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What is Bidirectional Exchange (BiDX)?

It is the two-way communication between a provider Electronic Health Record system (EHR) and the California Immunization Registry (CAIR2).  When a provider opens a patient record in their EHR, an electronic patient query is sent to CAIR2 and if a matching patient is found, CAIR2 returns an electronic response containing the patient’s immunization history and vaccine recommendations (optional) back to the EHR.  The EHR can then import any of the returned vaccine doses into the patient record. See this one-page flyer (PDF) on how BiDX gets your EHR and CAIR2 connected. To see how it works with one type of EHR and registry view this video.

Save Time and Improve Patient Care

  • No need to login to CAIR2 to view patient histories – they are immediately available for review or upload in your EHR!
  • Patient vaccine recommendations can also be returned,  helping your clinic keep your patients fully vaccinated!

Incentive Payments

  • Meet immunization reporting requirements of the EHR Incentive (‘meaningful use’) Program and the Medicare Merit-based Incentive Payment System (MIPS).
  • Meet immunization performance goals in programs such as Medi-cal Managed Care, MIPS, Pay-for-Performance, Patient-centered Medical Home recognition or Health Resources & Services Administration (HRSA) Quality Awards.

Get Started

More than 1,200 Sites are submitting patient queries to CAIR2 and receiving patient histories back to their EHR systems. Sites interested in BiDX (including data aggregators/HIEs) will need to go through a formal testing/onboarding process. Note: your Site will not be considered for BiDX unless you are currently sending production immunization data to CAIR2.   To begin the BiDX ‘onboarding’ process, follow the steps outlined below.

  1. Consult with your vendor about the readiness of your EHR system to send and receive BiDX messages and whether your EHR hub has already been ‘onboarded’.  Make sure your vendor has reviewed the CAIR2 Bi-directional (QBP/RSP) Data Exchange Implementation Guide. (PDF)
  2. Review the  CAIR2 Bi-directional Data Exchange Checklist (PDF) to make sure your clinic is ready. Changes to your current workflow will likely be necessary and your staff will need to be trained to use your EHR’s ‘BiDX’ functionality.
  3. Complete the CAIR2 Bi-directional Data Exchange Interest/Readiness Survey. This step is required as it places Sites in the BiDX ‘onboarding’ queue.

CAIR2 staff will review your Readiness survey responses and, as staff time allows, contact approved Sites to begin the self-directed testing process.  Once testing is completed, Sites will be allowed to begin BiDX messaging to CAIR2.

Active Patient Histories

To get the most value from the BiDX process, each site should consider submitting all active patient historical doses to CAIR2 so that patient vaccination recommendations returned to your EHR will be correct. Consult with one of our CAIR2 Data Exchange Specialists about submitting prior immunizations records (historical data) for your active patients.

What others say about BiDX

“A mother brought their child into the Urgent Care today with a laceration and couldn’t remember if the child had a recent Tetanus vaccine. CAIR query returned the historical vaccines and showed the patient had a recent DTaP and was able to avoid having to give the child the vaccination. May not sound like much, but to the child, it was a big relief.” – Dr. Laura Polito – Sansum Clinic Urgent Care

“Bi-directional exchange helps us save time in the clinic. We never want to go back to entering and looking up doses manually in CAIR2!”  – Heather – Open Door Health

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