What is Health Level Seven (HL7)?
Health Level Seven (HL7) is a standardized format for exchanging health-related information including patient records, laboratory results, and immunization history between different electronic health systems. For more information, visit www.hl7.org.
What is an HL7 interface to Nevada WebIZ?
An HL7 interface allows immunization data to flow from an electronic health record (EHR) system into NV WebIZ, the statewide immunization information system (IIS). This can reduce the time and effort needed to document immunizations and can reduce data entry errors. Establishing an HL7 interface plays a major role in the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program’s Promoting Interoperability requirements. Please see below for more information on declaration of intent for Nevada’s immunizing eligible providers and hospitals.
Why establish an HL7 interface?
All immunization records must be entered into NV WebIZ. Many providers enter immunization data into their own EHR system. To comply with Nevada Revised Statute (NRS) 439.265 and Nevada Administrative Code (NAC) 439.870-897), they must also enter that data into NV WebIZ. With the establishment of an HL7 interface, information is taken from the EHR, sent over the internet electronically, and processed by NV WebIZ, updating the IIS immediately (or within minutes/hours of EHR entry, depending on the EHR’s capability). Using this data submission method eliminates the need for double entry.
What version of HL7 can be used (to interface with Nevada WebIZ)?
How long does an HL7 interface project take?
An HL7 project typically takes 3-4 months from “kickoff” to “go-live.” It is not uncommon for projects to take longer as a result of shifting vendor or provider priorities, as well as the possibility of challenges with formatting or content. Some projects have taken less time as a result of highly-engaged participants, good data quality, and flexible vendor technology.
What does it cost to implement an interface with Nevada WebIZ?
NV WebIZ does not charge a fee of any kind for establishing an HL7 interface; however, it is important to speak with your EHR vendor about what they may charge for development and/or ongoing maintenance of an interface. After "Go-Live", it is the reporting provider's responsibility to monitor and maintain quality assurance of data delivered via HL7, Whether through onsite IT or vendor support.
Does Nevada WebIZ offer bi-directional messaging (two way messaging)?
Yes. NV WebIZ supports the ability to request immunization records from the IIS in real-time and on demand.
The First Step! Contacting the EHR Vendor
A provider should contact their EHR vendor and discuss their desire to establish an HL7 interface between their EHR and NV WebIZ. The provider should ask the following questions:
1. Will the EHR vendor provide support for development of an HL7 interface with a statewide IIS?
2. Will a fee be charged for development or maintenance (including future coding changes or upgrades) of an HL7 interface?
3. Does the EHR vendor employ an HL7 interface specialist or project manager? If so, how can that person be reached?
4. When will the EHR vendor be ready to assist in the development of the interface? Immediately, next month, next year, etc.?
What are the steps in the HL7 process?
1. HL7 Application: An organization/practice wishing to establish an interface should download, complete, and fax or scan/email the HL7 Application Form to NV WebIZ at 775-687-7596 or email@example.com.
2. Waiting list: Due to the high volume of organizations wishing to establish an HL7 interface, a waiting list is maintained. Completed HL7 Application Forms are added to the waiting list and organizations will be contacted when NV WebIZ staff are able to launch a new interface project. Considerations for selecting the next HL7 project can include (but is not limited to) readiness to interface, ability to dedicate IT support, and/or volume.
3. Kickoff Meeting: A meeting is held to review the steps in the project, document the responsible parties, determine the details of the Data Sharing Agreement(s) to be drafted, and provide configuration/connection specifications.
4. Progress Meetings: Meetings are held monthly (or more frequently) to ensure the project is progressing and to address any issues.
5. Configuration/Connection: The provider organization, through their designated representative (IT support, EHR vendor representative, etc.), configures their system to generate HL7 messages and establishes a connection via web service to the NV WebIZ “Test” system. For the most robust testing experience, it is required that the organization connect their Production (“live”) EHR to NV WebIZ’s Test environment.
6. Submission Method/Frequency: NV WebIZ offers web service submission only; SFTP submission is not supported or available. “Real-time” is the preferred frequency, but hourly or daily submissions are acceptable.
7. Testing/Reviewing: As immunization data is entered into a provider organization’s “live” EHR system, it is sent to the NV WebIZ “Test” system. Acknowledgement messages (ACK’s) are returned to the EHR system in response. The organization (or their designee) needs to monitor the ACK’s and take actions to correct submissions as needed until errors no longer occur. The NV WebIZ HL7 staff also monitors the HL7 test messages and communicates issues to the provider (or their designee). *Note: NV WebIZ requires that interface testing be done if changes/upgrades are made to an organization's EHR system to ensure ongoing submission of data. Organizations are encouraged to maintain the availability of a "test" version of their EHR system to accommodate this requirement.
Comparison: To ensure all immunization data is
sent from the organization’s EHR to NV WebIZ, Report Comparison MUST be
completed for each site submitting data.
This involves generation of a report each from the EHR and the NV WebIZ
Test site for comparison (i.e. If 2 Influenza vaccinations were entered in the
EHR, there should be 2 Influenza vaccinations report to NV WebIZ during the
same timeframe). Reports must match for
two (2) weeks before the interface is approved to go “live.”
- Important Notes!
all EHR systems are capable of generating this type of report. As such, organizations
are encouraged to verify this ability. If this report is not available,
contact the EHR vendor (or internal IT support) as soon as possible to add
this function. Many systems contain this report, but configuration may be difficult and vendor support may be needed.
- Prior to going live
with an HL7 interface, providers receiving publicly-funded vaccines (e.g.
Vaccines for Children (VFC) Program) must ensure their ability to
extract data from their EHR. The data extracted must be sufficient to manage and balance vaccine inventory
quantities in NV WebIZ in order to meet monthly VFC reporting requirements. Necessary data includes vaccine type, lot
number, funding source (Private, VFC, etc.) and number of doses administered
per lot (NDC may be required in the
future). Additional information may be
found by clicking here to view the Inventory Management
& Reconciliation Training Video or Guide, or by calling the NSIP at
9. Data Cleansing: NV WebIZ staff will generate data quality reports to resolve duplicates and other issues created by the organization’s manual data entry, and will contact the appropriate office for assistance if needed.
10. Go-Live: “Go-Live” is a term used to refer to the date on which the organization begins to submit real patient data to the “live” NV WebIZ system. On the go-live date, NV WebIZ user accounts for the organization’s office staff will be retained, but will be limited to viewing data and generating reports - add, update and delete abilities will be removed. Some organizations may wish or need to retain the ability to directly make certain edits to the data in NV WebIZ (such as deleting erroneously sent messages or correcting a patient’s name spelling). This will be addressed during the interface project.
Organizations are expected to regularly monitor their interface to ensure
ongoing, accurate submission, and should notify NV WebIZ staff as soon as
possible if changes to their EHR system occur or are planned.
How do I get started?
Download, complete and fax or scan and email the HL7 Application Form to Nevada WebIZ at 775-687-7596 or firstname.lastname@example.org.
***Providers wishing to establish an HL7 interface are expected to be able to dedicate staff to the project for interface configuration (IT support), data clean up (typically office staff), meeting attendance and ongoing support and maintenance of the interface (once “live”).***
Once an HL7 interface is in place:
- All patient immunization information that is entered into an EHR will flow into NV WebIZ (including, dependent upon the EHR’s ability, documented historical vaccinations).
- It takes (typically) less than 10 seconds for the record to be processed through a “real-time” interface and added to NV WebIZ, but hourly or daily submissions are also acceptable.
- NV WebIZ user accounts are changed to “view-only” (with the ability to generate reports). If necessary, one or two users at a provider office maintain the ability to edit patient records in NV WebIZ. We call this a “superuser.” A provider’s need for superusers will be determined in project progress meetings.
- Providers enrolled in the Vaccines for Children (VFC) Program must capture and send VFC eligibility (in the HL7 message) for all patients aged 0 through 18 years.
- Patients still retain the right to opt-out of participation in the IIS. Compliance with this requirement is discussed during progress meetings.
Promoting Interoperability Attestation
Eligible Professionals (EP’s) and Eligible Hospitals (EH’s) who administer immunizations and wish to declare their intent to submit data electronically to NV WebIZ (the statewide IIS) for Promoting Interoperability purposes should:
- First, verify that immunization data is currently being manually entered into NV WebIZ in accordance with State law.
- Then, complete and submit an HL7 Application Form.
Upon receipt of the completed form, an email will be sent to the contact listed on the form confirming the “declared intent” to submit data electronically to an IIS. This email can be used for attestation and is currently acceptable evidence for ongoing submission. Organizations will be contacted when NV WebIZ is able to begin an interface project.
At this time, NV WebIZ will not establish interfaces with EP’s and EH’s that do not administer immunizations. NSIP is not authorized to grant exemptions from reporting under Meaningful Use or issue letters specifying an EP or EH is exempt from a measure. No statement will be issued by NSIP for an organization or eligible professional that does not administer immunizations.
NV WebIZ - Declaration of Readiness
Public Health Authorities, such as NV WebIZ, are asked by CMS to declare their readiness to support the data exchange needs of EP’s and EH’s participating in the EHR Incentive Program. To that end, NV WebIZ declares the following capabilities:
- Currently able to receive vaccine updates via HL7 version 2.5.1, Release 1.5
- Currently able to respond to queries via HL7 version 2.5.1, Release 1.5
- Currently able to match NDC to CVX (if NDC unit of sale = NDC unit of use)
- Currently able to support evaluated history and forecast
David J. Crowell
HL7 Interface Manager
Nevada State Immunization Program