Implementation Workgroup:Current Activities and Next Steps

Member List• Elizabeth Johnson, Co-Chair, Tenet

Healthcare Corp.• Cris Ross, Co-Chair, Mayo Clinic• Robert Anthony, Centers for

Medicare & Medicaid• Robert Barker, NextGen Healthcare• Kevin Brady, NIST• Anne Castro, BlueCross BlueShield

of South Carolina• Simon P. Cohn, Kaiser Permanente• Tim Cromwell,Veterans Affairs• John Derr, Golden Living, LLC• Carol Diamond, Markle Foundation• Timothy Gutshall, Iowa HIT

Regional Extension Center

• Joseph Heyman, Whittier IPA• David Kates, NAVINET• Tim Morris, Emory University• Nancy Orvis, Department of

Defense• Steven Palmer, Texas

Health/Human Services Commission

• Wes Rishel, Gartner, Inc.• Kenneth Tarkoff, RelayHealth• John Travis, Cerner• Micky Tripathi, MA eHealth

Collaborative• Ex-Officio Aneesh Chopra, Chief

Technology

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Overview• Test Scenario Development• 2014 Test Methods Timeline• 2014 Test Methods: Public Review and Comment• IWG Next Steps

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Unit Based Test Procedures

• Current Test Procedures employ a unit based testing module where each criteria is tested individually.

• Testing data nor results are forwarded onto any other tests for that product

Development Methodology:Unit Based Testing

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Development MethodologyScenario Based Test Procedures

• Proposed Test Procedures will employ scenario based testing where results and data is forwarded onto test for that product

Development Methodology:Scenario Based Testing

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Development MethodologyScenario Based Test Procedures

• Scenario Based Test Procedures will be modularly developed so that individual tests can be skipped for products which do not have that capability

Development Methodology:Scenario Based Testing

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Test Scenario Development• Development Approach

– Reflects a typical clinical workflow in multiple care settings

– Allows persistence of data elements• Provides a model for data threading between different

certification criterion and various destinations within an EHR– Maintains testing flexibility (e.g. add/remove “unit test”)

• Types– Medication Management – Outpatient– Emergency Department – Inpatient

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Test Scenario Development

• Process– Develop clinically plausible workflow– Current Testing Scenarios based on 2011 Edition

Certification Criteria– Reevaluate against 2014 Edition Certification Criteria

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Test Scenario Example

• PDF of Medication Management Test Scenario Review

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Findings

• Scenario-based testing can be used to test EHRs

• Complexities in specific individual tests and testing data will yield difficulty in scenario testing

• Complexity, and cost-benefit will be evaluated further to determine next steps

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2014 Test Method Timeline

OCT NOVAUG SEPT DEC JAN

Public Comment Period

Technical Workshop (public)11/13/12 – 11/15/12

8/23/2012

9/7 11/15

W2 W3 W49/7 9/14 9/21 9/28

W510/17

W1

W19/7 9/21

W29/14 9/28

W39/21 10/5

W49/28 10/12

W510/17 10/31

Test Procedures Revised9/21 11/30

2014 Test Procedures Posted12/14/2012

LRI10/31

LRI10/31 11/14

National Coordinator Approval12/312/7

10/5A1

A1 10/5 10/19

12/712/142014 Scope Expansion for ACBs and ATLs

DRAFT

Workshop12/14/2012

2014Certification

Begins

1/2/201

A210/31 12/1

10/2/12 – 10/4/12Technical Workshop (ATL/ACB)

Test Scenarios Reviewed/revised12/7 On-going

2014 Test Method Timeline

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2014 Test Method (TPs, TD, TTs)Public Comment: Wave 1• Release Date: 9/7/2012 (Comment Period: 9/7/12 – 9/21/12)

– 170.314(a)(1) Computerized provider order entry– 170.314(a)(4) Vital signs, body mass index, and growth charts.– 170.314(a)(5) Problem List– 170.314(a)(6) Medication List– 170.314(a)(7) Medication allergy list– 170.314(a)(10) Drug formulary checks– 170.314(a)(11) Smoking status– 170.314(a)(15) Patient-specific education resources– 170.314(a)(17) Inpt setting only - advance directives– 170.314(d)(5) Automatic log-off– 170.314(d)(8) Integrity– 170.314(d)(9) Optional-accounting of disclosures– 170.314(f)(1) Immunization Information– 170.314(f)(2) Transmission to immunization registries– 170.314(f)(2) TOOL ONLY - Immunization Registry (IIS)

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2014 Test Method (TPs, TD, TTs)Public Comment: Wave 2• Release Date: 9/14/2012 (Comment Period: 9/14/12 – 9/28/12)

– 170.314(a)(3) Demographics– 170.314(a)(9) Electronic notes– 170.314(a)(13) Family health history– 170.314(a)(14) Patient list creation– 170.314(d)(6) Emergency access– 170.314(f)(5) Amb setting only—cancer case information– 170.314(f)(6) Amb setting only—transmission to cancer registries– 170.314(f)(6) TOOL ONLY - CDA Validation (Cancer Registry)

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IWG Next Steps

• Test Scenarios– Incorporate 2014 Certification Criteria– Review against 2014 Test Procedures

• 2014 Test Procedures– Provide input on the draft Test Procedures

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