NHIIS HL7 Onboarding

The New Hampshire Immunization Information System (NHIIS) is a statewide registry that records vaccinations administered in New Hampshire, from both public and private immunization providers. Provider organizations that use an electronic health record (EHR) to manage their demographic and vaccination records are encouraged to report all vaccine dose administrations to NHIIS using HL7 2.5.1, a national electronic data exchange standard.

In order for provider organizations to exchange data via HL7 with NHIIS they must proceed through the onboarding process. Providers should follow the steps below to establish an electronic interface between the EHR and NHIIS. The interface can be set up as unidirectional, bidirectional, or query-only:

  • Unidirectional interfaces exchange data in one direction, from the EHR to the IIS. Data exchanged refers to message submission (VXU) and acknowledgement (ACK).
  • Bidirectional interfaces exchange data in two directions, from the EHR to the IIS and from the IIS to the EHR. Data exchanged refers to query (QBP) message submissions that are sent to an IIS and response (RSP) messages that are returned by an IIS in response to a querying system. Bidirectional also includes a reporting component for doses administered using VXU and ACK messaging.
  • Query-only interfaces include only a query to the IIS (QBP) and RSP but do not have a reporting component (VXU/ACK). This type of interface is primarily used for school personnel or medical specialists that may need to check on a patient’s immunization status but do not actually administer vaccinations.

NHIIS HL7 Onboarding Process

Step 1: Onboarding Preparation

Before starting the onboarding process to establish an HL7 interface with NHIIS, provider organizations should review the following NHIIS documentation. In addition, provider organizations will be expected to complete all HL7 message conformance testing prior to contacting the NHIIS team. Conformance testing provides confirmation that the provider’s EHR system is capable of sending properly formatted HL7 messages. Instructions for NHIIS conformance testing are included below.

Step 2: Registration

After reviewing the documents noted in the Onboarding Preparation section, the responsible person from the provider will complete the NHIIS HL7 registration form

Please Note: Each clinic location must be added separately on the HL7 registration form. For example: if an Organization has 5 locations in NH and wants to establish HL7 connection with each location, then the organization will list all 5 locations in the HL7 registration form.

Ready to apply? Review the readiness checklists to ensure that you are ready to proceed with the onboarding process.

Unidirectional Exchange: VXU Messages

Bidirectional Exchange or Query-only: QBP/RSP Messages

What’s next? After the registration form has been submitted and exercises in the NHIIS onboarding module are complete, NHIIS staff will review the application form and contact you if any additional information is needed. Once your application has been approved, you will be invited to participate in a kick-off call where additional instructions to begin the testing process will be provided. Both the Clinic staff and EMR vendor representatives must be there on the call.

Step 3: Testing

Following the kick-off call, the provider organization will be provided with the URL and credentials for testing in the NHIIS QA environment. During each level of testing, the provider organization is responsible for monitoring the interface, reviewing message errors, and making corrections as needed. The NHIIS team will likewise review messages for content, errors, and data quality compliance.

Unidirectional Exchange: VXU Message Testing

VXU testing consists of the provider organization sending “live” HL7 messages to the NHIIS QA environment. Testing is used to confirm the interface connection and general message quality. Providers will be expected to submit real-time production patient and immunization data from their EHR to the NHIIS QA environment. Acknowledgment (ACK) messages will be returned to the EHR system in response. The provider organization (or their designee) should monitor the ACK messages daily and take action to correct submissions as needed until errors no longer occur.

Step 1: Confirm that the EHR system can connect with NHIIS and that NHIIS can successfully accept a test message from the EHR.

Step 2: Validate that messages from the EHR contain required fields and are populated with proper codes.

Step 3: Assess data quality and message content to ensure that accurate patient and immunization data has been sent.

Bidirectional Exchange or Query-only: QBP/RSP Messages

Providers will actively participate in the QBP/RSP testing process to ensure correct patient match results and confirm that clinical records are properly updated.

Step 1: Confirm that the EHR system can successfully connect with NHIIS.

Step 2: Configure and prepare the EHR for testing of query/response with NHIIS.

Step 3: Test the various workflows for sending and receiving data between the EHR and NHIIS.

Testing for QBP/RSP is typically composed of the following elements:

  1. Query from the provider organization EHR (QBP) to NHIIS for a patient of interest
  2. Response (RSP) from NHIIS to the provider organization EHR with a match or match candidates
  3. Update (VXU) from the provider organization EHR to NHIIS with vaccinations administered by the provider*
  4. Acknowledgement (ACK) from NHIIS to the provider organization EHR that the updates were received*

Providers should apply multiple layers of testing:

  • Submit 25-50 records via VXU to query against for a guaranteed response (exact match and forecast)*
  • Query using NHIIS engineered test scenarios (multi-match or too many matches)
  • Query NHIIS for real patients receiving vaccinations at the clinic (match/no match, VXU update after vaccination*)

Before moving into the NHIIS production environment, the provider organization must confirm that they are receiving accurate matches and are successfully completing end-to-end transactions.

*Note: query-only interfaces will not include the VXU reporting components. Query-only interfaces must be able to successfully query for a patient, select a proper match, and then view or consume the resulting immunization history/forecast for the desired patient.

Legacy Data Loads

For all provider interfaces that will have a VXU component, NHIIS will work with the provider organization to secure a legacy data load of all patients and vaccination records in the EHR in conjunction with moving the interface to the NHIIS production environment. As part of this process, NHIIS staff will perform a preview of the legacy data in the NHIIS QA environment to look for any significant data issues prior to scheduling the load in the NHIIS production environment.

Step 4: Production Approval

Once all testing requirements have been met satisfactorily, you will be invited to participate in a go-live call where additional instructions will be provided for connecting with the NHIIS production environment and ongoing interface monitoring requirements.

Ready to go live? Review the Go-Live checklist below to ensure that you are ready for the move to production.

Step 5: Production – Initial: Short-term Monitoring

Following the go-live call, the provider organization will be provided with the URL and credentials for the NHIIS production environment. The provider organization will confirm that a successful connection has been established and will begin submitting messages to the NHIIS production environment.

During the initial four-week monitoring period, the provider organization and NHIIS team should continue to closely monitor the interface, review message errors, and make corrections as if they are still in the testing phase. If major issues are detected, the interface may be sent back to the NHIIS QA environment for further testing until the issues can be resolved. The legacy data load will also be scheduled during this timeframe.

If no issues arise during the initial monitoring period, the interface moves to long-term monitoring and maintenance.

Step 6: Production – Long-term Monitoring and Maintenance

Once the provider organization has successfully made the transition to NHIIS Production, the provider organization (or their designee) must continue to review the ACK messages to ensure ongoing submission and data quality. Failed submissions or error messages should be corrected and resubmitted to NHIIS.

HL7 Onboarding Documents and Registration Forms