CDPH Gateway/CAIR2 – 5 Steps to Data Exchange

Provider sites who are interested in submitting immunization data to CAIR2 from their EHR systems should following the 5 steps listed below unless they are in  Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties, inc which case they should contact  CAIR San Joaquin  or in  San Diego county, in which case they should contact CAIR San Diego for assistance.    Note: Patient disclosure is required before immunization data can be entered into or submitted to CAIR.  For more information, please refer to the CAIR Disclosure/Sharing Policy page. 

For an official letter stating when CAIR (7 regions only) became able to receive ‘meaningful use’-qualifying immunization data, click here. 

Below are the 5 Steps your Site will need to complete in order to submit electronic data to CAIR2:

Step 1 – Site Enrollment

  1. Register at the CDPH Gateway/CAIR2 IZ Portal.
    • Consult with your EHR vendor to determine which Site type you are before registering.
    • Search for your existing CAIR2 Org ID if known (e.g 19XYZCLINIC).
    • Choose one of the following Site Types at registration:
      • Site Type #1 will submit data directly from their EHR to the CDPH Gateway/IZ Portal;
      • Site Type #2 will submit data via a distinct Sending Facility (e.g. HIO, vendor/EHR data warehouse, health plan data warehouse, other data aggregator);
      • Site Type #3 will act as a Sending Facility (e.g. HIO, vendor/EHR data warehouse, health plan data warehouse, other data aggregator.
  2. Review and agree to the CAIR Organization/Site and User Access & Confidentiality Agreement.
  3. Confirm your site registration by verify the Site Contact’s email address
  4. The  Site Contact and Data Exchange Contact will receive a secure Portal registration confirmation email (check junk/spam mail folder).
    • Retain this CDPH HIE Gateway/IZ Portal registration confirmation email for future reference.  Note: These secure emails will contain Site credentials as well as information on the follow-up steps your Site must take to prepare for data exchange with CAIR2.

Step 2 – Pre-Testing Preparation (Types #1 and #3 only)

  1. Download and review the CAIR2 HL7 Specifications documents:
  2. Use your certified EHR system to create test messages in accordance with the CAIR HL7 specification.
  3. Optional: to pre-test your HL7 messages, you are invited to use the CAIR2 HL7 Web Validator Tool which checks your message for correct formatting.
    • The Validator Tool is only to be used for pre-testing  and will not qualify a site for ‘meaningful use’.

Step 3 – Initial Test Submission (Site Types #1 and #3)

  1. Review the CAIR2 Test Plan for HL7 VXU Submission to CAIR2 (new submitters only)
  2. The new CAIR2 database is in a different location. Submitters will need to download and install the CAIR2 TEST WSDL (URL: to the server/interface engine that will be submitting the HL7 messages.
    • Test messages should be submitted at least a month before the end of the 90-day attestation reporting period, to allow time to address any unforeseen problems.
  3. Submitted test messages will be validated against the CAIR2 HL7 specification
    • As each submitted HL7 VXU message is received by CAIR2, an HL7 ACK (message accepted) or NAK (message has errors/warnings) is returned back to the submitter.
    • The returned ACK/NAKs will help to guide your Site in making changes to your data formatting until you can submit a message without errors. These ACK/NAKs follow the format laid out in the CDC HL7 Version 2.5.1: Implementation Guide for Immunization Messaging, Release 1.5 and will provide details as to any segments/fields that contain errors. The NAK will also inform as to whether the error constituted a message failure or simply an informational error/warning.

Site Type #2: Indirect

  1. Notify your intermediary Sending Facility (e.g. HIE, cloud-based EHR, data warehouse, etc.) that your site has registered in the CAIR2 IZ Portal. Provide your CAIR2 Provider ID and CAIR Region Code.
  2. If your Site is submitting data to CAIR2 through an intermediary Sending Facility, you should contact the Sending Facility/EHR vendor to determine whether ACK/NAKs returned to the Sending Facility by CAIR2 can be returned and displayed in your EHR.
    • Sites must monitor returned ACK/NAK messages and make corrections to their submissions as needed. Test messaging will also be monitored by DX staff.
  3. If your Sending Facility is unable to return ACK/NAKs or your EHR system is unable to display them, your Site will still be able to monitor data exchange messaging via the ‘Check Status’ functionality in the CAIR2 interface that is available to CAIR2 ‘Power’ users or the ‘Data Exchange Quality Assurance’ (DX QA) user role.   Go to the CAIR2 Account Update site to add a ‘Power’ user (requires formal training) or DX QA user (does not require training).

Step 4 – Continuing Test Message Validation (Site Types #1 and #3 only)

  1. Send a new set of test messages to CAIR2 for validation of ongoing data submissions
    • A minimum of 50-100 unique test messages bshould be submitted to CAIR2 using a variety of coded values in the HL7 VXU messages.
    • Test messages will be validated against the CAIR2 HL7 specifications and any errors found will be returned to the Site in an ACK/NAK for review.
  2. Address any errors found
    • If there are any errors occurring that require further discussion, a CAIR Data Exchange Specialist (DXS) is available to assist at; include your assigned CAIR2 ID and your CAIR2 Sending Facility ID (if you have one) in the email.
  3. Move to ‘Pre-Production’
    • After a minimum of 50 test messages have been validated and found to contain zero errors, CAIR asks that the Site send production data from their EHR to CAIR2 production (in a ‘testing’ state) to ensure data quality.
    • During ‘pre-production’, CAIR2 will monitor production data until it is determined that the data quality is found to be satisfactory.
    • Any errors found during this process should be addressed by the Site and data resubmitted.
  4. Move to ‘Production’
    • Once it has been determined by the CAIR2 DX Staff that a Site’s data has passed pre-production validation, the site is then moved from a ‘testing’ state to ‘production’.

Site Type #2: Indirect

  1. Your intermediary Sending Facility should notify you when your site has moved to production

Step 5 –  Ongoing Submission of Patient Data

  1. Continue ongoing submission
  2. Correct and re-send any failed messages

Questions?:  Please contact

Interested in bidirectional data exchange (BiDX)?

Using bidirectional messaging, your EHR system may be able to retrieve and display patient immunization histories and doses due recommendations from CAIR2.  BiDX will also be a MU Stage 3 requirement in 2019 and CAIR2 has begun onboarding sites to BiDX .  Follow the steps below to prepare for BiDX.

  1. Consult with your vendor support as to the bidirectional readiness of your current EHR and whether there may be additional costs/EHR upgrades necessary for BiDX.
  2. In order to receive accurate patient recommendations from CAIR2, CAIR2 needs to have full active patient histories. Consider submitting all active patient historical doses to CAIR2. Consult with one of our CAIR Data Exchange Specialist about submitting prior immunizations records (historical data) for your active patients.
  3. Complete the mandatory online CAIR2 Bidirectional Messaging Interest/Readiness Survey.  If you qualify, a DX specialist will contact you to begin the self -directed testing process.
  4. Review the national CAIR2 Bi-directional (QBP/RSP) Data Exchange Implementation Guide for proper message formatting.

Local Data Exchange Representatives

Data Exchange Rep

CAIR Regions Covered



Arlisha Adams
Janet Ajao
Iris Cheever
Eric Dansby
Twila Crook-Lindsey

Northern Cal
Greater Sac
Bay Area
Central Valley
Central Coast
Inland Empire


Help Desk

CAIR San Joaquin (RIDE: Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, and Tuolumne counties)


Danelle Wallace

CAIR San Diego  (SDIR)