REAL WORLD TESTING PLAN 2025
General Information
Plan Report ID Number: 20241105emp
Developer Name
eMedPractice, LLC
Product Name(s)
eMedicalPractice
Version Number(s)
2.0
Certified Health IT
2015 Edition
Product List (CHPL) ID(s)
15.02.05.2898.EMED.01.01.1.220112
Developer Real World Testing Plan Page URL
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 will be analyzed thematically, and themes will be 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
(STANDARDS VERSION ADVANCEMENT PROCESS (SVAP) STANDARDS UPDATES)
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) |
For the g10 criterion:
170.215(b)(1)(i) 4.0.0 HL7® FHIR® US Core Implementation Guide STU 4.0.0, June 2021 170.215(c)(2) HL7® FHIR® SMART Application Launch Framework Implementation Guide Release 2.0.0, November 26, 2021 170.215(d)(1) HL7® FHIR® Bulk Data Access (Flat FHIR®) (v2.0.0: STU 2), November 26, 2021 |
|---|---|
| Updated certification criteria and associated products | 170.315(g)(10) for eMedicalPractice |
| Health IT Module CHPL ID | 15.02.05.2898.EMED.01.01.1.220112 |
| Date of ONC ACB notification | 11/16/2022 |
| Date of customer notification (SVAP only) | 12/01/2022 |
| Conformance method and measurement/metric(s) |
measurement/metric from the RWT Plan associated with 170.315(c)(3) Clinical quality measures – report & 170.315(g)(10) Standardized API for patient and population services. |
| 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 export 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 the calculation of quality measures after recording in EHR. An user can export a de-duplicated archive of patient documents which are at a minimum is in accordance with the standard specified in: § 170.205(h)(3)in the CMS QRDA Category I IG format of the clinical quality measure. | |
| 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. |
A user can import a de-duplicated archive of patient documents which are at a minimum is in accordance with the standard specified in: § 170.205(h)(3)in the CMS QRDA Category I IG format of the clinical quality measure. | |
| 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 QRDAI & III files that can be submitted to CMS quality measurements. The user can generate an aggregate report with calculated summary data for the patient population of the clinical quality measures calculated in the Execute test (§ 170.315(c)(2)), which at a minimum is in accordance with the standard specified in § 170.205(k)(3). | |
| 170.315(c)(4) Clinical quality measures – filter |
Demonstration of the ability to filter the measures . |
This is to justify if a practice can filter the quality measures by specialty or by weightage. | |
| 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 test results are same for all specialties & facilities. |
|
|
Small & Rural health |
Will pick one small primary & rural care settings to collect the data calculate the measures. This type of primary care ambulatory setting represents more than 10% of our emedicalpractice customer base. Most of said Interoperability originated from these primary care facilities. |
|
Behavioral Health |
Will pick one behavioral health care setting to collect the measures data. This type of behavioral health care ambulatory settings represents at least 30% of our emedicalpractice customer base. |
|
Ambulatory specialty setting |
Will pick one for various specialty care setting to collect the patient data in real time. This specialist office can consume the referral in their system and complete the care. This type of care ambulatory settings represents at least 60% of our emedicalpractice customer base. |
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(c)(4) Clinical quality measures – filter |
Total number of measures available. Practice should be able filter by specialty. Error rates will be tracked and trended over 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 |
Small & Rural health Behavioral Health Ambulatory specialty setting |
3/30/2025 |
|
with final data collection, The datasets generated and analyzed during the current study. |
Small & Rural health Behavioral Health Ambulatory specialty setting |
10/30/2025 |
|
Report the final data to ACB |
Small & Rural health Behavioral Health Ambulatory specialty setting |
01/15/2026 |
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 2025, 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(g)(10) Standardized API for patient and population services
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
10/06/2024