The session will provide a view of the use of EHRs to meet MU requirements at both the state and local levels. In one instance a state has developed an EHR to use at 67 local health departments and data collected is to be shared with the state HIE, state Immunization Registry, and ELRs and biosurveillance. In the other instance, a state participated in the national pilot of the direct project for the public health use case for the exchange of data between EHRs and immunization registries.