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North Carolina Immunization Branch

NCIR Data Exchange - Meaningful Use Frequently Asked Questions

Please review the questions below before contacting the N.C. Immunization Branch. If you do not find a response to your question, please send your question in an e-mail to the Data Exchange Help Desk. The intended audience for this FAQ are provider organizations as well as electronic health records (EHR) vendor personnel.

FAQs are organized in the following four categories:

Portal and Meaningful Use

1. How do I register with the Immunization Registry for Meaningful Use?

The Meaningful Use Registration Portal is located here external link.

Eligible Hospitals (EHs) and Eligible Professionals (EPs) will register their intent individually using the National Provider Identifier. Eligible Hospitals and Eligible Professionals will be asked to complete a short survey that will capture information about the technical capability of their electronic health records to submit immunization information to the NCIR.

For organizations with less than 50 EPs or EHs, please enter your information directly in portal and no further action is needed from you.  Upon successful completion of registration you will receive an auto-response e-mail confirming your registration. You do not need to take any further action until you receive onboarding invitation from Immunization Registry.

For organizations with more than 50 EPs, you may enter your information directly in the portal, or use the bulk upload option by following the steps below:

  1. Sign up for an NCID if you do not already have one.
  2. Login to NC DPH Meaningful Use Site for Registration of Intent external link and request a provider user role
  3. Request the bulk upload option by emailing their help desk with your full name, organization, the number of EPs you intend to register, and the public health programs for which to want to register
  4. The help desk will then email you the necessary Excel spreadsheets to use for the bulk upload. Spreadsheets for NCIR must be emailed to ncirmuregistration@dhhs.nc.gov.  You will receive an auto-response email confirming receipt. You will not need to take any further action until you receive an onboarding invitation from NCIR.
  5. When the bulk upload functionality is available you will be notified by email.  You will then be expected to submit your spreadsheet again through that process. The spreadsheet you emailed MAY need to be changed to accommodate the new automated functionality.

Please note that the bulk upload functionality is for EPs only. If you are responsible for registering both hospitals and EPs, you must register hospitals through the Web application.

For reference, this document (PDF, 204 KB) provides the questions you will be responsible for answering in the Meaningful Use Registration Portal

2. What is active engagement and how can we be in active engagement?

Meaningful Use modified stage 2 regulations states that Eligible professionals (EPs) and Eligible Hospitals (EH’s) should be in active engagement with a public health agency to submit electronic public health data from CEHRT, except where prohibited and in accordance with applicable law and practice. Active engagement means that the provider is in the process of moving towards sending "production data" to a public health agency or clinical data registry, or is sending production data to a public health agency or clinical data registry.

You can be in active engagement with the NCIR in one of the three ways depending on where you are in the process.

  • Active Engagement Option 1 – Registration complete
  • Active Engagement Option 2 – Testing and Validation
  • Active Engagement Option 3 – Production

For further information regarding Meaningful Use please refer to CMS external link.

3. What are the next steps once I complete registration?

Once portal registration is completed, you will receive an automatic e-mail confirming your registration. This e-mail confirms your registration of intent with the NCIR and provides the documentation indicating that the registrant is in active engagement with the NCIR.

Please do not contact NCIR regarding onboarding. NCIR is continuing its data exchange projects and will not be onboarding additional providers/hospitals until these projects are complete. Please wait until NCIR reaches out to you regarding your next steps.

4. When will my organization be invited to onboard?

NCIR expects a large number of EPs and EHs registering intent for Meaningful Use. NCIR plans to review the registration information and invite for onboarding based on available resources.  NCIR will reach out to EPs and EHs directly when ready.

5. Where can I find additional information about meaningful use?

In October 2015, CME released a final rule that specifies criteria that EPs, EHs, and critical access hospitals (CAHs) must meet in order to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The final rule’s provisions encompass 2015 through 2017 (Modified Stage 2) as well as Stage 3 in 2018 and beyond. Additional information on the 2016 program requirements are located here external link. For a fact sheet on this program, please refer to this CDC resource external link.

For information on registration and attestation, please refer to the user guides external link and other resources developed by CMS.

If you have not participated in the Medicare or Medicaid EHR Incentive Programs previously, please visit the CMS EHR Incentive Programs external link website for more information on how to get started with participation.

6. We don't adminster immunizations. Do we still need to register intent with the NCIR?

The Registration Portal is for those who administer immunizations and intend to submit immunization information electronically.

From CMS external link:

Objectives for 2015 - 2017 Measures for Providers in 2015 through 2017 Alternate Exclusions and/or Specifications

Objective 10: Public Health Reporting

An EP scheduled to be in Stage 2 in 2015 must meet 2 measures. All EPs must meet 2 measures in 2016 and 2017.

Measure Option 1 – Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data.

Exclusions: Any EP meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the EP:

  • Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction's immunization registry or immunization information system during the EHR reporting period;
  • Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
  • Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period

7. Is the Registration deadline changing from February 29th?

The MU registration deadline is not set by the NCIR. As of now the deadline is still February 29th.  Please refer to CMS for additional information.

8. What is the Limits of Public Immunization Program’s Role in EHR-MU?

The EHR-Meaningful Use program is under the auspices of the Centers for Medicare and Medicaid Services (CMS).

From the CDC external link:

Meaningful Use does NOT create a mandate for Public Immunization Programs to:

  • Set or clarify MU standards. The standards have been created by the Office of the National Coordinator (ONC), and only ONC can interpret its intention in the standards.
  • Certify providers as meeting any MU standard. ONC/CMS determine eligibility for incentive payments, and providers are required to self-certify as having met ONC’s standards. Public Health’s sole role is maintaining the IIS and providing the Local Implementation Guide to delineate data exchange standards.
  • Certify or promote any EHR product as MU-ready. This certification is done by the Authorized Testing and Certifying Bodies (ATCBs) approved by ONC.
  • Adapt its immunization registry (IIS) to accommodate non-standard (i.e. other than HL7 2.3.1 or HL7 2.5.1) Electronic Health Record (EHR) submissions. MU specifically requires that the EHR product be certified. However, certification alone does not guarantee successful interoperation. Public Health still has the responsibility to set the standards for data exchange to its IIS in order to maintain the quality of IIS data.
  • Support the installation or configuration of any EHR. This is the vendor’s role.

9. If we are currently using the NCIR, do we still need to register?

Yes, EPs and EHs should register for Meaningful Use even if you are currently entering immunization information through the NCIR. 

10. When logging to portal we receive ‘Web page is unavailable’ message. What do we do?

Verify your browser meets the specifications on our Registration Portal Site. If you continue to have issue please contact cchi@listserv.med.unc.edu

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Bi-directional Interface Method

1. What workflows will NCIR bi-directional interface support?

The NCIR bi-directional interface will support the following two business work flows:

  • Real time Query and Response: Provider queries for immunization history and recommendations at the point of encounter
  • Real time Update: Provider administers an immunization and sends an update transaction.

2. What format will the bi-directional interface method use?

The NCIR will support HL7 2.5.1 transactions for the bi-directional interface method. The transaction types are HL7 2.5.1 VXU/ACK for updates and HL7 2.5.1 QBP/RSP for query/response.

3. What types of connections is NCIR utilizing to connect provider organizations?

The NCIR is utilizing Vendor Hub, Organization's Hub and NC HIE to connect to the NCIR.

All of the methods use web services to connect to the NCIR, and a provider can connect to the NCIR using any of the methods.

4. What capabilities are required to connect with the NCIR?

NCIR uses web services as the method of connection to the NCIR. Systems having the capability to communicate using web services will be able to connect with the NCIR.

5. What should I do to get ready for the onboarding process?

Check with your vendor to determine if your system has capability to handle HL7 2.5.1 transactions and specifically VXU/ACK and QBP/RSP transactions

You will need resources to test and complete the onboarding process. This will include your vendor resources for software and set up capabilities plus in house clinical resources to perform and verify tests, specifically:

  • HL7 interface specialist capable of making necessary changes to the EHR to meet NCIR specifications.
  • Web services capability to make connections with the NCIR.

It is strongly recommended that you discuss with your EHR vendor about their capability to handle acknowledgements (ACK HL7 2.5.1 messages) returned back from the NCIR. This mechanism should be able to display the error message to your user for correction.

6. Can you provide documents used during onboarding for reference?

The Local Implementation Guides (LIG) are provided below for reference. You will be provided with the latest versions of these guides when you are invited for onboarding

Local Implementation Guides:

NCIR Onboarding process documents:

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Batch Download from NCIR

1. What is the Batch interface method?

The Batch interface method is a unidirectional interface. Provider organizations using Batch interface download a file from the NCIR daily, either at the start of the day or at close of business. Information on NCIR clients selected for download in a Batch interface includes all new and historical data on those clients. This method has minimal set up requirements and the EHR can start receiving data almost immediately.

2. What file formats does the Batch interface work with?
NCIR can download data from the NCIR to EHR systems using either HL7 2.4 or HL7 2.5.1. The transaction types used are Unsolicited Vaccination update (VXU).

3. Is there a fee to use the batch interface with the NCIR?

No, the N.C. Immunization Branch does not charge a fee for this service. However, your certified EHR vendor may charge a fee to set up the interface.

4. What information is available for download as part of the Batch interface?

All active clients associated with the provider organization that have information added or updated since the previous download are eligible for download. Information downloaded for each eligible client includes client demographics, address, all immunizations (new and historical) and any applicable client comments.

Each batch download file contains data added or changed since the previous download. The daily downloads help keep these two systems in sync on a daily basis.

5. How do I begin using the Batch interface method?

You will need to verify that your EHR system has the capability to import HL7 VXU messages. Work with your EHR vendor to make any necessary changes per NCIR General Transfer Specifications (GTS) (PDF, 297 KB) for HL7 2.4 file format.

You may also refer the outbound message under each field in the Local Implementation Guides for HL7 2.5.1 file format.

In addition, each practice may have its own internal testing requirements before accepting data from NCIR.

6. What is the responsibility of the Provider organization before creating a user ID in NCIR?

Before NCIR access can be established for a provider organization, a User Agreement form must be completed and returned to the Immunization Branch.

The provider will also have all users complete an NCIR Confidentiality form for each specific user in their organization. These agreements should be made available during site visits.

7. In addition to regular users, what are some of the responsibilities specific to data exchange user?

The NCIR administrator will need to ensure that the person downloading data for the NCIR organization will only use the data for its intended purpose (loading to EMR) and as well take all necessary safeguards related to security and confidentiality of downloaded data. NCIR administrator will obtain necessary confidentiality forms before requesting Data exchange access.

8. Once the technology is in place, what steps should a practice take to begin using the Batch interface method?

  1. Identify the person who will download data for your organization.
  2. The NCIR administrator for your organization should create a user ID for the person identified in the previous step (if this person does not already have a user ID.) The user role can be categorized as: Typical user, Inventory control or Administrator.
  3. Send an e-mail to the Data Exchange Help Desk with the following:
    • A screen shot of "Manage Users" page in the NCIR, including the organization name and user ID
    • Request to add data exchange menu items for the user ID.
  4. The Data Exchange Help Desk will provide the user with data exchange access and will do the necessary set up to start the data exchange process.

9. What are the steps for downloading a batch file?
Please refer to this document (PDF, 234 KB) for steps on how to run a batch file download.

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NCIR Data Exchange Methods

 

  Batch Uni-directional Bi-directional
Purpose

Data transferred once a day from NCIR to EHR. All data modified or added since last download sent out

The NCIR can transfer data to EHRs and EHRs can transfer data to the NCIR. Transfers can occur in real time

Direction of Transfer

NCIR to EHR

Vaccination update: NCIR to EHR

History/Recommendations: EHR to NCIR

File Formats

HL7 standards version 2.5.1 and 2.4

HL7 2.5.1

Transaction Types

Unsolicited vaccination update (VXU)

Updates: HL7 2.5.1 VXU/ACK

Queries: HL7 2.5.1 QBP/RSP

Transport Protocol

n/a

Webservices

Currently in Use?

Yes

Yes

If you have questions not covered in this FAQ, send an e-mail to the Data Exchange Help Desk

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