Public Health Meaningful Use FAQ

General Questions

1. What data is Washington State Department of Health (DOH) accepting under Electronic Health Record (EHR) incentive programs?

DOH has the capability to electronically receive the following data for meaningful use:

  • Immunization Information
  • Laboratory Results for Reportable Conditions
  • Syndromic Surveillance
  • Cancer Reporting
  • Prescription Data
2. I previously registered to do public health reporting. Do I need to re-register?

You need to register your intent at least once for each public health objective. Once you register, you do not need to register again in future years, unless you were:

  • Qualified for an exclusion in the year of your initial registration
  • Exited the onboarding process, OR
  • Failed to participate in the onboarding processes (e.g., failed to respond within 30 days to the department's written requests for action on two occasions).
3. Our clinic has several practicing providers. Does each provider need to register?

No. A clinic may complete a single registration on behalf of all providers that primarily practice at the clinic. The clinic or healthcare organization is responsible for tracking the list of individual providers for whom the registration applies.

4. How should an eligible provider (EP) who works at multiple sites register?

Only register for the physical location where you work the majority of the time, using the DOH Meaningful Use Registration form. You may list other sites where you practice in the “comments” field of the registration form but this is not required.

5. Can I claim an exclusion from meeting Public Health objectives?

There are circumstances where you may qualify for an exemption from one or more Public Health objectives. These may include the following circumstances:

  • You do not administer immunizations.
  • Public health is not accepting syndromic surveillance data from your practice. Please refer to the Public Health Meaningful Use Eligibility Criteria for details on what data public health accepts for syndromic surveillance.
  • You do not diagnose or treat cancer.

You, the data submitter, are responsible for providing documentation to prove that you meet any exclusion criterion. Public Health does not issue exclusions or provide documentation confirming you qualify for an exclusion. For further assistance please contact Washington State Health Care Authority at

6. I am a vendor representing several clinics (or facilities). Do we need to complete the onboarding process for each clinic or facility that we represent?

Yes. The onboarding process must be completed by (or on behalf of) each legal entity attesting for Meaningful Use.

7. Our healthcare organization consists of multiple clinics and/or hospitals. Does each of our clinics and/or hospitals need to complete the onboarding process?

If all data for your organization is centralized AND messages will be generated centrally for all entities in your organization, you only need to complete the onboarding process once. If this is not the case, each facility will have to complete the entire onboarding process independently.

8. Our clinic has several eligible providers. Does each provider need to complete the onboarding process?

No. A clinic may complete the onboarding process on behalf of all providers that primarily practice at the clinic.

9. How do I submit my data and set up a secure data transport?
  • Immunization Reporting: The recommended transport method is via https real-time or Software Bridge assisted transport.
  • ELR: The required data transport method for Medicaid-eligible hospitals (EH) is via the Washington State Health Information Exchange (HIE).
  • Others may use Secure File Transfer (SFT) or Public Health Information Network Messaging System (PHINMS).
  • Syndromic Surveillance: The recommended data transport method is the Washington State HIE.
  • Cancer Registry: The required transport method for Medicaid-eligible providers is the Washington State HIE. All other providers can use the HIE or PHINMS.
  • Prescription Monitoring Program (PMP): The required data transport method for authorized providers is via the Washington State HIE.
10. What kind of supporting documentation is needed for audits?

Providers who receive an incentive payment for the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program potentially may be subject to an audit. It is the provider's responsibility to maintain documentation that fully supports the meaningful use and clinical quality measure data submitted during attestation. To ensure you are prepared for a potential audit, save any electronic or paper documentation that supports your attestation. An audit may include a review of any of the documentation needed to support the information that was entered in the attestation.

We suggest all eligible professionals (EPs) and eligible hospitals (EHs) refer to the CMS EHR Incentive Programs in 2015 through 2017 Supporting Documentation for Audits for a complete guide to preparing and maintaining documentation for audits.

CMS suggested documentation includes:

  • Dated screenshots from the EHR system that document successful submission to the registry or public health agency. Should include evidence to support that it was generated for that provider's system (e.g., identified by National Provider Identifier (NPI), CMS Certification Number (CCN), provider name, practice name, etc.).
  • A dated record of successful electronic transmission (e.g., screenshot from another system, etc.). Should include evidence to support that it was generated for that provider (e.g., identified by National Provider Identifier (NPI), CMS Certification Number (CCN), provider name, practice name, etc.).
  • Letter or email from registry or public health agency confirming receipt of submitted data, including the date of the submission and name of sending and receiving parties.

Syndromic Surveillance FAQs

11. Which entities in Washington State should submit syndromic surveillance messages?

DOH supports submission of syndromic surveillance data from eligible hospitals and eligible professionals in alignment with activities related to Meaningful Use or other EHR incentive programs. Some eligible professionals may qualify for an exclusion from syndromic surveillance reporting. Please refer to the Meaningful Use Eligibility Criteria to determine if Washington State is accepting syndromic surveillance data from your facility.

12. What are the current standards and guidelines for submitting syndromic surveillance data in Washington?

Please view the Washington State Messaging Guide for Syndromic Surveillance (PDF) for guidance on formatting syndromic surveillance messages.

13. For which conditions do I send syndromic surveillance data?

Unlike reportable conditions where you would send information to public health for a select number of conditions, syndromic surveillance requires sending limited data on every visit to your facility. The goal of syndromic surveillance is to provide a flexible, all-hazards system that can be used to monitor different aspects of population health as the need arises. This cannot be accomplished using traditional disease reporting. For additional guidance on what data should be included in a syndromic surveillance message, please view the Washington State Messaging Guide for Syndromic Surveillance (PDF).

14. We have generated some test syndromic surveillance messages. Can we verify that the messages look okay before we promote to our live, production system?

Upon request, DOH will review sample messages for basic adherence to structural requirements and expected value sets. Contact to coordinate a review of some sample messages.

The National Institute of Standards and Technology (NIST) has created a syndromic surveillance validation tool. This tool allows for both context-free validation (i.e., only message structure is verified) and context-based validation (i.e., structure and limited content are verified).

Please keep in mind that the NIST tools do not check messages for compliance with Washington-specific guidance.

NIST HL7v2 Syndromic Surveillance Test Suite

15. We have not received any feedback on our test messages. Why are we being asked to turn on a data feed from our production system before any of our messages have been evaluated by the Washington State Department of Health?

DOH recognizes that promotion of a system to production prior to testing goes against traditional IT methodology; however, DOH has found that validation of test messages generated by a test system is insufficient and a secondary validation process must be completed once the data feed is promoted to production.

Validation is a time intensive process. In order to most efficiently use the department's limited resources, the department is asking that facilities promote syndromic surveillance reporting to production prior to validation. This allows for the department to identify all issues and implement solutions in a single validation process.

16. How long will validation take?

DOH is unable to provide estimates on the length of time required to complete the validation process. The length of time will largely be dependent on how quickly a facility is able to resolve the issues identified by DOH. DOH encourages facilities to begin investigation of issues as quickly as possible as there is often a delay if vendor assistance is required to address one or more issues.

17. Will we be able to complete the onboarding process during our reporting period?

DOH cannot promise you will be able to complete the onboarding process during your reporting period, but you will improve chances of success if you start the process as early as possible (i.e. before the reporting period begins) and quickly respond to any requests from DOH.

18. What happens once my facility completes the onboarding process?

DOH hopes to maintain a long-term, collaborative relationship with facilities submitting syndromic surveillance data to the department. In order to maintain a productive partnership and a robust syndromic surveillance system, the department requests that facilities adhere to Expectations for Facilities Participating in Washington State's Syndromic Surveillance System (PDF).

19. Will we be notified by the Washington State Department of Health that we have completed the necessary onboarding steps required for attestation?

DOH will provide the following documentation of your facility's engagement:

  • Acknowledgement of registration
  • Invitation to onboard or qualification for exclusion (if not accepting data from your facility)
  • Acknowledgement of production status

Due to limited resources for onboarding, DOH will not be providing additional documentation of engagement. Please gather evidence such as email exchanges, meeting invites, message acknowledgements, and transport logs to show your facility is actively engaged with public health. In the event of an audit, additional documentation may be provided by DOH. Please contact with these requests.

20. Our facility started sending syndromic surveillance data to public health prior to Meaningful Use. Does this reporting meet the Meaningful Use criteria?

While the department appreciates our early adopters who began providing data to public health prior to Meaningful Use, this does not meet Meaningful Use requirements.

In order to satisfy these criteria, an expanded set of data must be sent from an Office of the National Coordinator (ONC) certified Electronic Health Record system to the Washington State Department of Health using an HL7 2.5.1 message format.

21. Which public health authorities in Washington State are accepting electronic syndromic surveillance data for Meaningful Use or other EHR incentive programs?

DOH is the only public health authority accepting syndromic surveillance data for EHR incentive programs in Washington State. The department will grant local health department staff access to data collected from their jurisdiction.

22. We are currently reporting syndromic surveillance data to our local health jurisdiction. If we choose to establish syndromic surveillance reporting to the Washington State Department of Health, should we continue to report data to our local health jurisdiction?

Yes, you should continue to report syndromic surveillance data to your local health jurisdiction without making any changes to data elements, file format, or mode of transmission. This will ensure that local health jurisdictions do not lose local surveillance capacity during the transition period. The local health jurisdiction will notify your facility when this reporting is no longer required.

23. What is syndromic surveillance, and how will reporting improve public health capability to monitor the health of Washington State?

Syndromic surveillance is defined as public health surveillance using healthcare data and statistical tools to detect and characterize events requiring public health investigation.

The goal of syndromic surveillance reporting is to provide public health with timely information that allows local, state, and federal public health authorities to detect and respond to outbreaks and health events more quickly.

Collection of syndromic surveillance data will enable public health to monitor healthcare utilization for infectious diseases (e.g. influenza), non-infectious conditions (e.g. heart disease, diabetes, and injuries), natural disasters or environmental exposures.

The department anticipates that the expanded set of data elements will improve public health capability to detect, characterize, and track events of public health significance.

24. What is the National Syndromic Surveillance Program?

The National Syndromic Surveillance Program (NSSP) is a collaboration among individuals and organizations at local, state, and federal levels aimed at promoting and advancing a syndromic surveillance system for the timely exchange of syndromic data. Please visit the CDC's NSSP Overview page for more information, or direct any questions to