Office for Health Information Technology

Public Health

Meaningful Use and Immunization Information Systems

Immunization Data reporting is one of the public health reporting options for Meaningful Use.  Centers for Medicare and Medicaid Services (CMS) incentives for hospital compliance with meaningful use include the ‘‘Medicare and Medicaid Programs; Electronic Health Record (EHR) Incentive Program’’ “Demonstrate Meaningful Use of Certified EHR technology”. The Stage 1 meaningful use objective and measure for immunization data are below:

The Medicare and Medicaid Programs Electronic Health Record Incentive Program Final Rule External site disclaimer (pdf*)(July, 2010), contains the following objective and measure relative to Immunization Information Systems (IIS) in its Stage 1 (beginning in 2011) criteria for Meaningful Use:

  • Objective: Capability to submit electronic data to immunization registries or  IIS and actual submission in accordance with applicable law and practice.
  • Measure: Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically).

The Final Rule External site disclaimer (pdf*)for Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology (July, 2010) identified the following standards for immunization data exchange:
Electronic submission to immunization registries.

  • Standard. HL7 2.3.1. Implementation specifications. Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven (HL7) Standard Protocol Implementation Guide Version 2.2.
    [Note: Currently supported by the Maine IIS]
  • (2) Standard. HL7 2.5.1. Implementation specifications. HL7 2.5.1 Implementation Guide for Immunization Messaging Release 1.0.
    [NOTE: Not currently supported by the Maine IIS]

The State of Maine has an Immunization Information System, this system has the capacity to provide HL7 messaging (2.3.1), this system has a functional transport layer (HTTPS:), and the IIS has the ability to both send and receive data;Unsolicited (Bi-Directional), Query, and Response.
Providers may also meet Meaningful Use Phase 1 and Phase II through direct entry into the IIS and transmission of immunization transactions to the EHR. This is allowed via the following clarification: External site disclaimer, P26.

Vocabulary standard for
immunizations. . is HL7 Standard Code Set CVX - Vaccines Administered, July 30, 2009 version

Security standards are included in the ONC Final Rule as well. In addition, a set of Frequently Asked Questions External site disclaimer are available to clarify the meaning of the Final Rule. For immunization, see especially FAQ 2 External site disclaimer and FAQ 18 External site disclaimer.

Testing Procedures

The National Institute of Standards and Technology (NIST) has provided a guidance document External site disclaimer (pdf*)and testing tools External site disclaimer for ensuring that certified EHR systems can properly record, modify, retrieve, and submit immunization data to an IIS.

Eligible Professionals or Eligible Hospitals must complete a Maine Immunization Program Data Exchange Survey:

  • Information on the current state of exchange
  • Providers wishing to initiate an exchange test, or production implementation, will be provided more specific information as required to meet their business needs.

Standards and Requirements

Implementation: Meaningful use requires facilities to submit at least one test transmission, and to follow-up with actual transmissions if the test is successful.

  • Maine CDC business and technical contacts will work with messaging partners on any questions regarding message data elements or message construct.
  • Based on the State of Maine Data Exchange Specifications, and the EHR system is able to produce a message based on the implementation guide, a test message should be sent to the Maine CDC technical contact for construct validation.
  • After any issues found during construct validation have been addressed, the Maine CDC technical contact will work with the facility to establish a message feed into Maine CDC’s acceptance testing environment.
  • The facility, if currently participating with the Maine Immunization program, should continue to contribute data by their current method while Maine CDC conducts content validation.
  • After the feed is established and validation is completed, Maine CDC will notify the facility that the message has been tested and accepted and it will be moved into production. The facility is expected to maintain the exchange to meet the meaningful use objective and to comply with appropriate reporting and usual practice.

Message transport: The Maine Immunization Information System currently supports an HTTPS: transport layer. Future interoperability efforts may extend these capabilities, but all current exchange efforts require HTTPS as the transport layer.

Data Exchange Documents (Documents opens in new window)