningful Use and Immunization Reporting

Parents, Guardians & Individuals | Schools, Child Care Facilities & Camps

If you are already registered with the Citywide Immunization Registry (CIR) and intend to submit immunization data to fulfill Meaningful Use (MU) requirements, please go to the Health Commerce System Website to register your intent.

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.

On 10/16/2015, CMS published a final rule for MU Stage 3 and modifications to MU for 2015-2017. For more information about these changes, please see the official CMS document or the Meaningful Use Public Health Reporting website.

Requirements for Immunization Submission

Stage 1:

Stage 1 ended in year 2015. For current requirements please see Modified Stage 2 Process, below.

Modified Stage 2 and Stage 3 Process:

On October 16, 2015, CMS published a final rule defining modifications to MU for 2015-2017 (PDF). In 2018, EHs and EPs that attest for MU Modified Stage 2 or Stage 3 will continue to attest to the same measures and objectives outlined in the 2015 CMS document. 2015 was the last year that a provider could attest for MU Stage 1. In 2017 and 2018, providers could attest to Modified Stage 2 or Stage 3. For both Modified Stage 2 and Stage 3, the EHR reporting period for new and returning participants is a minimum of any continuous 90-day period within the calendar year.

Submission of electronic data to immunization registries using Health Level 7 (HL7) standards satisfies the Immunization Registry Reporting Measure, and counts towards meeting the Public Health Reporting Objective for MU Modified Stage 2 and Stage 3. The best way for an immunizing provider to maintain compliance is by submitting or querying immunization data using the HL7 2.5.1 standard on an ongoing basis throughout their EHR reporting period.

For instructions on the Modified Stage 2 and 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
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

Information for EHR Vendors

Process for establishing an HL7 interface with the CIR

  • Must have the ability to generate an HL7 2.5.1 message
  • 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, you will need to contact your EHR vendor and put in a request 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.

Modified Stage 2 and Stage 3 Process:

  • 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 website, which includes step-by-step directions for EPs (PDF) and directions for EHs (PDF).
  • Ensure that you are using an EHR that is ONC certified for Meaningful Use.
    • Modified Stage 2 requires a 2014 Edition Certified EHR Technology (CEHRT)
    • Stage 3 requires a 2015 CEHRT
    • See if an EHR product has been certified (open with Google Chrome and filter your search by the certification criteria)
  • Contact your EHR vendor to request an HL7 2.5.1 interface with the CIR
  • Ensure that you have a CIR facility code. If you do not, you must register to obtain a CIR facility code.
  • Send the following information to the CIR (mutracking@health.nyc.gov)
    • Practice Name
    • CIR facility code
    • Primary contact name, e-mail and phone number
    • EHR software name and version number
  • Sign and return a copy of the CIR’s health care provider confidentiality statement (PDF)
  • Obtain account credentials from CIR staff
  • Work with your EHR vendor to implement an HL7 2.5.1 Web Service interface with the CIR
  • After the interface is implemented, maintain ongoing reporting in accordance with city and state law
  • Log HL7 ACK (acknowledgement) 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.

Active Engagement

To meet MU Modified Stage 2 or 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 the 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