Electronic Data Exchange and Promoting Interoperability for Public Health

 Texas Immunization Registry – Electronic Data Exchange 

Organizations that administer immunizations may participate in electronic data exchange with the Texas Immunization Registry. Electronic data exchange with the registry allows organizations to electronically import patient and immunization data into ImmTrac2 without the burden of manual data entry into both an electronic health records (EHR) system and ImmTrac2. 

What is Electronic Data Exchange? 

Electronic data exchange is a connection between systems exchanging data with one another. For the Texas Immunization Registry, electronic data exchange occurs between organizations, such as physician’s offices, hospitals, and local health departments, utilizing their EHR systems to exchange patient and immunization information with the registry. 

Information for Schools 

Schools may report student information to the Texas Immunization Registry if they adhere to Family Educational Rights and Privacy Act, FERPA (if subject to it) and the registry’s consent requirements. 

Visit the U.S. Department of Education website for more information on FERPA

Information for Health Plans 

Health plans that must meet Health Care Effective Data and Information Set (HEDIS) requirements currently query the registry for member data through a process known as immunization history query (IHQ) and immunization history response (IHR) files. 

Once the registry declares public readiness for bi-directional data exchange, health plans are required to transition over to bi-directional data exchange, as the IHQ and IHR files will no longer be accepted. 

Is Your Organization Ready for Data Exchange? 

To determine if your organization is ready to establish a data exchange connection with the registry, review the qualifications below. Organizations should review and complete each qualification before contacting the Texas Immunization Registry for establishing a data exchange connection. 

Registry Status Qualifications 

Ensure that your organization’s information is up to date with the registry as follows: 

  1. Your main headquarters or stand-alone facility is: 
    • Registered with the Texas Immunization Registry and the site agreement is not expired; or 
    • Renewed (i.e. site agreement) with the registry. 
  2. All your associated facilities are registered as sub-sites of the main organization (i.e. not as separate or stand-alone facilities) with the registry. 
  3. Your organization staff have active ImmTrac2 user accounts to log into the registry. 

Identify staff at your organization who will be the lead contacts and/or team for establishing and overseeing the data exchange connection with the registry. These staff will collaborate with the registry throughout the data exchange process. 

Suggested staff members include, but are not limited to, staff who oversee other types of data exchange for the organization, senior or lead clinical staff, subject matter experts, trainers, or IT support staff. 

For assistance with ImmTrac2 registrations, renewals or user accounts, contact the Texas Immunization Registry’s Customer Service at 800-348-9158. Also available for detailed information on site renewals is the publication stock #11-15252 ImmTrac Site Renewal Guide on the Forms & Documents webpage.  

Data Exchange Qualifications 

To engage in electronic data exchange, your organization must have an EHR system that meets the Texas Immunization Registry standards and requirements as follows: 

  1. Your organization, through their EHR system, must submit patient and immunization information in Health Level Seven (HL7) 2.5.1 Release 1.5 files to the registry. 
    Speak with your EHR vendor to confirm that your organization’s systems are upgraded to send data in this format. 

  1. Your organization, through your EHR system, must be able to submit immunization data to the registry according to the uni or bi-directional requirements.   

  • Uni-directional: Batch files means data is combined into one file that is submitted via File Transfer Protocol (FTP) on a weekly, bi-weekly, monthly, or yearly basis. 

  • Bi-directional: Real-time means data is submitted via web services (SOAP) as they are administered. 
    Speak with your EHR vendor to confirm whether uni or bi-directional requirements can be configured. 

  1. Your organization’s patient and immunization data does not have data quality issues or errors. Your organization must take and own responsibility of the patient and immunization data it submits as part of establishing a data exchange connection with the registry. To ensure your organization is submitting great data quality it must identify any data quality errors and correct them in a timely fashion. 
    Speak with your EHR vendor to confirm your organization’s systems are configured to federal and state requirements for data exchange to decrease the likelihood of data quality errors. 

Note: The registry verifies that the above qualifications have been completed before establishing a data exchange connection with an organization. 

Establishing A Data Exchange Connection 

The following steps must be completed to establish a data exchange connection with the registry.  More information about each step is found in the publication stock #11-15231 Electronic Data Exchange Resource Guide on the Forms & Documents webpage

Step 1: ImmTrac2 Registration/Renewal Information 

Your organization must have an up to date ImmTrac2 Site Agreement for all your sites. 

Step 2: Registration of Intent 

Organizations must fill out a Registration of Intent (ROI). These are processed within 2-5 business days after submission. 

Step 3: Gaining Access to Registry Data Exchange Methods 

The steps to gain data exchange access with the registry are: 

1.  Your organization receives login credentials to a data exchange account from the registry. 
2.  The account allows your organization to send data to the registry. 
3.  The registry sends data quality information back to your organization. 

Step 4: Testing 

The organization follows a test plan provided by the registry to ensure it can: 

1.  Connect to the registry,  
2.  Send data in the correct formats, 
3.  Receive data quality reports, such as error and consent notification files, 
4.  Correct data quality issues, and 
5.  Regularly check the data reported. 

Step 5: Production 

After successful testing, your organization is promoted to production. 

Step 6: Ongoing Submission of Data 

Once your organization has been promoted to production, further actions by your organization and EHR vendor may be necessary when data errors are identified. Organizations should continue to monitor for data errors. 

Important: Organizations in production must regularly submit data, check the data reported, and correct data quality issues. 

Promoting Interoperability (PI) for Public Health Overview 

The Centers for Medicare and Medicaid Services (CMS) launched an incentive program to encourage Eligible Providers, Eligible Hospitals, and Critical Access Hospitals to transition to Electronic Health Record systems. 

For more information about CMS, or about Promoting Interoperability (formerly known as “Meaningful Use”) visit the CMS website

DSHS – Promoting Interoperability 

For information about Texas (DSHS) support of Promoting Interoperability, including other agency initiatives on Promoting Interoperability, visit the DSHS Promoting Interoperability website

Texas Immunization Registry – Promoting Interoperability 

The Texas Immunization Registry supports Promoting Interoperability measures. To participate in Promoting Interoperability with the registry, your organization needs to establish a data exchange connection with the Texas Immunization Registry. 

Promoting Interoperability: Stage 2 

The Texas Immunization Registry is engaged in uni-directional (batch) data exchange with organizations. Uni-directional data exchange requires organizations to submit a large volume of data in a single file at a set date/time to the registry. In return, the registry sends data quality reports back to the organization. Both the organization and the registry use FTP to send and retrieve data. 

Promoting Interoperability: Stage 3 

On June 26, 2020, the Department of State Health Services (DSHS) announced that the Texas Immunization Registry (ImmTrac2) has the capability for bidirectional data exchange using the current data exchange standards specified in the Promoting Interoperability (PI) programs, including the Medicaid Electronic Health Record Incentive/PI Program. 

DSHS is providing health care providers the required six months’ notice to prepare for bidirectional data exchange by January 1, 2021. 

Bidirectional Onboarding Prioritization 

Entities exchanging data with the Texas Immunization Registry will be able to access and submit patient and vaccination information in real-time with this change. 

The following entities will be prioritized for onboarding for bidirectional data exchange: 

  • Reporting high-quality data (90% acceptance rate) 

  • Pharmacies 

  • Schools and universities 

To determine reporting acceptance rate, entities registered in ImmTrac2 can access the Texas Immunization Provider Summary (TIPS) Report. This report can be accessed via the “generate reports” section of ImmTrac2 and provides an overview of all user activity, online activity, and data exchange activity from the previous month. 


All Entities 

DSHS is accepting requests to exchange data bidirectionally from all authorized entities with Certified Electronic Health Record Technology (CEHRT) and are authorized to access the registry by Texas Statute.  

There are two registrations required to participate in bidirectional exchange with the Texas Immunization Registry: 

  1. Register as an authorized organization with the registry (e.g. gain access to ImmTrac2), and 

  1. Registration of intent (ROI) to implement bidirectional data exchange. 

The ROI for bidirectional data exchange is submitted only once to the Texas Immunization Registry. 

PI Program Participants  

Participants must be actively engaged with the Texas Immunization Registry during their reporting period to be able to attest to meeting the PI immunization registry reporting measure. Both registrations mentioned above are required to meet PI program requirements. 
To use participation with the Texas Immunization Registry to meet PI program requirements, a provider must complete their ROI no later than the 60th day of their reporting period the first year they want to report data to the registry. 

How to Prepare 

Prior to registering intent to participate in bidirectional data exchange with the registry, entities must: 

  • Review publication 11-14972, Texas Immunization Registry HL7 2.5.1 Implementation Guide, to identify how to configure HL7 data. 

  • Review publication 11-15235, Bidirectional Readiness Checklist, to determine steps to take to prepare for bidirectional data exchange. 

  • Review publication 11-15703, Texas Immunization Registry HL7 2.5.1 Error Guide, to identify all HL7 error messages and how to resolve them. 

Publications referenced, and other resources are available on the Forms & Documents webpage that will be useful in entities preparation for bidirectional data exchange. 

Next Steps 

Once a provider or their affiliated entity has successfully completed the Bidirectional Readiness Checklist, only then should the entity contact the registry for verification of readiness and information on how to register their intent to engage in bidirectional data exchange. 

Entities will be reviewed by the registry to determine their readiness for bidirectional data exchange and streamline the onboarding process. 

Proof of Promoting Interoperability Engagement and Exemption Requests 

For proof of Promoting Interoperability engagement, contact the Interoperability Team at the Texas Immunization Registry. The document may include your organization’s name, the date your organization registered intent, the date your organization began testing, as well as the date your organization went into production. Additional information such as files submitted may be provided upon request. Refer to the Data Exchange Support section below for our contact information. 

The Texas Immunization Registry does not provide Exemption/Exclusion Letters. To receive an exemption or exclusion, please contact CMS


For all registry related forms, publications, data exchange specifications, HL7 implementation guides and data exchange resources, refer to the Forms & Documents webpage.  

For training videos, webinars and other resources refer to the User Training webpage. 

Data Exchange Support 

For additional questions regarding data exchange or Promoting Interoperability with the Texas Immunization Registry, please contact the registry’s Interoperability Team: 

Phone: 800-348-9158 
Email: ImmTracMU@dshs.texas.gov 
Hours of Operation: Monday – Friday 8:00 a.m.- 4:30 p.m. Central Time