2014 Edition Test Scenarios January 2013. Contents Purpose of Test Scenarios3 Completed Work4 Current Work5 Using a Narrative Test Case Scenario to Develop

2014 Edition Test Scenarios

January 2013

2

Contents

Purpose of Test Scenarios 3

Completed Work 4

Current Work 5

Using a Narrative Test Case Scenario to Develop Test Scenarios 6–10

Test Scenario Development 11–12

Test Scenario Diagram Overview 13

Test Scenario Diagram – EHR Interoperability: Intake 14–15

Test Scenario Diagram – Ordering and Medication Management 16

Test Scenarios Development – Next Steps 17

Proposed Test Scenario Development Workplan 18

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)

Interoperability

Intraoperability

4

Completed 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)

Completed Work Current Work

5

Current Work

Developing Test Scenarios

(EHR Interoperability: Intake, Ordering and Medication Management)

• Developing against the 2014 Edition Test Method

• Focusing scope

• Generalizing scenarioso Setting specificity determined by unit testso Scenario details determined by patient test

data (e.g. pediatric vs. geriatric)

• Documents includeo Unit Tests List o Scenario Procedure

o Scenario Diagram o Scenario Test Data

o Scenario Narrative

Completed Work Current WorkDeveloped 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)

6

Using a Narrative Test Case Scenario to Develop Test Scenarios

Narrative Test Case Scenario “X” Setting

WHERE

7

Using a Narrative Test Case Scenario –

Extract Test Scenarios

EHR Interoperability: Intake

Patient Intake

Patient Interaction

Ordering & Med Mgmt.

Patient “Output”

WHAT

(extract individual Test Scenarios)


WHERE

8


Extract Test Case


Patient Intake

Patient Interaction



WHAT



WHERE

Test Data(extract specific

test case)

HOW

9


Determine Unit Tests


Patient Intake

Patient Interaction



WHAT



WHERE


test case)

HOW

Med listMed allergy listProblem list

TOC (in)Clinical info rec

DemographicsMed listMed allergy listProblem list

Smoking statusVital signsAdvance directives

*Examples of possible unit tests per test scenario. Actual unit tests may vary

CPOEeRxDrug-formularyD:D/D:AMed list

Med allergy listProblem listClinical info recTOC (in)eMAR

TOC (out)Clinical summary

Unit Tests*(determine specific unit tests)

10


Choosing Unit Tests and Test Scenarios


Patient Intake

Patient Interaction



WHAT



WHERE


test case)

HOW

Med listMed allergy listProblem list

TOC (in)Clinical info rec

DemographicsMed listMed allergy listProblem list

Smoking statusVital signsAdvance directives

*Examples of possible unit tests per test scenario. Actual unit tests may vary

CPOEeRxDrug-formularyD:D/D:AMed list

Med allergy listProblem listClinical info recTOC (in)eMAR

TOC (out)Clinical summary

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)

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

• 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 settingsXX

Inpatient settingXX

Ambulatory settingXX

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) – 1

1 2 3

4a

5 6

7a

7b4b1, 2 and 5

1, 2, 3, 5 and 6

data data data

1, 2, 3, 4, 5, 6, and 7

Test Criterion

Test Criterion

Test Criterion

Test Criterion

Test Criterion

data added by 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 list1) Med list

1

(a)(7) Med allergy list1) Med allergy list

2

(a)(5) Problem list1) 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)

6

7

8

9

Test Scenario Diagram – EHR Interoperability: Intake

(a)(1) CPOE1) Med Orders2) Lab Orders3) Rad/Img Orders

(b)(3) eRx1) 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)(7) Med allergy list

1) Med allergy list


1) Med list (C-CDA)2) Med allergy list (C-

CDA)3) Problem list


1) C-CDA

(a)(16) eMAR1) Patient2) Medication3) Dose4) Route5) Time6) Document (EHR

specific)

Blue – both settingsGreen – inpatient


Med allergy list (reconciled, if

applicable)

Med list (reconciled, if applicable)

Med from prescription (to update med list)




Med list (EHR)

Problem list (EHR)


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

1

23

4

5

6

7

8

9

15

10


Test Scenario Diagram – Ordering and Medication Management

(a)(1) CPOE1) Med Orders2) Lab Orders3) Rad/Img Orders

(b)(3) eRx1) 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)(7) Med allergy list

1) Med allergy list


1) Med list (C-CDA)2) Med allergy list (C-

CDA)3) Problem list


1) C-CDA

(a)(16) eMAR1) Patient2) Medication3) Dose4) Route5) Time6) Document (EHR

specific)

Blue – both settingsGreen – inpatient


Med allergy list (reconciled, if

applicable)

Med list (reconciled, if applicable)

Med from prescription (to update med list)




Med list (EHR)

Problem list (EHR)


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

1

23

4

5

6

7

8

9

16

10


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