NCIR FAQs for Providers

You might have some questions about connecting to the North Carolina Immunization Registry. Please read through our FAQs section below and let us know if you have a question we haven’t answered.

Is our organization required to use NC HIE to connect to the NC Immunization Registry (NCIR)?

Yes. Starting in October 2013, NC HIE will be the current pathway for electronic submission of immunization information directly from an EHR system to the NC Division of Public Health.

In December 2012, the NC Department of Health and Human Services released a policy statement declaring its intent to leverage NC HIE for many of its business processes and transactions with the public. The statement specifically references the intent to better fulfill public health’s purpose through real-time exchange of health information.

What functionality is available for electronic reporting to the NCIR via the NC HIE?

The functionality for electronic immunization reporting via the NC HIE is robust, and will allow organizations two types of communication with the NCIR:
1. The sending of immunization data updates to the NCIR, with acknowledgment of receipt from the NCIR, and
2. The query and response of specific immunization history, reactions or recommendations between an EHR and the NCIR.

The first type of communication satisfies Stage 2 Meaningful Use requirements.

How does our organization register our intent to report to the State’s public health systems?

As part of Meaningful Use, Eligible Hospitals (EHs) and Eligible Professionals (EPs) are required to register their intent to submit electronic public health data with the NC Division of Public Health (DPH). To begin the process of reporting electronically to any public health system in 2014, EHs and EPs must register intent with NC DPH within the first 60 days of their selected Meaningful Use reporting periods. Registering intent means the EH or EP is ready to begin work on integration with the NC HIE within 30 days of being contacted by NC DPH. Information on how to register intent is expected to be available at http://epi.publichealth.nc.gov/cd/meaningful_use/ in October 2013. Once an EH or EP completes the registration process, NC DPH will send acknowledgement of the registration. If this acknowledgement is not received with 10 days of registration, contact NC DPH to ensure registration was captured.

Once registered, what is the process for onboarding?

Once NCIR is ready to onboard a registered provider, NCIR staff will review the NCIR Onboarding Request form submitted through the registration web portal to decide data exchange capability, type of data exchange and timing of the onboarding process. If the Eligible Hospital (EH) or Eligible Professional (EP) has the required data exchange capabilities, NCIR staff will contact them to begin the onboarding process as resources are available. When the NC Division of Public Health (DPH) extends an invitation to connect, the EH or EP will have 30 days to begin the integration process. Providers that fail to respond within 30 calendar days to NC DPH requests for action on two separate occasions will not meet the public health measure for which action was requested.

NCIR draft specifications and onboarding documents for non-Vaccines for Children (VFC) programs/facilities will be available on the NCIR and NC HIE websites after the pilot organizations have gone live. This is tentatively scheduled for October 2013.

Organizations will also be provided the latest specifications and onboarding documents when they are invited to onboard. Receiving and using the latest specifications prior to onboarding helps providers avoid costly and unnecessary changes with their EHR vendors. The specifications are expected to change during the pilot process.

After registration of intent is complete, how long will it take for our organization to be onboarded?

Once registered, Eligible Hospitals (EHs) or Eligible Professionals (EPs) will be invited to connect by the NC Division of Public Health (DPH) as resources are available. Note that the Meaningful Use requirement may be met by registering intent to connect with NC DPH. EHs and EPs may prepare for connectivity by reviewing published specifications and working with their vendors to develop interfaces to meet such specifications.

What happens if our organization registers intent to connect to the NCIR within the required 60 days after the start of our Meaningful Use reporting period, but is not contacted by the State by the end of our 90-day or 3-month reporting period to begin the onboarding process?

An Eligible Hospital (EH) or Eligible Professional (EP) will not be penalized for not having achieved ongoing submission of immunization reporting within their Meaningful Use reporting period due to constraints on the state side, as long as the provider has registered their intent by the deadline.

To begin the process of reporting electronically to any public health system in 2014, EHs and EPs must register intent with the NC Division of Public Health (NC DPH) within the first 60 days of their selected Meaningful Use reporting periods. Registering intent means the EH or EP is ready to begin work on integration with NC HIE within 30 days of being contacted by NC DPH. Information on how to register intent is expected to be available at http://epi.publichealth.nc.gov/cd/meaningful_use/ in October 2013. Once an EH or EP completes the registration process, NC DPH will send acknowledgement of the registration. If this acknowledgement is not received with 10 days of registration, contact NC DPH to ensure registration was captured.

Per the Meaningful Use measure specifications published by the Centers for Medicare and Medicaid Services (CMS):

The EP must attest YES to meeting one of the following criteria under the umbrella of ongoing submission:

• Ongoing submission was already achieved for an EHR reporting period in a prior year and continues throughout the current EHR reporting period using either the current standard at 45 CFR 170.314(f)(1) and (f)(2) or the standards included in the 2011 Edition EHR certification criteria adopted by ONC during the prior EHR reporting period when ongoing submission was achieved.

• Registration with the PHA or other body to whom the information is being submitted of intent to initiate ongoing submission was made by the deadline (within 60 days of the start of the EHR reporting period) and ongoing submission was achieved.

• Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is still engaged in testing and validation of ongoing electronic submission.

• Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is awaiting invitation to begin testing and validation.

Our organization is currently performing double entry of immunization information into our EHR system and into the NCIR web portal. Is this satisfactory to meet the requirements of Meaningful Use?

No. To meet the Meaningful Use requirement of ongoing electronic submission of immunization data, Eligible Hospitals (EHs) and Eligible Professionals (EPs) are required to electronically submit immunization information directly from their native EHR systems to the state public health agency using the HL7 2.5.1 messaging standard via NC HIE.

If our organization is attesting to Stage 1 of Meaningful Use in 2014, how does the availability to do electronic submission to NCIR through the NC HIE affect us?

For 2014 only, to allow for upgrading to the 2014 certification criteria, all Eligible Professionals (EPs) will attest to a 90-day Meaningful Use reporting period and all Eligible Hospitals (EHs) will attest to a fiscal quarter Meaningful Use reporting period.

Stage 1 requirements dictate that all EHs and EPs attest to at least five Meaningful Use menu measures, including one public health measure. If an exclusion to a measure is claimed, the EH or EP must attest to all ten measures to show that no other measures could have been met without an exclusion. The two public health measures in Stage 1 are electronically reporting immunizations and syndromic surveillance data. In 2014, the NC Division of Public Health (DPH) is only accepting electronic syndromic surveillance submission from hospitals. Thus, EHs may select either measure to satisfy their Stage 1 menu measure requirements (as long as four other measures may be met without taking exclusions), and EPs must attest to electronically reporting immunizations to NC DPH.

To begin the process of reporting electronically to any public health system in 2014, EHs and EPs must register intent with NC DPH within the first 60 days of their selected Meaningful Use reporting periods. Registering intent means the EH or EP is ready to begin work on integration with NC HIE within 30 days of being contacted by NC DPH. Information on how to register intent is expected to be available at http://epi.publichealth.nc.gov/cd/meaningful_use/ in October 2013. Once an EH or EP completes the registration process, NC DPH will send acknowledgement of the registration. If this acknowledgement is not received with 10 days of registration, contact NC DPH to ensure registration was captured.

What should our organization be doing now to prepare for connectivity to the NCIR via the NC HIE interface?

NCIR specifications are subject to change and a draft specifications document will be released in October 2013. However, organizations will need to comply with HL7 2.5.1 specifications in order to transport data to NCIR via NC HIE. Providers may contact their vendor to ensure that they are compliant with HL7 2.5.1 and able to send VXU (Unsolicited Vaccination Record Update) messages and process ACK (Acknowledgment) messages.

What are the NC HIE’s priorities for connecting to NC Division of Public Health systems?

NC HIE is working closely with the NC Division of Public Health on several programs. The NC Immunization Registry (NCIR) and Electronic Lab Reporting for communicable diseases (ELR) are slated for pilots during Fall 2013.

Is there a standard fee for connecting to the NC HIE?

NC Health Information Exchange operates North Carolina’s statewide health information exchange: a secure, standardized electronic system in which providers can share important patient health information. While integration costs vary depending on EHR vendor and services requested, NC HIE charges healthcare providers a standardized annual fee for membership to access services.

Can our organization pay for additional services of the NC HIE?

Yes. Core services include the HIE Connectivity Fabric, which provides the foundational elements to connect patient records and information across multiple enterprises, the normalization of data from different sources and the enforcement of privacy policies and consumer consent declarations. Core services also include NC DIRECT secure messaging capability and connection to the national eHealth Exchange. An example of additional services that may be purchased á la carte or as a bundle include State services for achieving Meaningful Use and other legislative reporting requirements (NCIR, Electronic Lab Reporting, Central Cancer Registry).

Additional Questions? Call NC HIE at 919-926-1042 or email info@nchie.org.