Submitting Electronic Immunization Information to DSHS

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The Texas Department of State Health Services (DSHS) currently supports the submission of immunization data electronically to ImmTrac, the Texas Immunization Registry. To meet the meaningful use public health reporting objectives contained in the Centers for Medicare and Medicaid Services Electronic Health Record (EHR) incentive programs, providers may register with ImmTrac and batch data using HL7 Version 2.5.1 formatted VXU^V04 Messages (Unsolicited Vaccination Updates). This submission must be in accordance with all applicable laws and practices, including those specified for Meaningful Use (MU) in the American Recovery and Reinvestment Act (ARRA) of 2009. DSHS currently supports submission for both Stage 1 and Stage 2 meaningful use for immunizations.

As a participant in the submission of electronic data to the Texas state immunization registry, your organization will assist in the goal of improving the efficiency and quality of care to Texas residents while reducing costs to healthcare providers.

Information about submitting data to meet Stage 2 objectives may be found at http://www.dshs.state.tx.us/immunize/immtrac/HL7-and-Meaningful-Use/.

Questions relating to submitting immunization data from electronic health records should be directed to the ImmTrac Meaningful Use team at ImmTracMU@dshs.state.tx.us. Please include the acronym for Meaningful Use, "MU" in the subject line, or call (800) 348-9158.

Questions relating to the Centers for Medicare and Medicaid Services (CMS) MU incentive payment program’s registration, attestation, and other MU criteria should be directed to HHSC. Please review the website information thoroughly at www.tmhp.com/pages/healthit/hit_home.aspx before contacting the support desk at HealthIT@tmhp.com.

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Frequently Asked Questions Regarding Immunization Records Submission for Meaningful Use (MU) in Texas:

Q: When can I submit the immunization information to the Texas immunization registry?
A: DSHS is currently capable of receiving test messages in HL7 format.

CMS Final Rules state: “The testing could occur prior to the beginning of the EHR reporting period, but must occur prior to the end of the EHR reporting period.” (75 FR Page 44365-6)

Q: Can ImmTrac accept HL7 messages? If so, how do I submit the immunization information to the immunization registry?
A: Yes. Since July 2011, ImmTrac has accepted HL7 messages. The first step is to register your organization with ImmTrac. Registration with ImmTrac is required before moving forward with meaningful use with the Texas Immunization Registry. If you are unsure if your facility is registered, please contact the ImmTrac help desk at (800) 348-9158. Once you are successfully registered, you can submit your test immunization HL7 message directly to ImmTrac through the secure ImmTrac web application at https://www.immtrac.tdh.state.tx.us/Outreach/Login/Login.aspx.

Q: What do I do if I do not administer immunizations?
A: CMS’ Final Rule states: “We acknowledge that this objective is not relevant to all EPS [Eligible Providers], EHs [Eligible Hospitals] or CAHs [Critical Access Hospitals]. Therefore, in this final rule, we clarify that this objective and its associated measure apply only to EPs, eligible hospitals or CAHs that administer one or more immunizations during the EHR reporting period.” (75 FR Page 44364)

Q: What about submitting my patient’s immunization records into ImmTrac like I have done before? Will that satisfy the MU criteria?
A: Any electronic interface intended to satisfy a meaningful use requirement to submit data to a public health agency would need to be an ONC-compliant interface produced by a certified EHR product. Eligible providers and eligible hospitals are required to use Certified EHR Technology to qualify for the respective EHR incentive program. As an example, if the interface was intended to provide the capability of electronically recording, modifying, retrieving and submitting immunization information in a standardized format (45 CFR 170.302(k)), it would need to be certified.

  • Eligible hospitals and providers should submit immunization records performed in their practice from their certified EHR to DSHS.

Adapted from source: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3163&PageID=20780

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Stage 1 Menu Set Objective for Submission of Immunization Information

Meaningful Use Requirements – Objectives and Measures

Eligible providers may choose at least one of two public health objectives and measures from a menu set to meet the meaningful use requirements in Stage 1. These objectives include submitting electronic immunization information to immunization registries or immunization information systems, and/or submitting electronic syndromic surveillance data to public health agencies. Eligible hospitals must also choose at least one public health objective from the menu set which includes the two objectives previously listed and/or submitting electronic laboratory results to public health agencies.

Objective: Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to 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/CAH submits such information has the capacity to receive the information electronically).

To submit to ImmTrac, please visit:
www.dshs.state.tx.us/immunize/immtrac/attestation.shtm.

Follow the steps necessary to submit an attestation file.

Exclusion for Eligible Providers: Exclusion in accordance with paragraph (a)(2) of this section. An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.

Exclusion for Eligible Hospitals and CAHs: Exclusion in accordance with paragraph (b)(2) of this section. An eligible hospital or CAH that administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.
Source: Centers for Medicare and Medicaid Services Final Rules EHR Incentive Program Section 495.6(e)(9), Paragraph Citation 75 FR 44568 and 495.6(g)(8), Paragraph Citation 75 FR Page 44570. (Also see CMS Final Rules for the EHR Incentive Program).

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Stage 2 Menu Set Objective for Submission of Immunization Information

Meaningful Use Requirements – Objectives and Measures

Stage 2 retains the core and menu structure for meaningful use objectives established in Stage 1. Although some Stage 1 objectives were either combined or eliminated, most of the Stage 1 objectives, including immunization reporting, are now core objectives under the Stage 2 criteria. For many of these Stage 2 objectives, the threshold that providers must meet for the objective has been raised. We expect that providers who reach Stage 2 in the EHR Incentive Programs will be able to demonstrate meaningful use of their certified EHR technology for an even larger portion of their patient populations.

Objective
Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice.

Measure
Successful ongoing submission of electronic immunization data from Certified EHR technology to an immunization registry or immunization information system for the entire EHR reporting period.

Exclusions for Eligible Providers

Any EP that meets one or more of the following criteria may be excluded from this objective:

  • the EP does not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction's immunization registry or immunization information system during the EHR reporting period;
  • the EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for CEHRT at the start of their EHR reporting period;
  • the EP operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; or
  • the EP operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.

Exclusions for Eligible Hospitals and Critical Access Hospitals

Any eligible hospital or CAH that meets one or more of the following criteria may be excluded from this objective:

  • The eligible hospital or CAH does not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction's immunization registry or immunization information system during the EHR reporting period;
  • The eligible hospital or CAH operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for Certified EHR Technology at the start of their EHR reporting period;
  • The eligible hospital or CAH operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; or
  • The eligible hospital or CAH operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by Certified EHR Technology at the start of their EHR reporting period can enroll additional eligible hospitals or CAHs.

Sources: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_16_ImmunizationRegistriesDataSubmission.pdf (Accessed 10/11/2013);
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf (Accessed 10/11/2013);
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_HospitalCore_13_ImmunizationRegistriesDataSubmission.pdf (Accessed 10/11/2013)

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Other Federal and National FAQ:

Office of the National Coordinator (ONC) for HIT FAQ:
Federal government Health IT page
ASTHO Meaningful Use page
CDC's Meaningful Use web page

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Last updated October 30, 2013