Minnesota Dept. of Health
Minnesota Immunization Information Connection (MIIC)
PO Box 64975
St. Paul, MN 55164-0975
www.health.state.mn.us/miic
MIIC Data Exchange Worksheet
Complete this worksheet if your organization is interested in electronic data exchange with the Minnesota
Immunization Information Connection (MIIC). This worksheet can be used for organizations interested in:
• Starting a new data interface
• Making a change to an existing data interface
• Setting up a query and response (bi-directional exchange)
Portions of this Worksheet should be completed by technical staff who have knowledge of the data exchange
source system/electronic health record (EHR) and technical capabilities.
Organizations will be placed in a queue for onboarding to a new data interface or testing a data interface
change. All data exchange changes will be tested and a quality assurance review will be done in the MIIC test
environment prior to moving to the MIIC production (live) environment.
1. Organization/Health System Information
Organization/Health System:
Address:
(Street, City, State, Zip)
Provide the following information about the source system/
EHR:
What information are we looking for?
Vendor:
Indicate vendor and product. If multiple
source systems, complete a MIIC Data
Exchange Worksheet for each system.
Product:
Is this a certified EHR product?
Yes
N/A
Planned source system/EHR
changes or upgrades:
Will data be sent to an
intermediary or vendor hub?
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MIIC Data Exchange Worksheet
No
Use of certified EHR products is
required for Meaningful Use
submissions to MIIC.
Describe any planned upgrades that may
impact data exchange with MIIC and when
these upgrades will occur.
Data can be submitted to MIIC directly
from the organization/health system or
it may also be submitted to MIIC via an
intermediary or vendor hub.
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Provide the following information about the facilities/sites in
the organization/health system:
What information are we looking for?
Total number of facilities
sharing source system/
EHR (and to be included in
interface):
Data exchange with MIIC is site/ facility
specific. If multiple sites/facilities complete
Facilities Participating in MIIC Spreadsheet
and submit with this completed Worksheet.
Approximate number of
immunizations administered
annually:
Indicate an approximate number of
immunizations administered in a given
year by all facilities to be included in the
data interface.
Provide the following organization/health system contacts:
What information are we looking for?
Immunization contact:
Email:
Phone:
Technical contact:
Email:
Phone:
Provide the following contacts, if applicable
Provide an immunization contact for the
organization or health system; this would
be someone who could be contacted
regarding enrolling in MIIC and clinical use
of MIIC.
Provide a technical contact for the
organization or health system; this would
be someone from the organization or
system that is responsible for the data
exchange with MIIC.
What information are we looking for?
Interface technical contact:
Affiliation:
Email:
Phone:
Provide a contact for the person
responsible for setting up the interface
between MIIC and the source system/
EHR.
Meaningful Use contact:
Affiliation:
Email:
Phone:
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MIIC Data Exchange Worksheet
Provide a Meaningful Use contact for the
organization/health system, if applicable.
This individual would be responsible for
documentation for attestation purposes.
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2. MIIC Data Exchange Interface Interests
Note: HL7 2.5.1 file format and SOAP web service are preferred. If planned exchange does not include HL7
2.5.1 format and SOAP web service transport provide detailed justification below.
Indicate if this data exchange is related to Meaningful Use, the
CMS EHR Incentive Program
Meaningful Use:
Indicate Stage
Indicate and describe your interests in data exchange with
MIIC
Starting a new data interface.
Describe planned file format and file transport. If not
HL7 2.5.1 file format and SOAP web service include
justification:
Making a change to the existing data interface.
Indicate current file format, file transport, and
frequency of exchange:
Change in file format.
Indicate planned file format. If not HL7 2.5.1
provide justification:
What information are we looking for?
If interface is for Meaningful Use, indicate
Stage.
What information are we looking for?
Check this box if your organization isn’t
currently submitting electronic data to
MIIC.
Check this box if your organization
has previously exchanged/is currently
exchanging electronic data with MIIC but
wants to make changes.
HL7 2.5.1 is preferred.
HL7 2.3.1, HL7 2.4, and flat file may also
be accepted; if indicated please provide a
justification.
Change in file transport.
Indicate planned file transport. If not SOAP web
service provide justification:
SOAP web service is preferred.
PHIN-MS, sFTP, and secure upload within
the application may also be accepted; if
indicated please provide a justification.
Change in file content.
Describe planned change(s) to file content:
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MIIC Data Exchange Worksheet
Changes to file content may include:
additions of new facilities, adding/changing
dose-level eligibility data, adding/changing
immunization-related comments (e.g.,
refusals, contraindications), etc.
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Query and response (bi-directional exchange).
Indicate planned format and transport.
For organizations interested in real-time
bi-directional exchange using query and
response.
Indicate whether you plan to consume the MIIC
response into the source system/EHR (in addition to
displaying the response).
HL7 2.4 VXQ/VXR and HL7 2.5.1 QBP/
RSP are available formats.
SOAP web service and PHIN-MS may be
used for transport.
3. Source System/EHR Capabilities
Indicate if the source system/EHR is capable of recording and
transmitting the following content:
Yes
No
Yes
No
Yes
No
Yes
No
Client MIIC (IIS) consent.
Indicate how this information is stored in the
source system/EHR:
Immunization source.
Indicate how this information is stored in the
source system/EHR:
Vaccine lot number and manufacturer.
Indicate how these values are populated in the
source system/EHR:
Dose-level eligibility.
Indicate available options (valid values) in source
system/EHR:
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MIIC Data Exchange Worksheet
What information are we looking for?
Clients may choose to opt-out of
participating in MIIC. Clients who choose
to opt-out should be excluded from data
exchange with MIIC.
A source system likely includes both
immunizations administered and historical
immunizations. Both should be included
in data exchange with MIIC. Historical
immunizations are recorded by (but
not administered by) the organization
submitting the information to MIIC.
Vaccine lot number and manufacturer
should always be included in the data
interface for administered immunizations.
Dose-level eligibility refers to funding
program eligibility by immunization (as
opposed to by visit or by client). This
includes MnVFC eligibility status for
children and insurance status for adults.
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4. Checklist to Prepare for Data Exchange Testing with MIIC
Use this checklist to make sure you’ve completed the steps to
prepare for data exchange with MIIC:
Register for data exchange with MDH.
Indicate date completed/verified and applicable notes:
What information are we looking for?
Complete or update the
MDH Registration for Data Exchange.
Enroll in MIIC/sign a current MIIC User Agreement.
Indicate date completed/verified and applicable notes:
Work with your MIIC Regional Coordinator
to ensure your organization and all
sites/facilities to be included in the
data exchange have current MIIC User
Agreements on file.
Review file format specifications, file transport
specifications, and MIIC-accepted code sets.
Indicate date completed/verified and applicable notes:
Specifications and code sets are available
on the MIIC Data Submission and
Exchange web page. Map source system/
EHR codes to MIIC-accepted code sets.
Create and independently validate a sample test
message from the source system/EHR according
to specifications in the implementation guide for
chosen file format. If submitting in HL7 format, use the
appropriate validation tool(s) available. Fix errors until
the message format is valid.
These messages should not contain actual
client data. Note: additional message
format and content validation is done by
MIIC as part of the onboarding process.
Validation tools:
HL7 2.5.1
NIST Immunization Validation for
2014-Certified EHR Technology
Indicate date completed and applicable notes:
CDC Public Health Information Network
Message Quality Framework Tool
(2.5.1)
HL7 2.3.1
CDC Public Health Information Network
Message Quality Framework Tool
(2.3.1)
Subscribe all relevant contacts to receive MIIC Data
Submission and Exchange email updates.
Indicate date completed and applicable notes:
Submit completed MIIC Data Exchange Worksheet and
Facilities Participating in MIIC Spreadsheet to the MIIC
Help Desk at [email protected].
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MIIC Data Exchange Worksheet
Click on the red envelope at the top of the
MIIC Data Submission and Exchange web
page.
If data exchange applies to multiple sites/
facilities, submit completed Facilities
Participating in MIIC Spreadsheet in
conjunction with completed MIIC Data
Exchange Worksheet.
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5. Sample Test Message
Please provide an HL7 sample test message in the box below. This message should reflect the type of
messages you will be sending to MIIC and should not contain any actual patient data.
Please do not turn in this worksheet until a sample message is provided.
6. For Use by MIIC Staff
Questions? Please contact MIIC: [email protected].
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