Meaningful Use – Promoting Interoperability

Hawaii Department of Health Promoting Interoperability

The American Reinvestment & Recovery Act (ARRA) was enacted on February 2009 and includes the “Health Information Technology for Economic and Clinical Health (HITEC) Act”.  This Act supports the concept of electronic health records and Meaningful Use (MU) which is an effort led by Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC). “Promoting Interoperability” formally known as Electronic Health Records Meaningful Use began on December 2014. This includes a set of measures and metrics that are shared through a set of rules that are released in three stages.

To continue a commitment to promoting and prioritizing interoperability and exchange of health care data, CMS renamed the EHR Incentive Programs to the Medicare and Medicaid Promoting Interoperability Programs in April 2018. This change moved the programs beyond the existing requirements of meaningful use to a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.

Beginning in calendar year (CY) 2022, the Medicaid Promoting Interoperability Program ended. The program is currently known as the Medicare Promoting Interoperability Program for eligible hospitals and CAHs. For additional details about the end of the Medicaid Promoting Interoperability Program, please contact your state Medicaid agency or review the FY 2019 IPPS and LTCH final rule (83 FR 41676 through 41677).

Hawaii Public Health Declaration of Readiness

Immunization Registry Reporting: submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).

  • Up to 25 points total for all 4 measures
  • Yes/No attestation
  • Exclusions available

Syndromic Surveillance Reporting: submit syndromic surveillance data from an emergency department (POS 23).

  • Up to 25 points total for all 4 measures
  • Yes/No attestation
  • Exclusions available

Electronic Case Reporting: submit case reporting of reportable conditions.

  • Up to 25 points total for all 4 measures
  • Yes/No attestation
  • Exclusions available

Electronic Reportable Laboratory (ELR) Result Reporting: submit ELR results.

  • Up to 25 points total for all 4 measures
  • Yes/No attestation
  • Exclusions available

The U.S. Department of Health and Human Services (HHS) announced its plans for the Public Health Emergency (PHE) for the COVID-19 pandemic to end on May 11, 2023. The Biden administration also expressed its plan to allow the National Health Emergency to end on the same date. Unfortunately, this does not mean that COVID is “over,” but rather that it is no longer an “emergency.” What does this mean for employers? Below are a few policy matters for employers to consider.

Promoting Interoperability: Laboratory Reporting

The Hawaii Dept. of Health (HDOH), Disease Investigation Branch is accepting HL7 (version 2.5.1) messages from certified electronic health record (EHR) systems for electronic laboratory reporting (ELR) and Meaningful Use (MU) attestation. ELR reporting is designed to be secure, automated, and unobtrusive to facility operations. Successful ongoing submission to HDOH using the ELR reporting method will assist eligible hospitals in receiving Medicare and Medicaid incentive funds.

The Hawaii Dept. of Health  encourages all laboratories, providers and EHR vendors to coordinate with the Hawaii Health Information Exchange (HHIE) to establish a connection for secure data transmission via HL7 v2.3.1- or v2.5.1-compliant messages.  To register intent, a provider MUST HAVE a hospital / laboratory application which has certified laboratory messaging capabilities at the time of their registration. When ELR takes place via a compliant HL7 v2.5.1 message, it enables eligible hospitals to fulfill objectives towards data interoperability.

Please contact the HDOH ELR coordinator for more information about the Laboratory Reporting attestation process.

There are no changes to the HL7 implementation guide used for Electronic Laboratory Reporting in Meaningful Use stage 3.  However, there may be a need to re-validate if a hospital or laboratory updates or purchases new certified software.

Last reviewed June 8, 2023

In the fall of 2022, CMS finalized changes to the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals (CAHs) for calendar year (CY) 2023. These changes and requirements can be found below.

Promoting Interoperability: Syndromic Surveillance Reporting

Syndromic Surveillance is an investigational approach where health department staff, assisted by automated data acquisition and generation of statistical alerts, monitor disease indicators in realtime or near real-time to detect outbreaks of disease earlier than would otherwise be possible with traditional public health methods (CDC).
Public health agencies should declare readiness six months prior to being able to receive data.  As of July 01, 2020, the Hawaii Department of Health (HDOH) is ready to actively engage eligible professionals, eligible hospitals and /or critical access hospitals participating in Syndromic Surveillance.  Note that Syndromic Surveillance report data is not a replacement for reporting of communicable diseases, nor is it a substitute for electronic laboratory reporting (ELR).

Message mapping guides for syndromic surveillance are available at:

One tool that CDC offers for electronic message validation is the Message Evaluation and Testing Service (METS). This tool ensures that messages are adhering to HL7 standards defined in messaging guides. More details about METS may be found here.

NIST Test Procedure for syndromic surveillance

Promoting Interoperability: Immunization Information System (IIS) Reporting

To meet requirements, eligible professionals and eligible hospitals and/or critical access hospitals must be in active engagement with an immunization registry or other type of Public Health agency to submit electronic public health data in a meaningful way using Certified Electronic Health Record Technology (CEHRT). Active engagement can be in the form of registration of intent, testing and validation, and ongoing electronic submission of data to the registry.


The Hawaii Immunization Registry (HIR) was not available from June 1, 2017. The system was fully operational on August 4, 2021. Eligible professionals, hospitals and/or critical access hospitals enrolled with HIR seeking a meaningful use attestation for active engagement in 2018 and/or 2019 may qualify for an interoperability exclusion for those years due to HIR’s inability to accept, process or engage in ongoing electronic data exchanges to its system.

For more information on Medicare Promoting Interoperability Program Requirements, and Registration Form, please visit the Hawaii Immunization Registry (HIR) portal page at, select Forms tab.

Promoting Interoperability: Electronic Case Reporting

For Hawaii’s Healthcare Organization, electronic case reporting (eCR) is a way to fulfill their mandated reporting requirements.  Hawaii Dept. of Health (HDOH) is live with eCR reporting and is an accepted and encouraged form of provider reporting.  HDOH is currently accepting participating healthcare organizations to join a CDC eCR cohort for onboarding with the national APHL Informatics Messaging Services (AIMS) shared service platform.  AIMS is a secure, cloud based platform that accelerates the implementation of health messaging by providing shared services to aid in the visualization, interoperability, security and hosting of electronic data.

The State of Hawaii uses the HL7 electronic initial case report (eICR) standards (R1.1 and R3) for electronic case reporting (eCR) and to support the new CMS Promoting Interoperability 2022 regulations for eCR. It is these standards that we will use to eventually eliminate manual reporting requirements. We also require the use of APHL AIMS and the Reportable Condition Knowledge Management System (RCKMS) to ensure appropriate reporting.

Cancer Reporting:

Effective March 1st, 2018, Hawaii Tumor Registry would like to inform all Eligible Providers (EP) and Critical Access Hospitals (CAH) that the Hawai‘i Tumor Registry will no longer participate in Meaningful Use (MU) for Cancer Reporting.

If in the future the Hawai‘i Tumor Registry decides to participate once again, we will announce such notices on this web page, the State of Hawai‘i, Department of Health Meaningful Use web page.


Last reviewed July 5, 2023