Application for Immunization InterfaceImplementationAwards

For Health Information Exchange Organizations (HIOs) and Provider Organizations

Health information exchange organizations (HIOs) and provider organizations in California may be eligible for funding support to implement health information exchange (HIE)interfaces to the state Immunization Messaging Portal (IMP). The California Health eQuality (CHeQ) program is offering an opportunity to apply for funding of up to $20,000for implementing interfaces thatenable eligible providers tomeet HIE-related Meaningful Use objectives for public health reporting.

GOALS:

  • Provide funding to enable reporting of immunization information in California to the California Immunization Registry (CAIR)
  • Support interface implementations between HIOsand/orprovider organizations to the IMP to facilitate reporting of immunization information
  • Enable providers to meet HIE-related Meaningful Use objectives

ELIGIBILITY:

  • HIOs, and/or provider organizations (health system, hospital, physician group, etc.) that service providers eligible to report immunization data through the CAIR IMP. Note that providers in regions IV, IX, and X are not eligible to submit data through the IMP (see for more information). Technology vendorsmay not serve as prime applicants
  • Projects with a quote from anidentified vendor or service provider
  • Compliance with all state and federal laws related to the privacy and security of health information

FUNDING:

Funding is available for connecting an HIO or provider organizationto the Immunization Messaging Portal (IMP)at CAIR. Funding is not available to connect an HIO or other organization to EHRs or other submitting provider systems for imunization reporting. Funding may be applied to hardware and softwareforinterface implementation and/or vendor implementation costs.

TIMELINE AND EXPECTED MILESTONES:

The funding period will start as early as July 1, 2013 and end on October 31, 2013. By the end of the funding period, your organization must complete the interface implementationand provide CHeQ with a “Successful Validation Report” from IMP with confirmation email that states the site is ready for production submission and a “Successful Acknowledgement Message” from IMP.

INSTRUCTIONS:

You may request funding support of up to $20,000. Please send your application by email to r by fax to CHeQ IMP at (916) 734-4754. Questions should be directed to Becca Litman, . Applications will be reviewed on a first-come, first-served basis and awards will be made based on available funds. CHeQ has up to $130,000 to distribute for this opportunity. For more information on the Immunization Messaging Portal, see the California Immunization Registry (CAIR) website at

All Applicants must submit the Request for Funding Support Application, below, and a Vendor Quote for the project as a separate attachment.

Immunization Interface Awards

Request for Funding Support Application

Name of Prime Applicant:

Type of Organization:

HIO

Physician Group

Hospital

Health System

Other (please specify):

______

Mailing Address:Physical Address:(if different from Mailing Address)

Name of Primary Contact:

Title:

Phone: Fax:

Email:

Vendor(s):

Funding Amount Request:

Estimated number of immunizations per month:

□This project will be incompliance with all state and federal laws related to the privacy and

security of health information.

□I am currently registered in the Federal System for Award Management (SAM.gov), or

registration is pending. Please note, in order to receive ARRA or FFATA funding a subrecipient

MUST be registered in SAM. (see).

□ I have attached a vendor quote including itemized costs, project plan, and timeframe for

implementation

CHeQ: Application for Immunization Interface Implementation Support Page 1