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1. Conformance and Interoperability Testing ofNHIS, Turkey: TestBATN Framework and NHIS Test Scenarios http://www.srdc.com.tr/ TestBATN is supported by the Scientific and Technical Research Councilof Turkey (TÜBİTAK), TEYDEP Project No: 7070191

2. Overview IHIC 08, Crete, Greece NHIS Overview NHIS Web Services Integration Profile TestBATN Framework Turkey NHIS Test Scenarios Conformance and Interoperability Testing Event, Çeşme, İzmir Demonstration

3. NHIS Overview IHIC 08, Crete, Greece • Turkey’s National Health Information System(NHIS) aims to provide a nation-wide infrastructure for sharing Electronic Health Records (EHRs) • Currently, Minimum Health Data Sets, called the“Transmission Schemas”, from the Family Medicine InformationSystems (FMIS) and the Hospital Information Systems (HIS) tothe NHIS servers at the MoH premises • The implementation provides • Twenty five HL7 v3based Web Services • Sixteennon-HL7 Web Serviceseach of which is specialized to a specific Minimum Health Data Set Transmission

4. MHDS Web Services Integration Profile IHIC 08, Crete, Greece • The integration profile is based on the following national and international standards and specifications: • The Transmission Schemas are HL7 v3conformant messages and localized according to the national requirements • For transport protocol, HL7 Web Services Profile is used • For security, WS-Security Username Token overSSL is required for conformance • Codes in the messages must be from the Health Coding Reference Server (HCRS) • The id numbers of the doctors in the messages should exist in Doctor Data Bank • The patient id numbers in the messages are required to exist and be consistent with Turkey’s MERNIS (Central Demographics Management System) • For each Transmission Schema and MHDS, several semantic Business Rules are defined to provide consistency among the values used in the data elements

5. TestBATN Framework IHIC 08, Crete, Greece • A generic Web-based Conformance and Interoperability Testing Framework for e-Business standarts and specifications • HL7, Integrated Healthcare Enterprises (IHE), OASIS UBL, OAGIS, GS1 eCOM, CIDX, RosettaNet, etc. • How the TestBATN can be used? • Web-based testing service to support vendors to test themselves for conformance and interoperability • As a testing and monitoring tool in interoperability testing events • As a certification framework • As tool for SDOs or interoperability consortiums

6. TestBATN Features IHIC 08, Crete, Greece • A Test Execution Model consisting of high level testconstructs • Provides functionalities to handle or simulate different parts orlayers of the interoperability stack • Automate the whole testing process • Messaging Capabilities (Sending, Receiving, Listening) • Data Processing Capabilities • Test Assertions • Configuration Management • User Interaction (set/show scenario requirements, test questions, monitoring test execution)

7. TestBATN Test Description Language • A computer interpretable XML-based test description language which provides • Flexibility to design • Modify • Maintain and • Extend the testfunctionality • In contrast to a priori designed and hard coded test cases • Provides a graphical environment • Where a test designer can assemble the reusable testconstructs to desing a test scenario IHIC 08, Crete, Greece

8. Turkey NHIS Test Scenarios IHIC 08, Crete, Greece • Basic Conformance Test Cases:Tests the ability of the SUTs (HIS or FMISsystems) to send valid “Transmission Schemas” in terms of syntactic and structural constraints • The ability of the systems to send HL7 WebServices Profile conformant SOAP (Web Service) messages • The ability of the systems to send WSSecurity Username-Token Profile conformant SOAP (Web Service) messages • The ability of the systems to use theusername and the password assigned to it correctly, asspecified in the WS-Security Username-Token Profile in the corresponding SOAP header • Syntactic validations of “Transmission Schemas”sent by the systems against their corresponding XML schemas • Checking if the code systems and the codes used inthe “Transmission Schemas” are valid • Validation of the “Transmission Schemas” accordingto the corresponding business rules

9. Turkey NHIS Test Scenarios IHIC 08, Crete, Greece • Interoperability Test Cases: • Functions as a proxy between the SUTs(FMISs and HISs) and the MoH NHIS Server • Internally stores all intercepted messages for further testing • Applies the same checks presented in basic conformance test cases and generates its own transmission response based on the profile constraints • As the final step, the transmission responses of theMoH Server are validated against the ones generatedinternally by the TestBATN framework

10. Turkey NHIS Test Scenarios IHIC 08, Crete, Greece • Functionality/Semantic Test Cases: • Tests whether the information inthe transmissions accurately represents the intentionalsemantics of the FMIS or HIS users (e.g. doctors, family practitioners) • A real life scenario with some information requirements are provided to user or users are asked to specify the values • The information requirements are tested by semantic validations • Performed Tests: • Basic Conformance Tests • Testing whether the system provides all possiblecode values to its user for selection, • Checking whether the system accurately packs thevalue selected by the user into the transmission, • Testing whether the system (HIS or FMS) has theability to render this value to its users

11. NHIS Conformance Testing Event, Izmir 2008 IHIC 08, Crete, Greece • A conformance testing event(connect-a-thon like event), a five-day workshop, is organized by MoH, Turkey in June 2008 in Cesme, İzmir. • 200 Test Scenarios categorized under 25 testsuites are developed for TestBATN • During the workshop more than 5000 test scenarios are executed through TestBATN by an avarage of 130 participants from 55 vendors • After the workshop TestBATN is also deployed to MoH Servers and are still publicly available from web for vendors to test their products for conformance • 109 registered users • https://212.175.169.50:8443/testexecution/TestExecutionGUI.html

12. TestBATN Architecture Test Scenario Design Test Scenario Execution Party1 Party1 Party3 Party2 TestBATN Framework Configuration Management x: String y: XML $y Handle Preliminary Data z: ... Party 1 SOAP Adaptor <InitiateValue valueInitiator=“NHISSampleValueProvider" valueID=“diagnosisCode” /> ReceiveMessage Variable Declarations Expressions .... .... <acknowledgement> <typeCode code="%$ackTypeCode%" /> <message> <id extension="%$messageID%" /> </message> </acknowledgement> .... ..... Party3 HTTP Adaptor Business Process $y Source (XML) TestAssertion SendMessage XPath (Expr.) HTTPHeader SOAPHeader NHIS Sample Value Provider //hl7:examination//hl7:encounter//hl7:diagnosis/@code = $diagnosisCode Party 2 SOAPBody XSD Validator Exit Variable Assignment XPATH Validator x= TCP Adaptor ebXML Adaptor ListenMessage srdc:insertAfter(XML source, XML node, String xpath) srdc:formatXSDDate(String date) srdc:generateUUID() Schematron Validator Regular Expr. Validator srdc:generateUUID() HCRSCode Validator MLLP Adaptor IHIC 08, Crete, Greece SMTP Adaptor UDP Adaptor

13. Demonstration IHIC 08, Crete, Greece Thank you for your attention...