Stage 1 Immunization Electronic Data Submission Frequently Asked Questions
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The following frequently asked questions address most of the information required for an eligible professional (EP), eligible hospital (EH) or critical access hospital (CAH) that chooses to meet the meaningful use Stage 1 requirements by submitting electronic immunization information to immunization registries. This submission demonstrates meaningful use compliance with electronic health record (EHR) technology, as required in the Health Information Technology for Economic and Clinical Care Act of 2009 (HITECH). Visit the eHealth web site for more information about meaningful use and contact information if you still have other questions.
Frequently Asked Questions (FAQ)
Where do I submit the immunization data?
To receive guidance on how to meet this objective, it is recommended that you contact your Local Health Department (LHD).
How does immunization reporting work in California?
All 10 regional immunization registries in California are now able to receive immunization test messages and data that allow EPs, EHs and CAHs to demonstrate meaningful use of electronic health record (EHR) technology. However, in most cases, the test messages will be sent through a shared portal, the California Immunization Registry (CAIR), and then routed to the appropriate regional registry. Providers in the CAIR San Diego, CAIR San Joaquin region, and Imperial County use a different process. Please consult your local data exchange representative for more information.
For all other regions in California, the State has developed a strategy leveraging public and enterprise health information organizations (HIOs) to aggregate immunization reports. These data reports are routed through a portal service for added capacity, in anticipation of receiving large volumes of immunization reports from an extensive number of providers. CAIR has been collaborating with stakeholders, including HIOs, and vendors, to operationalize the State strategy in a way that will create the most efficiency at the registry level and leverages current State and federal investments. The resulting plan supports further development of regional HIE capacity by providing substantial connectivity to a key meaningful use reporting requirement.
The plan for reporting immunizations using an HIO and CAIR was showcased at California Connects in July 2012. The overall approach that includes connecting HIOs and EHRs through the portal service is anticipated for completion by June 2013.
CAIR continues to work closely with the State, HIOs and vendors to support current immunization reporting activities for meaningful use aligned with the State’s strategy. EPs, EHs, and CAHs in the CAIR Northern Cal, CAIR Greater Sacramento, CAIR Bay Area, CAIR Central Coast, CAIR Central Valley, CAIR Inland Empire, or CAIR LA-Orange regions that are interested in immunization message testing and data exchange should complete and submit the CAIR Data Exchange Screening Form and the CAIR Provider/Agency Access Agreement (if not already enrolled). Please contact your regional CAIR registry to learn more
What do I do if I do not administer immunizations?
An EP, EH or CAH who does not administer immunizations during the EHR reporting period may receive an exclusion from reporting immunizations.
For EP exclusion information, refer to page 44568 of the CMS Final Rules, 42 Code of Federal Regulations (CFR) 495.6(e)(9)(iii).
For EH and CAH exclusion information, refer to page 44570 of the CMS Final Rules, 42 Code of Federal Regulations (CFR) 495.6(g)(8)(iii).
Exclusions for nonapplicable objectives may be found on page 44566 of the CMS Final Rules, 42 CFR 495.6(a)(2).
When may I submit the immunization information?
Medicare meaningful use reporting timelines and other important dates may be found at the CMS web site.
Medi-Cal meaningful use reporting timelines and other important dates may be found at the Department of Health Care Services (DHCS) web site.
How do I send my immunization information to CAIR?
For the exchange of immunization information with the seven regional registries currently using the CAIR software, CDPH has developed an implementation guide and technical standards document (CAIR HL7 Data Exchange Specifications) to assist EPs, EHs and CAHs. The seven regional registries are: CAIR Northern Cal, CAIR Greater Sacramento, CAIR Bay Area, CAIR Central Valley, CAIR Central Coast, CAIR Inland Empire, and CAIR LA-Orange. Also refer to the CAIR Data Exchange Tech Support page for general guidance.
For further details, please contact your regional CAIR registry.
For my test message, may I submit “dummy” data instead of “real” immunization data from an actual patient?
Yes. The use of test information about a fictional patient that would be reporting the same data elements as that of an actual patient would satisfy this objective.
If my EHR technology is capable of submitting batch files to an immunization registry, is that sufficient for demonstrating compliance with the meaningful use certification criterion?
Yes. Submitting batch files to an immunization registry, provided that they are formatted according to one or both of the adopted standards, is not prohibited by this certification criterion and would be acceptable.
Where may I test my immunization message submission?
We recommend that your hospital use the Center for Disease Control Public Health Information Network Message Quality Framework (MQF) to assist in testing your initial immunization message submission.
What if my submission fails?
A failed attempt would meet the measure. EPs, EHs and CAHs should work with their vendors and the receiving entity with whom they tested to identify the source of the failure and develop remedies. For Stage 1 of meaningful use, a failed attempt would meet the requirements. Only one test is required for EPs practicing in a group setting that shares the same certified EHR technology.
When do I attest for meaningful use?
Start and end dates to attest for the EHR Incentive Program are different for Medicare versus Medi-Cal programs and EPs versus EHs and CAHs. The CMS website lists meaningful use reporting timelines and other important dates.
How do I attest for meeting meaningful use?
CMS and Medi-Cal will accept a yes/no attestation to verify that EPs, EHs or CAHs have fulfilled the objective and measure of submitting electronic immunization information in the first year reporting period. For auditing purposes, CMS also states that “all providers attesting to receive an EHR incentive payment for either Medicare or Medicaid EHR Incentive Programs should retain ALL relevant supporting documentation (in either paper or electronic format used in the completion of the Attestation Module responses). Documentation to support the attestation should be retained for six years post-attestation. Documentation to support payment calculations (such as cost report data) should continue to follow the current documentation retention processes.”
Please contact your regional CAIR registry for appropriate documentation to support attestation for this meaningful use objective.
Medicare EPs, EHs and CAHs
CMS has prepared a Meaningful Use Attestation Calculator
to assist you prior to submitting your attestation to see if you would be able to meet all of the necessary measures to successfully demonstrate meaningful use and qualify for an EHR incentive payment.
Also, review the CMS Attestation User Guide (PDF, 6.4 MB)
for hospitals and CAHs to provide step-by-step instructions for login and completing attestation. For the public health objectives, see pages 19 to 23 of the user guide.
Medi-Cal EPs, EHs and CAHs
To whom do I send my attestation?
Medicare EPs, EHs and CAHs may attest to meaningful use through the CMS web-based Registration and Attestation System.
Medi-Cal EPs, EHs and CAHs may attest to meaningful use through the Department of Health Care Services web site.
I have heard that states can change the requirements for submitting immunization information as an objective for the Medi-Cal Incentive Program. Has California changed any requirements for submission of immunization information?
No. California has not modified any requirements to date, although states do have the option to modify requirements for public health objectives/measures such as immunization information submission under the Medi-Cal Incentive Program,
National Resources and FAQs Regarding Meaningful Use
What are the Centers for Medicare and Medicaid Services (CMS) regulations with which I must comply to fulfill the public health objective of submitting immunization information to immunization registries?
To comply with the CMS regulations EP, EHs and CAHs must meet the objective of having the capability to submit electronic data to immunization registries or immunization information systems according to the following applicable regulations:
For the EP objective and measure related to this requirement, refer to page 44568 of the CMS Final Rules
, 42 Code of Federal Regulations (CFR) 495.6(e)(9).
For the EH and CAH objective and measure related to this requirement, refer to page 44570 of the CMS Final Rules
, 42 CFR 495.6(g)(8).
The measure must involve the actual submission of at least one test of certified EHR technology's capacity to submit electronic to immunization registries and follow-up submission if the test is successful.
What is the link to the CMS Frequently Asked Questions regarding meaningful use?
CMS Frequently Asked Questions
What are the Office of the National Coordinator for Health Information Technology (ONC) regulations with which I must comply to fulfill the public health objective of submitting immunization information to registries?
ONC regulations refer to standards and specifications of the EHR technology itself, rather than the actions of healthcare providers. For more details, please refer to the ONC Final Rule on Standards and Certifications.
What is the link to the ONC Frequently Asked Questions regarding meaningful use?
ONC Regulations Frequently Asked Questions
What is the link to the Association of State and Territorial Health Officials (ASTHO) Frequently Asked Questions regarding meaningful use?
ASTHO Frequently Asked Questions About Meaningful Use
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