Real World Testing Plan 2024

REAL WORLD TESTING PLAN 2024

GENERAL INFORMATION

Plan Report ID Number: 20231103emp

Developer Name

eMedPractice, LLC

Product Name(s)

eMedicalPractice

Version Number(s)

2.0

Product List (CHPL) ID(s)

15.02.05.2898.EMED.01.01.1.220112

Developer Real World Testing Plan Page URL

https://emedpractice.com/real-world-testing-plan

JUSTIFICATION FOR THE REAL WORLD TESTING APPROACH

Structured interviews will be conducted with five ambulatory offices staff holding a range of clinical, administrative and managerial roles, and with differing levels of exposure to the certification criteria. Qualitative data were analyzed thematically, and themes were subsequently organized within the constructs of the PARIHS framework.

The PARIHS (Promoting Action on Research Implementation) framework proposes that successful implementation of measures in practice is a function of the relation between the nature of the evidence, the context in which the proposed changes are to be implemented and the mechanisms by which the change is facilitated. The framework is expressed as:

SI = f (E, C, F)

where SI=successful implementation, E=evidence, C=context, F=facilitation and f=function of

Each factor, evidence, context and facilitation consist of sub-elements that can be rated on a scale from low to high. High ratings on each factor are more likely to produce successful implementation results.

Evidence	Context	Facilitation
Staff perceptions	Culture	Measure fit
	External factors	Familiarity/exposure
		Burden
		Engagement

STANDARDS UPDATES (INCLUDING STANDARDS VERSION ADVANCEMENT PROCESS (SVAP) AND UNITED STATES CORE DATA FOR INTEROPERABILITY (USCDI))

MEASURES USED IN OVERALL APPROACH

Description of Measurement/Metric

Test Plan: The test cases will include actions by varying user types to capture the required data and workflows. In some scenarios, real world patient data will be used to confirm compliance with the things such as successful transmission statuses for some certification criteria requirements. Compliance with Required standards will be tested via manual inspection and/or with ONC-recommended test tools.

Test Methods: The following test methods will be used to complete testing of conformance with the certification criteria requirements.

Entry of simulation data
Analysis of log data & log files
Testing with ONC-approved testing tools
Real time patient centric scenarios in production environment

Standard (and version)	USCDI 1.0
Updated certification criteria and associated products	b1, b2, e1, g9
Health IT Module CHPL ID	15.02.05.2898.EMED.01.01.1.220112
Method used for standard update	N/A
Date of ONC ACB notification	11/16/2022
Date of customer notification (SVAP only)	N/A
Conformance measure	measurement/metric from the RWT Plan associated with b1, b2, e1, and g9 ( 170.315(b)(1) Transitions of care for b1, 170.315(b)(2) Clinical information reconciliation and incorporation for b2, 170.315(e)(1) View, download, and transmit to 3rd party for e1, 170.315(g)(9) Application access - all data request for g(9)
USCDI updated certification criteria (and USCDI version)	b1, b2, e1, & g9 (USCDI v1.0)

Measurement/Metric
Certification criteria will be tested by successful demonstration of each measure. Final metric will be calculated by percentage of clients who successfully demonstrate the required certification criteria. The study is to explore staff perspectives on the feasibility and acceptance of a range of strategies to support implementation of complexity of workflows and use cases within care settings.

Measurement/Metric

Certification criteria will be tested by successful demonstration of each measure.

Final metric will be calculated by percentage of clients who successfully demonstrate the required certification criteria.

The study is to explore staff perspectives on the feasibility and acceptance of a range of strategies to support implementation of complexity of workflows and use cases within care settings.

Associated Certification Criteria

The following are the list of certification criteria associated with the measure and relied upon software.

Measurement/Metric	Description	Justification	Relied Upon Software
170.315(b)(1) Transitions of care	Demonstration of creation of a C-CDA at the end of an ambulatory encounter with transmission to the referral provider of care via Direct Messaging. Verify receipt of C-CDA transmissions in the referral provider's environment from the referral inbound queue and save it to the EHR.	This is to justify to creation of a C-CDA document from referral at the end of a patient visit with transmission to the referral provider of care via Direct Messaging. This is to demonstrate the ability to receive a C-CDA via Direct messaging into the email Inbound Documents Queue and process it as a clinical document and save it to the EHR.
170.315(b)(2) Clinical information reconciliation and incorporation	Demonstration of incorporating problem list, medication list and allergy medication list reconciliation from discrete problems, medications and medication allergies parsed from a C-CDA in referral providers environment. Verify the successful reconciliation of parsed discrete data in the referral provider's environment into the problem list, medication list and allergy list in the clinical summary.	This is to demonstrate the ability to reconcile patient clinical data from referral in to discrete problems, medications, allergies, Lab data & notes parsed from a C-CDA into the EHR in a production environment.
170.315(b)(3) Electronic Prescribing	Demonstration of creation and transmission of an electronic prescription, cancel and refill flows on any selected practices. Verify the successfully transmitted electronic prescriptions in the practice eRx log and Surescripts log.	This to justify providers sending real eRxs to pharmacies, receiving refills and rxchange requests from pharmacies in real world.
170.315(b)(10) Electronic Health Information export	Demonstration of complete health information export options based on customer requirements.	This is to justify a practice can download patient data in any of these formats C-CCD, hl7 and also scanned documents.
170.315(c)(1) Clinical quality measures - record and export	Demonstration of the ability to export patient data recorded in the EHR for a given patient population and import that into the Cypress Test Tool for calculation of specified quality measures that will match the results obtained in the testing for 170.315(c)(2).	This is to justify capturing all data points to calculate quality measures and export to QRDA I files. Same results should be calculated after importing to cypress tool.
170.315(c)(2) Clinical quality measures - import and calculate	Demonstration of the ability to calculate quality measures for the patient data and measures specified in the demonstration for 170.315(c)(1) and match to the quality measure results obtained from the Cypress Test tool.	This is to justify the calculation of quality measures final results with cypress tool.
170.315(c)(3) Clinical quality measures - report	Demonstration of the ability to generate QRDA 1 and QRDA 3 files.	This is to justify if a practice can generate QRDA files that can be submitted to CMS quality measurements.
170.315(e)(1) View, download, and transmit to 3rd party	Login to the patient portal to view clinical summary, create and make a valid C-CDA available to download or transmit to 3rd party.	This is to justify a patient can login the patient portal, view the clinical summary and download it.	WinRAR (Version 5)
170.315(f)(1) Transmission to public health agencies-immunization registry	Demonstration of the ability to add an immunization to a patient and generate a VXU message for an administered immunization and transmit it via HL7 2.5.1 to a public health agency successfully (FL SHOTS). Verify the immunization log of successful VXU message transmissions.	This is to justify if a practice can report the information on administered immunizations to a public health agency.
170.315(f)(2) Transmission to public health agencies-syndromic surveillance	Demonstration of the ability to generate a Syndromic Surveillance message for an Urgent care patient and transmit it via HL7 2.5.1 to a public health agency.	This is to justify if any urgent care setup can submit information to a public health agency on patient health information.
170.315(f)(4) Transmission to cancer registries	Demonstration of the ability to generate a message for an ambulatory care patient and transmit it via HL7 2.5.1 to a cancer registry.	This is to justify if a practice can submit a message to a cancer registry.
170.315(g)(7) Application access - patient selection	Demonstration of a patient's ability to make a data request through API for one or more data elements from the USCDI data set.	This is to justify that if a patient makes a request for a data category for one or more of the data elements in the USCDI data set from an API.
170.315(g)(9) Application access - all data request	Demonstration of a patient's ability to make a data request through API for one or more data elements from the USCDI Data Set.	This is to justify that if a patient makes a request for complete data elements in the USCDI Data set from an API.
170.315(g)(10) Standardized API for patient and population services	Healthcare data standard(FHIR) with an application programming interface (API) for representing and exchanging electronic health records.	This is to justify that if a patient data can be exchanged between two health care providers using FHIR.
170.315(h)(1) Direct Project	This measure will demonstrate the ability to send and receive direct project messages.	This is to justify that a practice can send and receive referrals between the practices.

Care Setting(s)

Care Setting	Justification
The selected specialty facility settings are representative of all of the settings that are currently using the eMedicalPractice. The test results are same for all specialties & facilities.
Ambulatory Primary care	Will pick three primary care settings to exchange the data between the patient referral networks in real time. Primary care providers can send a referral in real time to any specialist office using direct email by exchanging the CDA files. This type of primary care ambulatory setting represents more than 40% of our emedicalpractice customer base. Most of said referrals originated from these primary care facilities.
Ambulatory Pulmonary	Will pick one pulmonary care setting to exchange the patient data in real time. This specialist office can consume the referral in their system and complete the care. This type of pulmonary care ambulatory settings represents at least 10% of our emedicalpractice customer base. The specialist office will be sending back consultation notes to the primary care office in real time. Primary care offices will consume the real time consultation notes to complete the referral loop.
Ambulatory Infectious diseases	Will pick one infectious diseases care setting to exchange the patient data in real time. This specialist office can consume the referral in their system and complete the care. This type of infectious care ambulatory settings represents at least 10% of our emedicalpractice customer base. The specialist office will be sending back consultation notes to the primary care office in real time. Primary care offices will consume the real time consultation notes to complete the referral loop.

Expected Outcomes

Measurement/Metric	Expected Outcomes
170.315(b)(1) Transitions of care	Total number of successfully transmitted referrals along with attached CCDA via Direct messaging based on receipt of MDN ACK message status. Total number of failed transmissions based on receipt of message status. Total number of received email messages via inbound Direct messaging, to measure the volume of successful receipts of referrals via Direct Messaging. Error rates will be tracked and trended over time
170.315(b)(2) Clinical information reconciliation and incorporation	Total number of problem list reconciled Total number of medication list reconciled Total number of medication allergy list reconciled Total number with all 3 domains reconciled. Error rates will be tracked and trended over time.
170.315(b)(3) Electronic Prescribing	Log data will be verified in prescription log. Total number of new electronic prescriptions successfully transmitted Total number of changed electronic prescriptions successfully transmitted Total number of canceled electronic prescriptions successfully transmitted Total number of refill prescriptions successfully transmitted Total number of medication history requests sent electronically. Error rates will be tracked and trended over time.
170.315(b)(10) Electronic Health Information export	Data request on schedule basis or one to the export the patients. Total data exports performed. Data errors/accuracy will be tracked over the time and trended over the time.
170.315(c)(1) Clinical quality measures - record and export	Total number of measures selected by provider. Total number of defects identified and resolved. Total number of successful submissions to CMS or exported by provider. Data errors/accuracy will be tracked over the time and trended over the time.
170.315(c)(2) Clinical quality measures - import and calculate	Total number of measures selected by provider & imported. Total number of defects identified and resolved. Total number of successful submissions to CMS or exported by provider. Data errors/accuracy will be tracked over the time and trended over the time.
170.315(c)(3) Clinical quality measures - report	Total number of measures selected by provider. Total number of defects identified and resolved to calculate the population dashboard. Total number of successful submissions QRDA III files to CMS or exported by provider. Data errors/accuracy will be tracked over the time and trended over the time.
170.315(e)(1) View, download, and transmit to 3rd party	Total number of patient registered for patient portal. Total number of CCDA documents made available to patients via a patient portal. Error rates will be tracked and trended over time.
170.315(f)(1) Transmission to public health agencies-immunization registry	Total number of immunization registry HL7 messages transmitted of administered immunizations. Total number of response message transmissions occurred by querying immunization log. Data errors/accuracy will be tracked over the time and trended over the time.
170.315(f)(2) Transmission to public health agencies-syndromic surveillance.	Total number of Syndromic Surveillance HL7 messages transmissions occurred. Data errors/accuracy will be tracked over the time and trended over the time.
170.315(f)(4) Transmission to cancer registries	Total number of HL7 messages transmissions occurred to Cancer registries. Data errors/accuracy will be tracked over the time and trended over the time.
170.315(g)(7) Application access - patient selection	Total number patient API authentication requests came in. Total number patient API requests completed by checking in log. Data errors/accuracy will be tracked over the time and trended over the time.
170.315(g)(9) Application access - all data request	Total number patient API authentication requests came in. Total number of patient API requests completed for all data by checking in log. Error rates will be tracked and trended over time.
170.315(g)(10) Standardized API for patient and population services	Request a patient request using FHIR API from source provider office. Receive a complete patient clinical data and documents related to the specific patient. Error rates will be tracked and trended over time.
170.315(h)(1) Direct Project	Expect to see messages successfully sent and received. Error rates will be tracked and trended over time.

SCHEDULE OF KEY MILESTONES

Key Milestone	Care Setting	Date/Timeframe
Identify 5 various ambulatory care settings and start capturing the feasibility study	Ambulatory	3/30/2024
with final data collection, The datasets generated and analyzed during the current study.	Ambulatory	10/30/2024
Report the final data to ACB	Ambulatory	01/15/2025

Disclaimer

eMedicalPractice is committed to Real World Testing (RWT) plan as much as possible but execution of this plan is dependent on eMedicalPractice customer participation on the RWT activity throughout calendar year 2024, based on their availability, which is beyond eMedicalPractice’s control. eMedicalPractice strives to review the plan on an ongoing basis and may modify the RWT plan steps as and when necessary to fully meet the needs of RWT. There are a few criteria that need mentioning owing to less adoption by the industry or by customer base.

Use of the following certified criteria has low usage among the customer base. Testing the following transactions for RWT might be difficult and eMedicalPractice reserves the right to test transactions using a simulated environment.

170.315(e)(1) View, download, and transmit to 3rd party-Use of download & transmit.
170.315(f)(2) Transmission to public health agencies-syndromic surveillance.
170.315(f)(4) Transmission to cancer registries.
170.315(g)(7) & 170.315(g)(9) Application access – patient selection & all data requests.

ATTESTATION

This Real World Testing plan is complete with all required elements, including measures that address all certification criteria and care settings. All information in this plan is up-to-date and fully addresses the health IT developer’s Real World Testing requirements.

Authorized Representative Name

Nandu Dhanekula

Authorized Representative Email

Nandu@emedpractice.com

Authorized Representative Phone

561-921-0978

Authorized Representative Signature

Date

10/06/2023

REAL WORLD TESTING PLANS & REPORTS

Testing Plan	Testing Report
RWTP-2025
RWTP-2024
RWTP-2023	RWTR-2023
RWTP-2022	RWTR-2022