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North Carolina Immunization Branch

The North Carolina Immunization Registry (NCIR)

NCIR Data Exchange

Frequently Asked Questions (FAQ)

Information Updated on June 1, 2014

*Please check back frequently for future updates

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 ncirdataexchange@dhhs.nc.gov.
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:

BI-DIRECTIONAL INTERFACE METHOD

1. Does NCIR accept data from a certified EHR or other IT systems?
The NCIR does not currently accept data through data exchange. However, the state is in the process of end-to-end testing and piloting the bi-directional interface. This interface will allow the NCIR to receive immunization information from EHR systems as well as allow EHR systems to query NCIR for immunization information.

2. 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.

3. 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.

4. What are NCIR plans to end-to-end and pilot test the bi-directional interface?
NCIR plans to first perform an end-to-end test and pilot with a non VFC provider followed by an end-to-end test and pilot with a VFC provider.

5. What are different types of connections NCIR is currently piloting?

NCIR has following pilots currently in progress:

    • Using Vendor Hub to connect to the NCIR
    • Using NC HIE to connect to the NCIR
    • Using an organization's Hub to connect to the NCIR

All of above methods use web services to connect to the NCIR. Note that a provider can connect to the NCIR using any one of the above methods once pilot is completed.

6. What is the timeline for bi-directional interface end-to-end testing and pilot?

Since pilot depends on internal and external stakeholders, the tentative timeline has a number of dependences and we will keep this FAQ updated with current information. We recommend that this FAQ be checked periodically for status updates. Here is an overview of each of the pilots and their status:

Vendor Hub

  • Connection has been made with the vendor hub in the test environment.
  • Vendor is sending test messages and is continuing to refine and test as per NCIR specifications
  • A pilot organization has been identified and work will start to roll out a provider through this Hub once testing is completed.

HIE Hub:

  • Connection has been made with the NC HIE hub in the test environment.
  • Test messages have been exchanged for vaccination update transaction and testing is continuing. The pilot organization is continuing to refine and test messages.
  • The Query/Response testing will start once the vaccination update transaction is completed.

Organizational Hub:

  • NCIR has had stake holder meeting and has sent specifications
  • The interface team is working on building messages as per NCIR specifications
  • Pilot organization identified and in the process of establishing connection.

7. What capabilities are required to connect with the NCIR?
NCIR uses web services as the method of connection to the NCIR. Systems having capability to communicate using web services will be able to connect with the NCIR.

8. 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 transactions and specifically VXU/ACK and QBP/RSP transactions
  • Check if your team (internal IT team or vendor team) has the following skillsets available
    • HL7 interface specialist capable of making necessary changes to meet NCIR specifications.
    • Web services capability to make connections with the NCIR.
  • Check with your vendor to ensure that your EHR has a mechanism to handle acknowledgements (ACK HL7 2.5.1 messages) coming back from the NCIR.  This mechanism should either be able to display the error message to your user for correction or have an alternate way through which user can review the errors/warnings periodically. It is strongly recommended that you discuss with your EHR vendor about their capability to handle acknowledgements returned back from the NCIR.
  • 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.
  • Review and/or complete the following documents before you are invited to Onboard.

9. Can you provide direction to Eligible Professional (EP) and Eligible Hospital (EH) for the purpose of Meaningful Use stage 1 and stage 2 while NCIR is in the process of end-to-end testing and piloting the bi-directional interface?  


Please refer to the following link regarding Meaningful use direction:
http://www.ncdhhs.gov/dma/provider/ehr.htm

Go to the bottom of the page and select Meaningful Use: Stage 2 (+/-) for further instructions. Look under "NC Immunization Registry Exclusion" Title for details. The information posted in DMA website regarding NCIR is also listed below for reference.



From DMA website:

Until further notice, eligible professionals (EP) and eligible hospitals (EH) participating in the NC Medicaid EHR Incentive Program may continue to claim an exclusion for the Meaningful Use immunization registry measure for the purpose of meeting Stage 1 and Stage 2 Meaningful Use.

The North Carolina Immunization Registry is working toward accepting data electronically and deployment will begin once technical readiness has been proven and administrative operability is available.  

Please continue to check the NC Medicaid EHR Incentive Program website for more updates as they become available. Thank you for your continued patience as we work toward advancing healthcare in North Carolina.

10. Do I need attestation by the state for meaningful use for Stage 1?
No, Attestation by the state is not required for stage 1 MU.  It is self-attestation by the provider.

Once NCIR is ready to receive data you will be instructed on how to send us a test file. Please refer to DMA guidance (listed in previous question) until then.

11. How do I register with DPH for Meaningful Use stage 2?
At this time NCIR has not opened up registration. Once NCIR is ready, we will post instructions for registration using NC DPH portal (https://ncdphmeaningfuluse.org).Until further notice, please refer to the following link regarding Meaningful use direction: http://www.ncdhhs.gov/dma/provider/ehr.htm.
We will update this FAQ as soon as we commence registration for the NCIR.
 

12. Will the state publish specifications, Onboarding process and testing manuals for the bi-directional interface?
Yes, the state will publish final specifications, Onboarding process and testing protocols once bi-directional interface is pilot tested and is ready for roll out. Also, you will be provided the latest set of documents when your organization is invited to onboard.

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UNIDIRECTIONAL INTERFACE

13. What is a unidirectional interface?
A unidirectional interface allows the NCIR to send information to an EHR system. This interface helps prevent duplicative data entry. The EHR system used by a provider office must have the capability to import data from the NCIR.

14. What are the two unidirectional interface methods the NCIR currently supports?
The NCIR supports a Batch interface method and a Real Time interface method. Provider organizations using Batch interface download a file from the NCIR daily, either at the start of the day or at close of business. The Real Time interface sends immunization information to an EHR system as soon as it is entered in the NCIR.

15. What file formats do the unidirectional interfaces work with?
Both Batch and Real Time interfaces use HL7 standards version 2.3.1 and 2.4 to communicate between the NCIR and EHR systems. The transaction types used are Unsolicited Vaccination update (VXU) or Health level 7 (HL7). HL7 is the standard used for communication between health systems. Immunizations are identified by CVX codes and optionally by CPT code or vaccine group.

16. Is there a fee to use a unidirectional 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.

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BATCH INTERFACE METHOD

17. What is the Batch interface method and how is it different from the Real Time 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.
The Real Time interface method is also unidirectional interface. The interface sends immunization information to an EHR system as soon as it is entered in the NCIR. Only the new immunization information added to the NCIR is sent to the EHR. Set up of a Real Time interface with the NCIR requires configuring both the EHR and NCIR system by a technical person familiar with the Public Health Information Network Messaging System (PHINMS) transport protocol.

18. What transaction type does the Batch interface method use?
The Batch interface uses the HL7 VXU transaction type. This is the same transaction type used by the Real Time interface method. So, a provider can start with the Batch interface method and then transition to the Real Time interface method once they are comfortable with file formats and data.

19. Can we obtain a one-time data download from NCIR?
Currently, we are unavailable to help providers with this request. NCIR is in the process of developing our bi-directional data exchange as well as working on meaningful use requirements with various stakeholders. Please check back to this FAQ section periodically, as we hope to have an update on this topic once the bi-directional data exchange is available.

20. Are any providers currently using the batch interface method?
Yes, the Batch interface is used by both local health departments and private providers. The Real Time interface method is being tested by providers involved in our pilot project. If your office would like to take part in the pilot project for the Real Time interface method, please let us know.

21. 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.

22. 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 as per NCIR General Transfer Specifications (GTS) (view link below). In addition, each practice may have its own internal testing requirements before accepting data from NCIR.

23. Where can I find HL7 General Transfer Specifications (GTS)?
Refer to the NCIR HL7 - General Transfer Specifications (PDF, 297 KB) for more information.

24. 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, the following items must be completed:

  1. a User Agreement form
  2. a NCIR confidentiality form
  3. The provider will need to fax the User Agreement back to the Immunization Branch.

The provider will keep the confidentiality agreement(s) for each specific user in their organization. These agreements should be made available during site visits.

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

26. 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 (contact information below) with the following:
    1. A screen shot including the organization name and user id (see manage Users)
    2. 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.

27. What are the steps to run a batch file download in the NCIR?
First, complete the steps outlined above to obtain Data exchange access and to complete necessary set up within NCIR. Then, follow the steps given below to run a data exchange file.

    • Log on to NCIR website (https://ncir.dhhs.state.nc.us external link ) using the user id and password obtained in previous step.
    • Click on ‘Exchange data’ link under Data exchange on the left.
    • Key in a Job Name and click ‘Request Download’ button. [Job name is optional but recommended.] The job is submitted in the background and will run within few minutes depending on volume of data requested.
    • Click on ‘Check Status’ menu item on the left to view status of job. Once job is complete, a blue hyper-link appears under Job Name. Click on the hyper-link and then click on hyper-link under HL7 24 output. The HL7 file will open up. To save file, click the Back button and right click the HL7 24 output hyper-link and select “Save target as.”

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    REAL TIME ONE-WAY INTERFACE METHOD

    28. What is Real Time interface method and how is it different from the Batch interface method?
    The Real Time interface method is a unidirectional interface. The interface sends immunization information to an EHR system as soon as it is entered in the NCIR. Only the new immunization information added to the NCIR is sent to the EHR. Set up of a Real Time interface with the NCIR requires configuring PHINMS software at EHR system by a technical person familiar with the PHINMS transport protocol.
    The Batch interface method is also a unidirectional interface. Providers using this method 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.

    29. What transaction type does the Real Time interface method use?
    The Real Time interface uses the HL7 VXU transaction type. This is the same transaction type used by the Batch interface method. So, a provider can start with the Batch interface method and then transition to the Real Time interface method once they are comfortable with file formats and data.

    30. What is the transport protocol is used for the Real Time interface method?
    The NCIR uses PHINMS software as the transport protocol to send real time transactions to EMR. The PHINMS software was developed by the U.S. Centers for Disease Control and Prevention (CDC) and serves as a transport protocol to exchange information securely between health systems over the internet. Additional details on PHINMS may be obtained at the following website: http://www.cdc.gov/phin/tools/PHINms/index.htmlexternal link

    31. Will the state install and implement PHINMS software for providers?
    No. The state will only install and operate PHINMS software on the NCIR side. The state will not install or maintain PHINMS software on the EHR side. However, the state will share necessary information related to PHINMS to aid set up in provider offices. If you do not have the necessary technical personnel to install and maintain PHINMS on an ongoing basis, consider using batch interface before transitioning to real time.

    32. Are any providers currently using the Real Time interface method?
    Yes. The Real Time interface method is being tested by a provider involved in our pilot project. If your office would like to take part in the pilot project for the Real Time interface method, please contact us.

    NCIR Data Exchange Methods
      Unidirectional [NCIR can transfer data to EHRs; EHRs cannot transfer data to the NCIR.] Bi-directional [Data transfer both ways.]
      Batch Real Time Both Batch and Real Time
    Purpose Data transferred once a day. All data modified or added since last download sent out. Data transferred in real time. Only new data added transferred. The NCIR can transfer data to EHRs and EHRs can transfer data to the NCIR.  Transfers can occur in real time.
    File Formats HL7 standards version 2.3.1 and 2.4 HL7 standards version 2.3.1 and 2.4 HL7 2.5.1
    Transaction Types Unsolicited Vaccination update (VXU) or Health level 7 (HL7) Unsolicited Vaccination update (VXU) or Health level 7 (HL7) In development and pilot testing phase.
    Updates - HL7 2.5.1
    VXU/ACK
    Queries - HL7 2.5.1
    QBP/RSP
    Transport Protocol n/a PHINMS. Vendor requires some knowledge of PHINMS to implement. In development and pilot testing.
    Currently in Use? Yes In pilot testing phase In development and pilot testing.

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

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