2014 Edition Test Scenarios

1. 2014 Edition Test Scenarios January 2013

2. Contents

3. Purpose of Test Scenarios • Make clinically relevant (i.e. align with plausible clinical scenarios) • Ensure interoperability (using data across systems) • Ensure intraoperability(using data within a system) Intraoperability Interoperability

4. Completed Work Completed Work Current Work

5. Current Work Completed Work Current Work

6. Using a Narrative Test Case Scenario to Develop Test Scenarios WHERE Narrative Test Case Scenario “X” Setting

7. Using a Narrative Test Case Scenario – Extract Test Scenarios WHERE Narrative Test Case Scenario “X” Setting WHAT EHR Interoperability: Intake (extract individual Test Scenarios) Patient Intake Patient Interaction Ordering & Med Mgmt. Patient “Output”

8. Using a Narrative Test Case Scenario – Extract Test Case WHERE Narrative Test Case Scenario “X” Setting WHAT EHR Interoperability: Intake (extract individual Test Scenarios) Patient Intake HOW Test Data (extract specific test case) Patient Interaction Ordering & Med Mgmt. Patient “Output”

9. Using a Narrative Test Case Scenario – Determine Unit Tests WHERE Narrative Test Case Scenario “X” Setting Unit Tests* (determine specific unit tests) WHAT EHR Interoperability: Intake Med list Med allergy list Problem list TOC (in) Clinical info rec (extract individual Test Scenarios) Patient Intake HOW Demographics Med list Med allergy list Problem list Smoking status Vital signs Advance directives Test Data (extract specific test case) Patient Interaction Ordering & Med Mgmt. CPOE eRx Drug-formulary D:D/D:A Med list Med allergy list Problem list Clinical info rec TOC (in) eMAR Patient “Output” TOC (out) Clinical summary *Examples of possible unit tests per test scenario. Actual unit tests may vary

10. Using a Narrative Test Case Scenario – Choosing Unit Tests and Test Scenarios WHERE Narrative Test Case Scenario “X” Setting Unit Tests* (determine specific unit tests) WHAT EHR Interoperability: Intake Med list Med allergy list Problem list TOC (in) Clinical info rec (extract individual Test Scenarios) Patient Intake HOW Demographics Med list Med allergy list Problem list Smoking status Vital signs Advance directives Test Data (extract specific test case) Patient Interaction Ordering & Med Mgmt. CPOE eRx Drug-formulary D:D/D:A Med list Med allergy list Problem list Clinical info rec TOC (in) eMAR Patient “Output” TOC (out) Clinical summary • Determine /Choose Unit Tests and Test Scenarios • Unit Tests: determined by Setting (“popping” tests) • Test Scenarios: determined by Test Data *Examples of possible unit tests per test scenario. Actual unit tests may vary

11. Test Scenario Development – Unit Based Testing • Minimum requirement • Independent tests • Individual test data and results • Currently employed for 2011 Edition Test Procedures Unit Based Testing

12. Test Scenario Development – Scenario Based Testing • Alternative to unit based testing • Dependent tests • Dependent test data and results • Can remove individual test from sequence Scenario Based Testing If test 1 is not applicable…

13. Test Scenario Diagram Overview Both settings XX Test Scenario Diagram visually represents the “linking” of Unit Tests Inpatient setting XX Ambulatory setting XX Test use of EHR data: Evaluates ability to automatically use data already stored in the EHR • Scenarios represent a suggested sequence for testing criteria • Unit Tests are “poppable” (i.e. can remove from scenario for various reasons) • Scenario is made setting specific by adding/removing setting specific tests (e.g. choose between 4a or 4b) 4a Test Criterion data added by criterion data added by criterion Test procedure: Evaluates conformance to certification criterion 7a 1 2 3 Test Criterion Test Criterion Test Criterion data data data 5 6 4b 7b 1, 2 and 5 Test Criterion 1, 2, 3, 5 and 6 1, 2, 3, 4, 5, 6, and 7 Number of Tests: 2*(Number of Criteria) – 1

14. 1 3 Test Scenario Diagram – EHR Interoperability: Intake (a)(5) Problem list Problem list (a)(6) Med list Med list 2 (a)(7) Med allergy list Med allergy list 5 (b)(4) Clinical Info Reconciliation Med list (C-CDA) Med allergy list (C-CDA) Problem list (C-CDA) Med allergy list (EHR) 7 Problem list (reconciled) Med allergy list (reconciled) Med list (reconciled) 8 6 Problem list (EHR) Med list (EHR) Med list (C-CDA) Med allergy list (C-CDA) Problem list (C-CDA) 4 9 (b)(1) TOC – receive, display, incorporate C-CDA

15. Test Scenario Diagram – EHR Interoperability: Intake Med from prescription (to update med list) Med list (reconciled) Med list (reconciled, if applicable) 1 (a)(6) Med list Med list 6 9 Med allergy list (reconciled, if applicable) Prescriptions after drug-formulary check Patient, med, dose, route, time (a)(2) D:D/D:A checks (a)(1) CPOE Med Orders Lab Orders Rad/Img Orders Med Orders 2 3 Med list (EHR) (a)(7) Med allergy list Med allergy list (a)(5) Problem list Problem list Problem list (reconciled) Med allergy list (reconciled) 7 (b)(3) eRx Prescriptions including medication, prescriber, pharmacy, and patient info Problem list (EHR) Med allergy list (EHR) Prescriptions Prescriptions after drug-formulary, drug-drug, drug-allergy interaction check 5 Remove if ambulatory setting (b)(4) Clinical Info Reconciliation Med list (C-CDA) Med allergy list (C-CDA) Problem list 10 (a)(16) eMAR Patient Medication Dose Route Time Document (EHR specific) 8 (a)(10) Drug-formulary checks* Drug-formulary or preferred drug list *Can be moved within the scenario Med list (C-CDA) Med allergy list (C-CDA) Problem list (C-CDA) (b)(1) TOC – receive, display, incorporate C-CDA 4 Blue– both settings Green– inpatient

16. Test Scenario Diagram – Ordering and Medication Management Med from prescription (to update med list) Med list (reconciled) Med list (reconciled, if applicable) 1 Remove if clinical info reconciliation is not applicable (e.g. a new patient) (a)(6) Med list Med list 6 9 Med allergy list (reconciled, if applicable) Prescriptions after drug-formulary check Patient, med, dose, route, time (a)(2) D:D/D:A checks (a)(1) CPOE Med Orders Lab Orders Rad/Img Orders Med Orders 2 3 Med list (EHR) (a)(7) Med allergy list Med allergy list (a)(5) Problem list Problem list Problem list (reconciled) Med allergy list (reconciled) 7 (b)(3) eRx Prescriptions including medication, prescriber, pharmacy, and patient info Problem list (EHR) Med allergy list (EHR) Prescriptions Prescriptions after drug-formulary, drug-drug, drug-allergy interaction check 5 Remove if ambulatory setting (b)(4) Clinical Info Reconciliation Med list (C-CDA) Med allergy list (C-CDA) Problem list 10 (a)(16) eMAR Patient Medication Dose Route Time Document (EHR specific) 8 (a)(10) Drug-formulary checks* Drug-formulary or preferred drug list *Can be moved within the scenario Med list (C-CDA) Med allergy list (C-CDA) Problem list (C-CDA) Remove if patient is not a transition/referral (b)(1) TOC – receive, display, incorporate C-CDA 4 Blue– both settings Green– inpatient

17. Test Scenarios Development – Next Steps Goal: Post the Draft EHR Interoperability: Intake Test Scenario for public comment on January 31, 2013 and post the Final version on February 28, 2013 • EHR Interoperability: Intake document development • Test Scenario Procedure • Test Scenario Data • IWG Meetings to discuss EHR Interoperability: Intake Test Scenario • ATL and ACB focus group to discuss Test Scenarios • Assess competency of ATL and ACB • Pilot EHR Interoperability: Intake Test Scenario • Identify vendors to participate in the piloting

18. Proposed Test Scenario Development Workplan