Certified Electronic Record Technology for Public Health Reporting

Meaningful Use & EHR

Public health electronic reporting requirements can be easily provided to TDH using an EHR. The process to begin reporting electronically begins when a potential trading partner registers with TDH expressing their intent to exchange data electronically using the Trading Partner Registration (TPR) system.

The Centers for Medicare & Medicaid Services (CMS) requires Eligible Clinicians (ECs) and Eligible Hospitals (EHs) to maintain proof of active engagement with public health. TPR manages active engagement statuses, generates emails and letters as proof of public health reporting for registered users. Additionally, CMS incentivizes interoperability leading to an increase in partnerships between TDH and health providers capable of reporting electronically.

New and returning TPR users can request training or registration assistance at the "How to submit a request for TPR assistance/training" site.  Once your request has been submitted you should receive and email in one to two business days. If you do not receive an email within two business days send an email to MU.Health@tn.gov.

Declaration of Readiness for Public Health Reporting

As of Jan. 1, 2023, TDH is declaring readiness for the following Public Health Reporting objectives and measures. 

Promoting Interoperabiity and Merit-Based Incentive Payment System (MIPS) participants should check here periodically for updates to TDH’s declaration of readiness to receive data from Certified Electronic Health Record Technology (CEHRT).

For questions related to the TDH Declaration of Readiness, contact the TDH Meaningful Use Coordinator at (615) 253-8945 or MU.Health@tn.gov.

Active Engagement Definitions & Options

Active Engagement – The participating entity is in the process of moving towards sending "production data" to a public health agency (PHA) or clinical data registry (CDR), or is sending production data to a PHA or CDR.

The deadline for eCR registrations is September 3, 2024, for trading partners whose Promoting Interoperability Performance Period began on July 5, 2024. To ensure active engagement for CY 2024, eCR registrations must be submitted before this date.

Promoting Interoperability program participants must use technology certified to ONC Certification Criteria for Health IT. The Certified Health IT Product List (CHPL) is a comprehensive and authoritative listing of all certified health information technology that have been successfully tested and certified by the ONC Health IT Certification program.

Preferred Secure Transport Options

Below are the current preferred transport methods for each of the Public Health measure. Additional mechanisms might be available and can be discussed when appropriate.  

Useful Links

Use the links below to learn more about Promoting Interoperability (PI) Programs. Be sure to check here periodically for updates.

See links below for additional information: 

• Promoting Interoperability (PI) Latest News
• MIPS Promoting Interoperability (PI) Measures
  
• MIPS Promoting Interoperability (PI) Measures (2025)
• Calendar Year 2024 Program Requirements for eligible hospitals
• Medicare Promoting Interoperability Program FAQs
• Office of the National Coordinator for Health Information Technology - ONC
  

Contact

If you have any questions or comments you would like to share, click on the link below to enter your information in the Office of Informatics and Analytics (OIA) Feedback form.

For questions regarding Promoting Interoperability programs and/or public health reporting, please contact the TDH Partner Engagement Team at MU.Health@tn.gov.

Promoting Interoperability

In 2011, the Centers for Medicare and Medicaid Services (CMS) established the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to encourage eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to adopt, implement, upgrade, and demonstrate meaningful use of certified electronic health record technology (CEHRT).

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).

EHR Incentive Program Documents

The documents listed on this page are intended to assist eligible professionals (EPs), eligible clinicians (ECs), eligible hospitals (EHs), and critical access hospitals (CAHs) in their efforts to be actively engaged in public health reporting. 

Promoting Interoperability Frequently Asked Questions (FAQs)

The following are answers to questions commonly asked by trading partners before and during the onboarding process. If you have additional questions, please contact the Partner Engagement team at MU.Health@tn.gov or submit your questions or feedback using the Office of Informatics and Analytics (OIA) Feedback form. .

Public Health Registry Reporting FAQs

1.    How should an Eligible Clinician (EC) determine if there is a specialized registry maintained by a public health agency in Tennessee that is accepting data for Promoting Interoperability?

ECs should refer to the TDH Declaration of Readiness for all public health related objectives, including specialized registries maintained by TDH.

Other Specialized Registry options include, but are not limited to:

Surveys from the National Center for Health Statistics

• National Health Care Surveys
• National Hospital Care Survey (NHCS)
• National Ambulatory Medical Survey (NAMCS)

See also the National Institutes of Health (NIH) list of available registries.

2. How does sharing data from the provider Electronic Health Record (EHR) benefit the state of Tennessee?

Improved accuracy and completeness of all surveillance data impacts all areas of public health interventions designed to reduce incidence of disease or increase early detection. As a result, disparities among various disadvantaged population groups can be identified to develop effective interventions.

3. What kind of documentation will TDH provide to me so that I can use that documentation to attest to Promoting Interoperability?

In Tennessee, the onboarding process to exchange data with TDH begins when a potential trading partner registers with TDH expressing their intent to exchange data electronically. The Trading Partner Registration (TPR) system allows potential trading partners to register for Immunization Messaging, Cancer Case Reporting, Electronic Laboratory Reporting (ELR), Electronic Case Reporting (eCR), and Syndromic Surveillance Messaging (Eligible Hospitals w/Emergency Room and eligible clinicians (ECs) in urgent care settings), one location - online. The TPR system provides documentation that can be utilized for Promoting Interoperability attestations and allows users to view their progress from end to end, with milestone letters documenting on-boarding progress. TDH will provide official electronic letters documenting completed milestones throughout the on-boarding process in the TPR system. These letters can be used as proof of active engagement documentation for your records.

Providers should retain ALL relevant supporting documentation (in either paper or electronic format) used in the completion of the Attestation Module responses for six years post-attestation. See the CMS’ Audits and Appeals Overview – https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Appeals_Audits.

4. Who should contact if have questions about a specific Public Health measure?

Public Health Measure options:

a.    Cancer Case Reporting send an email to TNCancer.Registry@tn.gov

b.    Electronic Case Reporting (eCR) send an email to CEDS.Informatics@tn.gov

c.     Electronic Laboratory Reporting (ELR) send an email to CEDS.Informatics@tn.gov

d.    Immunization Registry Reporting send an email to TennIIS.MU@tn.gov

e.    Syndromic Surveillance Messaging send an email to CEDS.Informatics@tn.gov

For additional questions regarding Public Health reporting, please visit:  https://www.tn.gov/health/cedep/meaningful-use-summary.html or contact the TDH Partner Engagement Team at MU.Health@tn.gov.

5. Does Physician Reporting under MU replace facility reporting?

No. Physician Reporting under Promoting Interoperability does not replace hospital and laboratory reporting requirements. It is important to note that hospitals and laboratories cannot demonstrate cancer reporting under Promoting Interoperability.

6. Can I submit cancer case information even if I don’t directly treat cancer?

No, if an eligible clinician does not diagnose or directly treat cancer then the clinician may not satisfy the cancer reporting menu option.

If the eligible clinician does diagnose or directly treat cancer cases, they must ensure that the EHR software can submit cancer cases and meets 100% of the required certification criteria, CQM domains, and either inpatient or ambulatory CQMs.

Certified Health IT Product List

Trading Partner Registration (TPR) FAQs

1. What is the Trading Partner Registration (TPR) system? 

The TPR system allows potential trading partners to register their intent to electronically exchange data with the Tennessee Department of Health (TDH). TPR also permits potential trading partners to efficiently communicate with TDH and provide TDH with updated information about each trading partner, a necessity for establishing and maintaining electronic interfaces.

2.  How can I access the TDH Trading Partner Registration (TPR) system?

To begin the process of registering intent to exchange data with TDH, you must first have a PAAMS/TN.gov account. This account allows you to register for TN.gov services including TDH Trading Partner Registration. Go to https://apps.tn.gov/paams/ to create your PAAMS/TN.gov account.

If you already have a PAAMS/TN.gov account, simply login to https://apps.tn.gov/paams/, click “Add another service” button. Locate TDH Trading Partner Registration in the Reporting and Submissions section and then click continue. You may then login at https://apps.tn.gov/tpr/. New users may be added to both existing and/or newly created accounts by clicking on the “Add Users” button in the PAAMS/TN.gov account.

3.    What is PAAMS?

The Portal Admin Account Management System (PAAMS) is the system used for TN.gov services. Your account will allow you to use the TPR system in addition to many other PAAMS/TN.gov web portal systems. If you have an existing account, there is no need to create a new one to use the TPR system.

4.    Where can I learn more about each TPR interface?

a.    Cancer Case Reporting: https://www.tn.gov/health/health/health/tcr.html

b.    *Drug Overdose Reporting: https://www.tn.gov/health/health/odsurveil.html

c.     Electronic Case Reporting: https://www.tn.gov/content/dam/tn/health/documents/eCR_Fact_Sheet.pdf

d.    Electronic Laboratory Reporting (ELR): https://www.tn.gov/content/tn/health//health/elr.html

e.    Immunization Registry Messaging: https://www.tennesseeiis.gov/tnsiis/

f.      Syndromic Surveillance: https://www.tn.gov/health/health/odsurveil.html

* Not include in Promoting Interoperability programs

5.    I don’t see the interface I want to register for, what should I do?

Send an email to the Partner Engagement Team at MU.Health@tn.gov. In the email list the name of the interface you wish to connect to, your name, the name of your organization, and your phone number.

6.    What are the different TPR access levels and what does each mean?

• View Access: Users with view access you will be able to view milestones and entity information.
• Edit Access: Users with edit access you will be able to view milestones and edit entity information.
• Approval Access: Users with approval access you will be able to view milestones, edit entity information, and approve user requests to the entity record.

7.    What information do I need to complete the registration process?

The information needed to complete the registration process might come from many different sources within your organization and includes:

• Information about your organization
• Information about your system(s) and associated vendor(s)
• Information about your system’s capabilities for the desired interfaces
• Information about the individuals who will be responsible for the testing and validation process as well as a contact from the organization
• Information about your transmittal volume

For further guidance on the information needed to complete registration, refer to the Trading  Part Registration Worksheet.

8.    What is a classification?

Trading partners are grouped into one of three classifications for the registration process. The classifications help organize trading partners into categories, which is beneficial to maintaining relationships between multiple associated trading partners.

9.    How do classifications differ from one another?

A trading partner selects one of three classifications for registration: Organization, Facility, or Professional.

• Organization classification is used by trading partners with multiple locations, potentially carrying multiple affiliated organizations, facilities, and/or professionals.
• Facility classification is used by trading partners that are a single location, potentially carrying affiliated professionals.
• Professional classification is used for trading partners registering as an individual, and the trading partner should be a person; if registered as a professional, the user will only be able to register that professional. No affiliated organizations, facilities or other professionals can be registered underneath a professional in the hierarchy..

10.  I don’t fit into any of those classifications, how should I register?

Trading partners may not clearly fall within one of these classifications. In that case, trading partners are advised to register using the organization classification. As the highest level

of classification, an organization could easily register other affiliated organizations, facilities, or professionals later, if necessary.

11.  What are “parent” and “child” entities?

“Parent” and “child” are terms the TPR system has adopted to help document various entity affiliations while maintaining hierarchy relationships. To document an affiliation, register your first (“parent”) entity, and then add a “child.” For example, a Health System may be registered as an organization, with multiple hospital locations registered underneath it. In that situation, the Health System is the “parent”, and the hospital locations are “children.”  

Although this hierarchy is preserved in the system, each entity has its own demographic, interface, and Promoting Interoperability information, which may differ greatly among related parent/children affiliates.

12.  What happens after I complete my registration?

All registrations must be approved by appropriate TDH staff. You will receive an automated email notification once your registration has been approved. TDH program staff will contact you with more information about testing and on-boarding in a separate email. Click the link below for additional information related to on-boarding for each individual interfaces.

https://www.tn.gov/health/cedep/meaningful-use-summary/public-health-reporting-options.html

13.  How should I structure my organization when registering to exchange data with the immunization registry?

The Immunization Information System (IIS) supports a 2-tier hierarchy of locations - Organization and Facility. Organizations are the top tier and typically identify the legal entity. Facilities are the bottom tier and typically identify physical locations of each provider office or practice. Patients, vaccinations, and the Vaccines for Children (VFC) Provider Identification Number (PIN), if applicable, are at the facility level. An organization may have one or more facilities, but a facility may only be a member of one organization. The Trading Partner must make the Tennessee Department of Health (TDH) aware of their hierarchical structure and must notify TDH when this structure changes (for example, when new facilities are added or removed from an organization). Please notify the Tennessee Immunization Information System (TennIIS) team at TennIIS.MU@tn.gov.

14.  Who do I contact for general TPR system help?

If you have questions or need general help using the TPR system, contact Partner Engagement Team at MU.Health@tn.gov.

15.  Who do I contact if I cannot login to TPR?

For login assistance, contact:

NIC, TN – TN.gov Help Desk

(615) 313-0300 or (866)8TN-EGOV

Email: Apps.Support@TN.Gov.

16.  If other people in my organization who need access to these registrations, how do I set that up?

Authorized users may obtain access to your registration by logging in to the TPR system, clicking “Add New Entity”. From there, click “Search for your Records” enter required information, and click “Search for your Records.” Locate the appropriate entity and select the access level. An email notification will be sent to the entity’s admin user for approval or denial of the request. Denied users can request access to an entity’s information again, if initially due to requested level of access: simply adjust the requested access level selection and follow the same steps to re-submit.

Note: Admin users can only approve or deny requests – they cannot change the level of access.

17.  I need to update/change information for my previously submitted registration, how do I do that?

An existing registration can be updated at any time by users with Edit or Approval access to that entity. When viewing the submitted registration information, select the File Information tab and click “Edit Information” for the section you wish to edit. Complete all necessary edits and click “Continue,” through to “Complete Registration,” then “Finalize Registration” to exit Edit mode. An email notification will be sent to TDH staff for review.

18.  Can an EHR vendor register on behalf of its clients?

Yes – An EHR vendor can register on behalf of their clients; however, EHR vendors must be sure to list points of contact information for their client in the Entity Information and Incentive Program sections of TPR and not list themselves as the point contact for the entity.

19.  Can an organization register for multiple facilities?

Yes – TPR allows users to register multiple organizations.

20.  Can other organizations registered in TPR see my organizations registration information?

No – The information your organization provides is visible only to you, TDH administrative users, and others you give access to the data.

21.  Is TPR only for Promoting Interoperability?

No – All providers who would like to exchange data with TDH for the interfaces that currently utilize the TPR system should use the TPR system register their intent to electronically exchange data, regardless of Promoting Interoperability participation status.

Other Public Health Promoting Interoperability FAQs

Electronic Laboratory Reporting (ELR) Frequently Asked Questions 

Syndromic Surveillance FAQs (page 9) 

Immunization Registry Submission

Cancer Case Reporting 

If you have any questions or comments you would like to share, click on the link below to enter your information in the Office of Informatics and Analytics (OIA) Feedback form.

Contact

If you have any questions or comments you would like to share, click on the link below to enter your information in the Office of Informatics and Analytics (OIA) Feedback form.

For questions regarding Promoting Interoperability programs and/or public health reporting, please contact the TDH Partner Engagement Team at MU.Health@tn.gov.

Laboratory Results Reporting

Certain diseases and events are declared to be communicable and/or dangerous to the public and are to be reported to the state or local health department by all hospitals, physicians, laboratories and other persons knowing of or suspecting a case in accordance with the provision of the statutes and regulations governing the control of communicable diseases in Tennessee (T.C.A. §68 Rule 1200-14-01-.02).

Laboratories can currently report either:

1. Manually, or
2. Via Electronic Laboratory Reporting (ELR)*

Reporting by laboratories does not nullify the health care provider’s or institution’s obligation to report these diseases and conditions, nor does reporting by health care providers nullify the laboratory’s obligation to report.

The Reportable Diseases and Events List is updated annually. A list of these conditions, diseases, and events can be found by visiting the Tennessee Department of Health Reportable Diseases site.

* In TN, ELR is the electronic submission of laboratory results thought to be indicative of a reportable condition, disease, or event, as described by the TDH, using interoperability standards.

Manual Lab Submission

Manually submitted lab reports can be faxed or mailed to either:

1. The TN Department of Health, Communicable and Environmental Diseases and Emergency Preparedness central office or,
2. The local health department.

Please visit the Tennessee Department of Health Reportable Diseases site for timelines, mailing addresses, and fax numbers for the state and local health offices.

Manual lab reports submitted to the health department must contain certain minimum data elements, if known.  For a list of those data elements, click HERE.

Confluence document found here: Proposed HHS ELR Submission Guidance using HL7 v2 Messages - Orders & Observations - Confluence.

Electronic Laboratory Reporting (ELR)

In TN, ELR is the electronic submission of laboratory results thought to be indicative of a reportable condition, disease, or event, as described by the TDH, using interoperability standards. The following sections detail the acceptable file formats, vocabulary, and identifiers accepted by TDH.

File Formats:

TDH requires the use of Health Level 7 International (HL7) version 2.x messages for electronic transmission of ELR data.

The preferred format of ELR data is HL7, Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health Release 1 (US Realm) with errata.  For a copy, please click HERE.

TDH will also receive ELR messages following the Implementation Guide for transmission of Laboratory-Based Reporting of Public Health Information using Version 2.3.1 of the HL7 Standard Protocol (dated March 2005).  For a copy, please contact edx@cdc.gov.

For information on HL7 standards and specifications, please click HERE.

Vocabulary

TDH requires the use of standard vocabulary when appropriate.  Examples of expected standard vocabulary include:

- Logical Observation Identifiers Names and Codes (LOINC)
- Systemized Nomenclature of Medicine (SNOMED)
- Unified Code for Units of Measure (UCUM)

Please visit : PHINVADS and Reportable Condition Mapping Tables (RCMT)  or LOINC for more information on standard vocabulary and the Reportable Conditions Mapping Tables (RCMT).

Identifiers
TDH requires the use of identifiers when appropriate. Examples of expected identifiers include:

- Object Identifier (OID)
- Clinical Laboratory Improvement Amendments (CLIA)
- National Provider Identifier (NPI)

ELR Message Validation
TDH uses free, on-line ELR message tools to assist with validation. Examples include:

- CDC’s “Message Evaluation and Testing Service (MET) METS - Message Evaluation and Testing Service | CDC

- NIST HL7 2.5.1 Validation Suite for certifying 2014 Edition Meaningful Use EHR technology

ELR On-Boarding
For public health, clinical, and regional laboratories not associated with Meaningful Use, please contact the Communicable and Environmental Diseases & Emergency Preparedness Surveillance Systems and Informatics Program at CEDS.Informatics@tn.gov for on-boarding information. For more information on ELR on-boarding, including the on-boarding process, on-boarding checklist, frequently asked questions, business rules, and message format and vocabulary, please see the ELR Onboarding Handbook.

ELR Registration
The on-boarding process to exchange ELR data with the Tennessee Department of Health (TDH) requires registration by each potential trading partner in the TDH Trading Partner Registration (TPR) system. The TPR provides documentation that can be utilized for Meaningful Use (MU) attestation, and allows users to view their progress from end to end through the use of milestone letters documenting the on-boarding process. If you have not yet registered with TDH in the TPR system and you wish to send ELR to TDH, please contact MU.Health@tn.gov for assistance. For more information on ELR on-boarding, including the on-boarding process, on-boarding checklist, frequently asked questions, business rules, and message format and vocabulary, please see the ELR Onboarding Handbook .

Meaningful Use
ELR is a Public Health Menu Item for Meaningful Use Stage 1 and a Core Item for Meaningful Use Stage 2. Please click HERE for more information about Meaningful Use and the other Public Health Options.

Additional Information and Useful Links
For more information or to receive a draft copy of our trading partner agreement, please contact the Communicable and Environmental Diseases & Emergency Preparedness Surveillance Systems and Informatics Program ELR team at CEDS.Informatics@tn.gov.

For Frequently Asked Questions (FAQ), please click HERE.

For an ELR Fact Sheet, please click HERE.

TN Department of Health Reportable Diseases

HL7

LOINC

PHINVADS and Reportable Condition Mapping Tables (RCMT)

METS - Message Evaluation and Testing Service | CDC

TDH MU

SNOMED

UCUM

NIST HL7 2.5.1 ELR Validation Suite

HL7 OID Registry

Options for Public Health Reporting

The Medicare and Medicaid Promoting Interoperability (PI) Programs are designed to encourage the use of Electronic Health Information Technology to improve the quality, safety, efficiency of patient health care in our nation. Eligible providers who adopt, implement, upgrade to Certified Electronic Health Record Technology (CEHRT) may receive incentive payments if they can demonstrate the use of their systems in a meaningful way. To participate in PI programs, eligible clinicians (ECs), eligible professionals (EPs) and eligible hospitals (EHs) must meet certain Public Health Measures.

For more information on the Public Health reporting options, including the on-boarding and testing processes, trading partner agreements and specifications, please review the information listed below. All fact sheets will be updated as soon as changes are required and/or if updates are made.

Contact

If you have any questions or comments you would like to share, click on the link below to enter your information in the Office of Informatics and Analytics (OIA) Feedback form.

For questions regarding Promoting Interoperability programs and/or public health reporting, please contact the TDH Partner Engagement Team at MU.Health@tn.gov.

Trading Partner Registration System