5 Steps to Data Exchange

Sites who are interested in submitting immunization data to CAIR2 from their EHR systems will need to proceed through the 5 steps listed.  However, if your Site is in Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties,  please contact CAIR San Joaquin  for further instructions.  And if your Site is in San Diego county, please contact CAIR San Diego for further instructions.

Note: Patient disclosure (see CAIR Notice) is required before immunization data can be submitted to CAIR.  For more information, please refer to the CAIR Disclosure/Sharing Policy page. The CAIR Notice is available in a variety of languages.


Below are the 5 Steps your Site will need to complete in order to submit electronic data to CAIR2. If you have any additional questions after reviewing this page, please review to the CAIR2 DX FAQs.

Step 1 – Site Enrollment

  1. Register at the CAIR2 IZ Portal.
    • Choose one of the following Site Types at registration (Consult with your EHR vendor to determine which Site type you are before registering.)
      • Site Type #1 will submit data directly from their EHR to CAIR2;
      • Site Type #2 will submit data to CAIR2 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 CAIR2 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.

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: https://cair.cdph.ca.gov/CATRN-WS/IISService?WSDL) to the server/interface engine that will be submitting the HL7 messages.
  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 should 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 CAIRDataExchange@cdph.ca.gov; include your assigned CAIR2 ID and your CAIR2 Sending Facility ID (if you have one) in the email.
  3. 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 CairDataExchange@cdph.ca.gov.