STC | iQ (v. April 2018) State User Guide

Interface Form (Administration)

State users can create standard interface form templates on the Interface Forms page. These interface forms can capture the information needed in onboarding so that an organization/facility's readiness to onboard can be evaluated. Some of the user responses can be ranked to carry heavier weight. The ranked responses are calculated and the higher an interface form's score, the better the provider's chances are for being more quickly and easily onboarded.

Click here to watch a video about this topic.

Click the Admin > Interface Form menu link to open the Interface Forms page.

Interface forms are listed in three sections on the page:

Active - This is the interface form that is currently being used. Active interface forms can only be viewed on the Interface Forms administration page, not edited. Click the View icon to open and view it. An active interface form is created when a draft form is published and the next highest whole number is assigned to it as the version number.
Draft - This is the interface form that is currently being built. Every time it is saved, it is given the next minor version number (the numbers after the decimal point - 8.21, for example). Draft interface forms can be edited. By default, iQ is released with one draft interface form. Once the draft version is published, the published version is saved under the Active heading and both the active form and the draft form are given the next highest whole number as a version number, and the draft version can continue to be edited and saved. When the next version is published, the previous active interface form is moved down to the Archived list and the new version becomes the Active version, with the next major version number.
Archived - These interface forms are no longer in use, but are saved because they might have been used by providers previously. Active interface forms are archived when a draft version is published - the previously active form (if there is one) is moved to the Archived list, while the newly published version is given a new version number and listed in the Active section. The draft version is also renumbered.

View the Active Interface Form

To view the active interface form - the one that is currently assigned to newly added providers on the Provider Profile page - click the View icon (). The State View icon (), displayed at the bottom of the interface form page, indicates that the state-only questions are visible on the form. To hide the state-only questions to view the form as a provider would see it, click the State View icon. The Provider View icon () appears in its place, to indicate that the state-only questions are hidden. Click the Provider View icon to return to State View mode. Click through the various tab sections at the top of the page to view those questions. To close the active form, click the Close icon ().

Edit a Draft Interface Form

To edit a draft interface form, click the Edit icon (). The Interface Form Editor page opens. Make any necessary changes and click the Save icon ().

The draft interface form opens with six separate sections listed as tabs:

Provider Info
EHR Info
EHR Docs
IIS Participation
MU & Status
Bi-Direction

Since some of the information on interface forms is required, only the optional information is displayed on the tabs. For example, the organization/facility name, address and phone number are required, so that question category is automatically populated on the form and not included as an option in the question categories list on the left. Each optional component can be dragged and dropped onto the form. Each component contains one or more questions that are meant to be answered during the onboarding process. Some of the questions can be ranked to give the user an idea of which provider is more ready than another to be onboarded.

At any time while editing, save the form by clicking the Save icon ().

Example Interface Forms administration page

While editing a draft interface form, click the Save icon () to save the form (after which the minor version number increases by one, such as from 8.21 to 8.22). Click the Close icon () to close the draft interface form and return to the main Interface Forms administration page.

Note that each question section has a Placeholder Tooltip Text where the user can enter information to help providers correctly fill out the form. This text displays when the Organization/Facility user hovers their mouse over the information icon in the question area. In addition, the questions and any response fields or options in blue (radio buttons labels, textbox labels, checkbox labels) can be edited in the draft interface form by clicking on the text and changing it. Some fields and options are required and, therefore, not editable.

After editing a form, it must be published in order to become the active interface form (see Publish an Interface Form).

Provider Info Tab

Tab 1 is the Provider Info tab. Drag and drop a question category from the left side of the Provider Info tab section onto the Drop Questions Here spot on the page, which changes color once the component is selected. Once the question category is moved to the form, it is removed from the list of question categories. To remove the question category from the form, click the Delete icon (). The question category is then returned to the list of categories.

If the questions in a category are meant to be required (as opposed to optional), select the Required option. If the questions should only be viewed/edited by State users, select the State only option.

Each question section has a Placeholder Tooltip Text where the user can enter information to help providers correctly fill out the form. The text displays when the Organization/Facility user hovers their mouse over the question area. In addition, the questions and any response fields or options in blue (radio buttons labels, textbox labels, checkbox labels) can be edited by clicking on the text and changing it. Some fields and options are required and, therefore, not editable.

Click here to see an example Provider Information tab section.

Question Category	Question	Response Options/Fields	Weight Ranking?
Provider Information	(Basic organization information. This section is mandatory on all interface forms.)	Organization Name Facility Name Street Address City State Zip Phone Number	No
Mailing Address	(Basic mailing address information)	Same as physical address: Yes/No Street Address City State Zip Phone Number	No
Project Lead	Who will be the Project Lead for this location?	First Name Last Name Phone Email	No
Technical Lead	Who will be the Technical Lead for this location?	First Name Last Name Phone Email	No
QA Contact	Who will be the Quality Assurance contact for this location?	First Name Last Name Phone Email	No
Inventory Manager	Who will be the Inventory Manager for this location?	First Name Last Name Phone Email	No
VFC Provider	Are you a VFC provider?	Yes No If Other field (to enter text)	No
IIS ID	What is your IIS ID, if known?	IIS ID	No
Clinic Type	What type of clinic is this site?	Pediatric Family Practice Community Health Hospital Birthing Facility - Approximately how many births per month? (number field) - Do you have a process for updating a newborn's name from "Baby Boy/Girl" to the name given by the parents/guardians? (Yes/No)	Yes
NPI Number	What is your NPI number?	A field for text entry	No
Provider Numbers	How many providers are practicing at this site?	A field for number entry	No
Patient Record Numbers	Approximately how many patient records do you currently house?	1-500 501-1000 1001-10,000 10,001+	Yes
Vaccine Numbers	Approximately how many vaccines are given at your location per month?	1-500 501-1000 1001-10,000 10,000+	Yes
Patient Ages	What age ranges of patients do you see?	Newborns and infants Children under 19 years Adults 19 and older Staff Seasonal and Influenza	Yes
Private Stock Vaccines	Does this location purchase private stock vaccines?	Yes No	Yes

EHR Info Tab

Tab 2 is the Electronic Health Record Information tab. Drag and drop a question category from the left side of the EHR Info tab section onto the Drop Questions Here spot on the page, which changes color once the component is selected. The question category is in position and ready to be dropped into place when the background color turns dark green. To remove the question category from the form, click the Delete icon (). If the questions are meant to be required (as opposed to optional), select the Required option. If the questions should only be viewed/edited by State users, select the State only option.

Some answers/options for a question include a drop-down list from which a numerical score (1-10) can be selected. This score is used in ranking an organization/facility's readiness to onboard based on the answer provided. The higher the score given to the field, the more weight the answer has.

Question Category	Question	Response Options/Fields	Weight Ranking?
EHR Vendor	Who is your EHR vendor?	Drop-down list containing these options: Amazing Charts Athena Aprima CPSI eClinicalWorks MacPractice McKesson Med3000 Meditech NextGen Other (with If Other field for entering text)	Yes
EHR Version Number	What is your EHR's version number?	A field for text entry	No
EHR Type	What type of EHR is this?	Billing Scheduling Full Other (with If Other field for entering text)	Yes
EHR Contact	What is the contact information for your EHR vendor?	First Name Last Name Phone Email	No
EHR Length of Use	How long has this EHR been in use at this location?	Years (field for entering the number of years) Months (field for entering the number of months)	No
EHR Upgrade	When is your next planned EHR upgrade?	In the next 6 months In the next year In the next 3 years No upgrade planned for the foreseeable future If Other (with field for entering text)	Yes
EHR Capabilities	With the current or projected version of your EHR, which of the following capabilities are possible?	Review error logs Distinguish or point to different locations Realtime interface Batch interface	Yes

EHR Docs Tab

Tab 3 is the Electronic Health Record Documentation tab. Drag and drop a question category from the left side of the EHR Docs tab section onto the Drop Questions Here spot on the page, which changes color once the component is selected. The question category is in position and ready to be dropped into place when the background color turns dark green. To remove the question category from the form, click the Delete icon (). If the questions are meant to be required (as opposed to optional), select the Required option. If the questions should only be viewed/edited by State users, select the State only option.

Question Category	Question	Response Options/Fields	Weight Ranking?
Patient Demographic Information	Which of the following patient demographics are captured by your EHR?	Unique medical record number for each patient First Name Middle Name Last Name Date of Birth Gender Phone Number Cell Phone Number Address VFC Eligibility Race Ethnicity Financial Class for VFC Eligibility Multiple Birth Indicator/Birth Order Guardian/Next of Kin Name Guardian/Next of Kin Relationship to Patient Guardian/Next of Kin Address Guardian/Next of Kin Phone Number Primary Facility	Yes
Vaccination Information	Which of the following vaccination information is captured by your EHR?	Vaccine Code (CVX, CPT) and Name Lot Number Manufacturer Code Expiration Date VIS Publication Date VIS Form Given Date Purchase Source or Supply (Public/Private) VFC/Program Eligibility Route of Administration Site of Administration Dose Size Vaccinator (Administering Provider) Facility Name/ID	Yes
Forecasting Feature	Does the EHR have a patient-specific vaccine forecasting feature?	Yes No	Yes
Chickenpox Documentation	Is patient history of chickenpox documented in the EHR?	Yes (with text field for: If Yes, in which field or section?) No	Yes

IIS Participation Tab

Tab 4 is the IIS Participation tab. Drag and drop a question category from the left side of the IIS Participation tab section onto the Drop Questions Here spot on the page, which changes color once the component is selected. The question category is in position and ready to be dropped into place when the background color turns dark green. To remove the question category from the form, click the Delete icon (). If the questions are meant to be required (as opposed to optional), select the Required option. If the questions should only be viewed/edited by State users, select the State only option.

Question Category	Question	Response Options/Fields	Weight Ranking?
Immunizations	Do you currently enter immunizations in the IIS?	Yes No	Yes
All Ages	Do you enter information for patients of all ages?	Yes No (with text field for If No, which age ranges do you enter information for?)	Yes
Historical Data	Do you enter historical data into the IIS?	Yes No (with text field for If No, why not?)	Yes

MU & Status Tab

Tab 5 is the Meaningful Use and/or Interface Status tab. Drag and drop a question category from the left side of the MU & Status tab section onto the Drop Questions Here spot on the page, which changes color once the component is selected. The question category is in position and ready to be dropped into place when the background color turns dark green. To remove the question category from the form, click the Delete icon (). If the questions are meant to be required (as opposed to optional), select the Required option. If the questions should only be viewed/edited by State users, select the State only option.

Question Category	Question	Response Options/Fields	Weight Ranking?
Interface with IIS	Do you currently have an interface with the IIS?	Yes No	Yes
MU Stage	Have you submitted an "Intent to Register" for a Meaningful Use Public Health Stage?	No Yes (If Yes, for which Meaningful Use stage? Stage 1, Stage 2, Stage 3)	Yes
Transport Method	What is your current or probable transport method?	HTTPS HTTP TCP/IP	Yes
HL7 Version	Which HL7 version is your EHR capable of transmitting?	2.3.1 2.5.1 Other (specify) (with field to enter text)	Yes
Vaccine Codes	What type of vaccine codes does your EHR have the capability to send?	CVX CPT NDC	Yes
Code Table Maintenance	Who is responsible for code table maintenance?	Vendor only Provider only Either Vendor or Provider Not sure Other (with field to enter text)	Yes
EMR Message Trigger	What triggers the EMR to send the message to your IIS?	Realtime upon saving/submitting the encounter Batch load - Daily Batch load - Weekly Batch load - Monthly	Yes
Immunizations per Visit	If a patient receives 3 immunizations within a single visit, how many HL7 messages will be sent?	One message including all 3 immunizations Three messages - one message per immunization	Yes
Message Content	How much information will be sent in a message?	Just an update with the information entered during that visit A patient's complete immunization history every time a change/update is made	Yes
Refusal Messages	Does your interface support immunization refusal messages?	Yes No Not sure	Yes
SSN Suppression	Does your interface have the ability to SUPPRESS a patient's Social Security number?	Yes No	Yes
Message Updates & Edits	Does your interface support "update" or "edit" messages if a change is made to the patient record?	Yes No Not sure	Yes
Message Deletions	Does your interface support "delete" messages if a message is deleted from your EHR?	Yes No Not sure	Yes
Message Transfer Method	How are your HL7 messages transferred to your IIS?	HTTPS Web Bridge SOAP	Yes
EHR Vaccine Codes	Which of the following EHR vaccine codes are available for use?	(checkbox)	Yes
EHR Manufacturer Codes	Which of the following EHR vaccine manufacturer codes are available for use?	(checkbox)	Yes
EHR URL Pointing	Can the EHR point to more than one URL?	In the QA environment? (Yes/No) In the production environment? (Yes/No)	Yes
EHR Server Location	Where does your server reside?	(field for entering text)	Yes

Bi-Direction Tab

Tab 6 is the Bi-Directional Screening Checklist tab. Drag and drop a question category from the left side of the Bi-Direction tab section onto the Drop Questions Here spot on the page, which changes color once the component is selected. The question category is in position and ready to be dropped into place when the background color turns dark green. To remove the question category from the form, click the Delete icon (). If the questions are meant to be required (as opposed to optional), select the Required option. If the questions should only be viewed/edited by State users, select the State only option.

Question Category	Question	Response Options/Fields	Weight Ranking?
EHR IIS Query Ability	Does your current EHR version have the ability to query the IIS?	Yes No Not sure	Yes
EHR Bi-directional Interface	Does your EHR have the ability to use a bi-directional interface?	Yes No Not sure	Yes

Publish an Interface Form

To make an interface form the Active form, you must publish it by clicking the Publish icon () on the main Interface Forms page. This moves the draft interface form to the Active heading and changes the version number to the next whole number. For example, if the version number of the draft form was 8.24 (meaning that the active interface form was version number 8.0 and the draft form had been edited and saved 24 times), both the active interface form and the draft interface form are re-numbered to version 9.0. The previously active interface form, version number 8.0, is moved down to the Archived list of forms.

Assign an Interface Form to a Provider

To assign an interface form to a provider, go to the Provider List page. Either add a new provider or locate a current provider in the list and click on the organization/facility name, which opens the Provider Profile page for that provider. (Note that clicking the organization/facility name also changes the search bar to show the organization/facility name, too.) Scroll down to the bottom of the page and click Assign Interface Form. The button only appears for providers that have not had an interface form previously assigned to them. A new tab section is added to the top of the page, next to Profile and Documents: Interface Form [version number]. See the Interface Form for more information about the Interface Form tab section.