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 [email protected]; 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
Top Related