MINNESOTA IMMUNIZATION INFORMATION CONNECTION
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
or making a change to an existing data interface.
Portions of this worksheet should be completed by technical staff who have knowledge of the data exchange source
system/electronic health record (EHR) technical capabilities. If you have questions about any of the information in this
worksheet, please review the MIIC Data Exchange Worksheet Reference Guide at Process for Working on Data Exchange
with MIIC (http://www.health.state.mn.us/divs/idepc/immunize/registry/hp/dataprocess.html).
The information requested in this worksheet is vital to us understanding the work you want to do and ensuring that you
are reasonably ready to work with us when we begin the onboarding process. Put “N/A” in any fields that do not apply
to you rather than leaving them blank.
Once the worksheet is complete send it to the MIIC Help Desk at [email protected]. Your organization will be
placed in queue and invited to begin the onboarding process as resources allow. Priority for onboarding will be given to
organizations interested in bi-directional HL7 2.5.1 interfaces using SOAP Web service.
Contact Information
Contact
Information
Organization/Health System:
Street:
City:
State:
Immunization Contact:
Email:
Phone:
Vendor Contact:
Email:
Phone:
Technical Interface Contact:
Email:
Phone:
Meaningful Use Contact:
Email:
Phone:
Production Support Contact:
Email:
Phone:
Zip:
Interface Questions
A. Is this a new interface or a change to an existing interface? If this is a change to an existing interface, what is your
current file format and transport protocol?
B. What transport method do you plan to use to send us your data?
C. What format do you plan to use when sending us your data?
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MIIC DATA EXCHANGE WORKSHEET
D. Will the interface include bi-directional query and response messaging?
E. Will the interface be directly between your EHR/source system and MIIC or will the data go through an intermediary
or hub? If data will go through an intermediary or hub, please describe it (i.e., is a third party utilized?).
F. How many facilities are included in this interface?
G. Approximately how many immunizations would come through this interface annually?
H. Do you plan on sending dose-level funding eligibility information to us through this interface?
I. What are the triggers in your system that create the messages that will be sent through this interface?
J. Are you able to suppress social security number information in your messages? We require that providers not send it
to us in their electronic messages because we are not able to store or process it.
EHR/Source System Information
A. What is the name of the product (including version) from which you will be sending data?
B. Who is the vendor of this product?
C. Is this a certified EHR product? If so, what certification does it have?
D. Are you planning any system changes or upgrades for the near future that may impact immunization messaging? If
yes, when do you plan to do that? How long do you expect it will take to complete?
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MIIC DATA EXCHANGE WORKSHEET
Onboarding Preparation
Use this checklist to make sure you have completed the steps to prepare for data exchange with MIIC.
 Register your intent to work on an interface with MIIC at Electronic Data Submission Registration
(https://apps.health.state.mn.us/edataregistry).
 Ensure that you are enrolled to participate in MIIC. If you are not enrolled, follow the steps at Participating in MIIC
(www.health.state.mn.us/divs/idepc/immunize/registry/hp/join.html) to enroll.
 Subscribe relevant contacts to receive MIIC Data Submission and Exchange email updates by clicking on the red
envelope near the top of the page at Submitting and Exchanging Data with MIIC
(www.health.state.mn.us/divs/idepc/immunize/registry/hp/data.html).
 Review the Immunization Onboarding Process template at Process for Working on Data Exchange with MIIC
(http://www.health.state.mn.us/divs/idepc/immunize/registry/hp/dataprocess.html). Verify that you can commit to the
timelines included.
 Review the MIIC-specific file specifications, transport options, and code sets found at Submitting and Exchanging Data
with MIIC (www.health.state.mn.us/divs/idepc/immunize/registry/hp/data.html).
 If you will be sending dose-level eligibility information, review the reporting options on the Reporting Dose-Level
Eligibility to MIIC fact sheet at Vaccine Ordering and Management in MIIC
(http://www.health.state.mn.us/divs/idepc/immunize/registry/hp/ordering.html).
 If you will be sending data through the interface on behalf of more than one facility, fill out the Facilities Participating
in Minnesota Immunization Information Connection (MIIC) Spreadsheet at Participating in MIIC
(www.health.state.mn.us/divs/idepc/immunize/registry/hp/join.html). Submit the spreadsheet to the MIIC Help Desk at
[email protected] to ensure that we are aware of all facilities that will be sending data through your
interface.
 Complete the NIST Test Message Preparation and Validation guide found at Process for Working on Data Exchange
with MIIC (http://www.health.state.mn.us/divs/idepc/immunize/registry/hp/dataprocess.html).
Minnesota Department of Health
Minnesota Immunization Information Connection
PO Box 64975, St. Paul, MN 55164-0975
651-201-5207
[email protected]
To obtain this information in a different format, call: 651-201-5503.
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