2014 Edition Test ScenariosDevelopment Overview

Presenter: Scott Purnell-Saunders, ONCAugust 27, 2013

Contents

Development 3

Workflow Review 4

Overview 5

Overview: Workflow 6

Overview: Workflow Descriptions 7

Overview: Workflow Assumptions 8

Group 1: Scenarios 9

Encounter: Intake Workflow 10

Encounter: Interoperability Intake Workflow 11

Encounter: Care Ordering Workflow 12

Encounter: Care Results Workflow 13

Encounter: Post-Care Workflow 14

Example: Encounter: Intake 15

Group 2: Scenarios 16

Next Steps 17

2

Review Overview Group 1 Group 2 Next Steps

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

Review Overview Group 1 Group 2 Next Steps

2012 2013 2014

Script Development

Proof of Concept

Pilot

Scenario Development

Group 1 Draft Scenarios Released

Approved Group 1 Scenarios Available

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

Review Overview Group 1 Group 2 Next Steps

ONC is asking for your feedback on the concept, structure, and usability of the following Group 1 Draft Test Scenarios.

5

Overview

Group 1

# Scenario Name Criteria Included

1 Encounter: Intake a3, a5, a6, a7, f1, a11, a13, a17, f5, a4

2 Encounter: Interoperability Intake b1, b4

3 Encounter: Care Ordering a1, a2, b3, a10, a16

4 Encounter: Care Results a12, b5, a8, a15, a9, e2

5 Encounter: Post-Care a14, b7, b6, e3, e1, b2

Development: July – December 2013

Group 2

# Scenario Name Criteria Included

6 Reporting c1, c2, c3, f2, f3, f4, f6

7 Privacy & Security d1, d2, d3, d4, d5, d6, d7, d8, d9

8 System g1, g2, g3, g4

Development: 2014

Review Overview Group 1 Group 2 Next Steps

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 8 scenarios

6

Review Overview Group 1 Group 2 Next Steps

Considerations:

• It does not represent the only way unit tests could be linked in a clinical workflow

• It does not imply anything about how providers should use CEHRT

• It only addresses the 2014 Edition EHR Certification Criteria

• Future editions of the certification criteria could allow ONC to develop scenarios addressing other concerns

Overview: Workflow Descriptions

7

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

Review Overview Group 1 Group 2 Next Steps

Scenario 1

Encounter: Intake

Scenario 2

Encounter: Interoperability

Intake

Scenario 3

Encounter: Care Ordering

Scenario 4

Encounter: Care Results

Scenario 5

Encounter: Post-Care

Scenario 6

Reporting

Scenario 7

Privacy & Security

Scenario 8

System

Group 1

Development: July – December 2013 Development: 2014

Overview: Workflow Assumptions

8

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

Review Overview Group 1 Group 2 Next Steps

Group 1: Scenarios

9

Group 1 includes five scenarios

Group 1

Scenario 1

Encounter: Intake

Actions which could be performed by any member of the care team or patient before the patient sees a provider.

10 criteria

Scenario 2

Encounter: Interoperability

Intake

Actions which could be taken to incorporate a summary of care document received from another provider or hospital before treating the patient.

2 criteria

Scenario 3

Encounter: Care Ordering

Actions related to ordering care for the patient (medications, laboratory or imaging) during the care episode.

5 criteria

Scenario 4

Encounter:Care Results

Actions related to the results of earlier care orders for the patient, provision of resources for the patient and provider, and visit notes.

6 criteria

Scenario 5

Encounter:Post-Care

Actions which could be performed after the encounter with the patient has ended, but are directly related to the provision of care to the specific patient, including the creation of summary of care records.

6 criteria

Review Overview Group 1 Group 2 Next Steps

Encounter: Intake Workflow

10

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:

Scenario 1

Encounter: Intake

Actions which could be performed by any member of the care team or patient before the patient sees a provider.

10 criteria

Workflow:

• 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

Tests:

• 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

Encounter: Interoperability Intake 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

Workflow:

• Transitions of care: receive, display, and incorporate transition of care / referral summaries

• Clinical information reconciliation

Tests:

Scenario 2

Encounter: Interoperability

Intake

Actions which could be taken to incorporate a summary of care document received from another provider or hospital before treating the patient.

2 criteria

11

Encounter: Care Ordering Workflow

12

During a visit (ambulatory) or admission (inpatient), the following orders are recorded for the Patient:

Workflow:

• Computerized provider order entry• Drug-drug, drug-allergy interaction

checks

• Electronic prescribing• Drug-formulary checks• Electronic medication administration

record

Tests:

Scenario 3

Encounter: Care Ordering

Actions related to ordering care for the patient (medications, laboratory or imaging) during the care episode.

5 criteria

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.

• Medication

• Laboratory

• Radiology/imaging orders

Encounter: Care Results Workflow

13

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.

Workflow:

• Image results• Incorporate laboratory tests and

values/results• Clinical decision support

• Patient-specific education resources• Electronic notes• Clinical summary

Tests:

Scenario 4

Encounter:Care Results

Actions related to the results of earlier care orders for the patient, provision of resources for the patient and provider, and visit notes.

6 criteria

Encounter: Post-Care Workflow

14

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.

Workflow:

• 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

Tests:

Scenario 5

Encounter:Post-Care

Actions which could be performed after the encounter with the patient has ended, but are directly related to the provision of care to the specific patient, including the creation of summary of care records.

6 criteria

15

Example: Encounter: Intake

Cover Page Workflow / Script

Review Overview Group 1 Group 2 Next Steps

Group 2: Scenarios

17

Group 2 will include three scenarios

• ONC has outlined the workflow for these scenarios, and plans to develop them in 2014

Group 2

Scenario 6

Reporting

Actions which relate to reporting to CMS and other bodies, and which could be performed by administrative users of the EHR.

7 criteria

Scenario 7

Privacy & Security

Privacy and security requirements to be fulfilled by EHR systems.

9 criteria

Scenario 8

System

Automated actions to be performed by EHR systems and actions related to system design.

4 criteria

Review Overview Group 1 Group 2 Next Steps

Next Steps

17

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

Review Overview Group 1 Group 2 Next Steps