2014 Edition Test Scenarios Development Overview

1. 2014 Edition Test ScenariosDevelopment Overview Presenter: Scott Purnell-Saunders, ONC August 27, 2013

2. Contents

3. Development ONC plans to develop the 2014 Edition Test Scenarios in two groups • ONC released the Group 1 2014 Edition Draft Test Scenarios two weeks ago • They are available on ONC’s website: http://www.healthit.gov/policy-researchers-implementers/2014-edition-draft-test-scenarios • Group 2 will be developed in 2014

4. Workflow Review After the test scenario pilot this spring, ONC outlined a larger workflow for the 2014 Edition Test Scenarios • The workflow follows a patient from their initial contact with a provider’s office or hospital through their care and follow up • It also follows a provider or hospital through public health and clinical quality measure reporting • The workflow is a framework for testing products using a series of clinically-plausible scenarios • ONC has outlined what criteria could be met by each scenario • The pilot scenario is included in this workflow • The workflow was reviewed with ONC clinical experts • ONC is asking for your feedback on the concept, structure, and usability of the following Group 1 Draft Test Scenarios.

5. Overview

6. Overview: Workflow ONC has drafted a clinically-plausible workflow to guide the development of the 2014 Edition Test Scenarios • This workflow is intended to represent one way that all of the 2014 Edition EHR Certification Criteria could be included in a clinically-plausible workflow The draft workflow includes 8scenarios • Considerations: • It does not represent the only way unit tests could be linked in a clinical workflow • It does notimply anything about how providers should useCEHRT • It only addresses the 2014 Edition EHR Certification Criteria • Future editions of the certification criteria could allow ONC to develop scenarios addressing other concerns

7. Overview: Workflow Descriptions Group 1 Group 2 Group 1 scenarios represent activities that are largely towards the clinical end of the spectrum and could be performed by members of the care team and/or patient Group 2 scenarios represent activities that are largely towards the administrative end of the spectrum and could be performed by administrative users Development: July – December 2013 Development: 2014

8. Overview: Workflow Assumptions ONC has outlined what criteria could be included in each scenario • In the outlines on the following slides, ONC assumes that testing will proceed sequentially through each scenario • The test scenario procedures provide additional guidance for what additional criteria are required if a scenario is not tested in sequence • Workflow is the core of each test scenario procedure and guided the development of the test scenario data

9. Group 1: Scenarios Group 1 includes five scenarios Group 1

10. Encounter: Intake Workflow Workflow: • The Patient arrives for a visit with a Provider (ambulatory) or at a Hospital (inpatient). • The following information about the Patient is recorded in the Provider’s or Hospital’s EHR: • Demographics • Medications • Medication allergies • Problems • Immunization information • Smoking status • Family health history • Inpatient only: Advance directives • Ambulatory only: Cancer case information • Vital signs, BMI, and growth charts Tests: • Demographics • Vital signs, BMI, and growth charts • Problem list • Medication list • Medication allergy list • Smoking status • Family health history • Advance directives • Immunization information • Cancer case information

11. Encounter: Interoperability Intake Workflow Workflow: • The Provider or Hospital receives a transition of care or referral summary for the Patient from a recent Hospital admission (ambulatory) or ambulatory visit (inpatient). • The transition of care / referral summary for the Patient is received, displayed, and incorporated in the Provider’s or Hospital’s EHR. • Clinical information reconciliation is performed between the medication, medication allergy, and problem lists stored in the EHR and those contained in the transition of care / referral summary Tests: • Transitions of care: receive, display, and incorporate transition of care / referral summaries • Clinical information reconciliation 11

12. Encounter: Care Ordering Workflow Workflow: • During a visit (ambulatory) or admission (inpatient), the following orders are recorded for the Patient: • Medication • Laboratory • Radiology/imaging orders • The EHR indicates drug-drug, drug-allergy contraindication interventions. The Provider or a member of the care team generates prescriptions for electronic transmission, and checks whether a drug formulary exists for the Patient and given medication. • In the inpatient setting only, a member of the care team administers medication and documents the medication administration in the Patient’s record in the Hospital’s EHR. Tests: • Computerized provider order entry • Drug-drug, drug-allergy interaction checks • Electronic prescribing • Drug-formulary checks • Electronic medication administration record

13. Encounter: Care Results Workflow Workflow: • During a subsequent visit (ambulatory) or at a later point in the hospital admission (inpatient), the following occurs: • The EHR indicates that image results for the Patient are available, and they are accessed. • Clinical laboratory tests and values/results for the Patient are received and accessed. • The EHR electronically identifies diagnostic and therapeutic reference information for the Provider and education resources for the Patient. • Electronic notes for the Patient’s visit or admission are recorded in the EHR, and, in the ambulatory setting only, a clinical summary for the Patient is created. Tests: • Image results • Incorporate laboratory tests and values/results • Clinical decision support • Patient-specific education resources • Electronic notes • Clinical summary

14. Encounter: Post-Care Workflow Workflow: • In the ambulatory setting: • After the visit, the Provider exchanges messages with the Patient • In the inpatient setting: • A member of the care team sends the Patient’s electronic laboratory results to the Patient’s ambulatory providers • In both settings: • The Patient views, downloads, and transmits health information to a 3rd party • A transition of care / referral summary for the Patient is created and transmitted • A list of patients including the Patient is created, as well as a set of export summaries for all the patients in the EHR. Tests: • Patient list creation • Data portability • Transmission of electronic laboratory tests and values/results • Secure messaging • View, download, and transmit • Transitions of care – create and transmit

15. Example: Encounter: Intake Cover Page Workflow / Script

16. Group 2: Scenarios Group 2 will include three scenarios • ONC has outlined the workflow for these scenarios, and plans to develop them in 2014 Group 2

17. Next Steps September • Draft test scenarios posted September 11 • Feedback on draft test scenarios to committee chairs before October 11 • Individual feedback may be submitted to ONC.Certification@hhs.gov; please include “2014 Edition Test Scenarios” in the subject line October • Feedback on draft test scenarios ends October 11