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).  MU is defined by the use of certified EHR technology in a meaningful manner as defined by CMS and ONC.  This includes a set of measures and metrics that are shared through a set of rules that are released in three stages.   “Promoting Interoperability” formally known as Electronic Health Records Meaningful Use began on December 2014.

Hawaii Public Health Declaration of Readiness

MeasuresStage 2: MU (2014-2017)Stage 3: Promoting Interoperability
Electronic Lab ReportingYesYes
Electronic Case ReportingNAYes
Immunization Registry ReportingYesNo
Syndromic Surveillance ReportingNoYes
Cancer Registry ReportingYesYes (National Reporting as of May 2021)

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 of HL7 2.5.1 for ELR data.  To register intent, a provider MUST HAVE a hospital / laboratory application which has certified laboratory messaging capabilities at the time of their registration.

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 September 15, 2020

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 real-time 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.

Please contact the HDOH eCR coordinator for more information about the Case Reporting attestation process.

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 December 28, 2021