2014 Edition Test Scenarios January 2013

Contents Purpose of Test Scenarios3 Completed Work4 Current Work5 Using a Narrative Test Case Scenario to Develop Test Scenarios6–10 Test Scenario Development11–12 Test Scenario Diagram Overview13 Test Scenario Diagram – EHR Interoperability: Intake14–15 Test Scenario Diagram – Ordering and Medication Management16 Test Scenarios Development – Next Steps17 Proposed Test Scenario Development Workplan18 2

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) 3 Interoperability Intraoperability

Completed Work 4 Developed 4 Narrative Test Case Scenarios (Inpatient, Ambulatory, Emergency Department, and Medication Management) Developed against the 2011 Edition Test Method Broad scope (e.g. encompasses full settings) Specific to setting and patient data Narrative (i.e. no procedure) Completed Work Current Work

5 Developing Test Scenarios (EHR Interoperability: Intake, Ordering and Medication Management) Developing against the 2014 Edition Test Method Focusing scope Generalizing scenarios o Setting specificity determined by unit tests o Scenario details determined by patient test data (e.g. pediatric vs. geriatric) Documents include o Unit Tests List o Scenario Procedure o Scenario Diagram o Scenario Test Data o Scenario Narrative Completed Work Current Work Developed 4 Narrative Test Case Scenarios (Inpatient, Ambulatory, Emergency Department, and Medication Management) Developed against the 2011 Edition Test Method Broad scope (e.g. encompasses full settings) Specific to setting and patient data Narrative (i.e. no procedure)

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

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

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

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

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

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

Test Scenario Development – Scenario Based Testing 12 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…

Test Scenario Diagram Overview 13 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) Test Scenario Diagram visually represents the linking of Unit Tests Both settings XX Inpatient setting XX Ambulatory setting XX Test procedure: Evaluates conformance to certification criterion Test use of EHR data: Evaluates ability to automatically use data already stored in the EHR Number of Tests: 2*(Number of Criteria) – a 56 7a 7b 4b 1, 2 and 5 1, 2, 3, 5 and 6 data 1, 2, 3, 4, 5, 6, and 7 Test Criterion data added by criterion

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

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

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

Test Scenarios Development – Next Steps 17 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

Proposed Test Scenario Development Workplan 18