CCHIT Certified 2011 Ambulatory EHR Test Script 20100326

CCHIT Certified 2011 Ambulatory EHR Test Script April 7, 2010

CCHIT Certified 2011 Test Script – Ambulatory + Child Health + Cardiovascular of 121

© 2010 Certification Commission for Health Information Technology

Certification Commission for Health Information Technology

CCHIT Test Scripts

For Certification of Ambulatory EHRs Includes steps and appendix information required for Child Health Certification

Includes steps and appendix information for Cardiovascular Medicine Certification including CV Advanced Reporting Capability Certification

April 7th, 2010

Product (NUMBER CODE ONLY):_________________________ Date: __________________________ Evaluator: _________________________________________ Signature: _______________________





Legend

Test steps that require the Proctor to update the Audit Trail Worksheet are highlighted in cyan.

Test steps that apply to Child Health Certification or Cardiovascular Certification are highlighted in purple.

In the Cardiovascular Scenario, items that are required ONLY for CV Advanced Reporting Capability Certification are highlighted in green.

Test Environment Setup Parameters for Script Execution

For ePrescribing steps:

Applicants using a 3rd Party ePrescribing product must be active with the „Test PBMD‟ on the SureScripts/RxHub platform to properly perform Step 4.58. The ePrescribing network requires that the provider is setup in their network for each Applicant, so that the ePrescribing steps can be executed. Please arrange for the provider (Dr. Butler) to be set up in the ePrescribing network at least one week prior to your inspection date.

Users

There must be five Physician type users with valid login. These users must have at least the following permissions: full access to all clinical functions. o Dr. Robert Alexander – Primary Care Physician in scenario 1 o Dr. McCoy - OB/GYN in scenario 2 o Dr. Internist E. Butler – Internist in scenario 3 o Dr. Jones – Internist o Dr. Green – Cardiologist in CV scenario

There must be one Nurse Practitioner type user with valid login. This user must have at least the following permissions: access to all clinical functions. o Ellen Thompson, CFNP – for use in Scenario 1

There must be one Nurse user with valid login. This user must have at least the following permissions: access to all clinical functions.

There must be one Reception user with valid login. This user must have access to only the following functions: registration and demographic functions.

There must be one Medical Assistant user with valid login. This user must have at least the following permissions: access to all clinical functions.

There must be one Office Manager user with valid login. This user must have at least the following permissions: access to all clinical functions and access to all information necessary to carry out test procedures 4.72 to 4.86.





There must be one Security Administrator type user with valid login. This user must have at least the following permissions: access to all information necessary to carry out security administrative tasks; no rights to access clinical data or Protected Health Information (PHI) as defined by the Centers for Medicare and Medicaid Services (CMS).

o See page 19, section 160.103 Definitions in CMS site: http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/adminsimpregtext.pdf External Providers: For use at step ADM.12, content of the directory is as follows:

Name Address Telephone Specialty

Dr. Dem Bones 456 Anytime Lane, Annapolis MD 21405 410-555-0151 Orthopedics

Dr. Ava Heart 344 Artery Drive, Piney Point MD 301-555-0133 Cardiology

Dr. Ivana Facey 912 Skincare Way, Hollywood MD 20636 301-555-0178 Plastic Surgery

Ms. Mary Smith, RN, CDNE 1234 Elm Street, Anytown USA 555-555-1212 Nutritionist

NOTE: The information in the table above is provided as an example only; if the applicant wishes to demonstrate this function using different content that is acceptable.

Patients

Patient ID numbers are provided for each patient required in the inspection. If the system assigns sequential numbers or other patient ID numbers, please provide a complete list of Patient ID numbers for all patients listed in setup, to the CCHIT Proctor prior to the inspection. There must be a patient record for Ellen Thompson. Patient ID for Ellen Thompson is PID#41205321. As Ellen Thompson is Dr. Alexander‟s sister-in-law, Dr. Alexander should not have access to Ellen Thompson‟s chart. There must be a patient record for Joe Smith Birthdate: 3/23/1967 Telephone: 312-555-1234 Patient ID: PID#41205322 There must be a patient record for Joe Smith Birthdate: 07/01/1998 Mother: Jessica N. Smith Father: J.N. Smith Address: 1600 Rockville Pike, Rockville, Maryland

http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/adminsimpregtext.pdf





Telephone: 301-555-1212 (home) Mom‟s cell: 202-555-1212 Patient ID: PID#41205323 Patient record includes historical data. Information in Appendix A is to be entered as previous visits for this patient at this practice. There must be a patient record for Emily Jones Birthdate: 11/1/2008 Mother: Stacy Jones Father: Michael Jones Address: 2501 Merrvale Road, Rockville, Maryland Telephone: 301-555-0199 (home) Mom‟s cell: 202-555-0199 Dad‟s cell: 202-555-0111 Patient ID: PID#41205324 Preference for Reminders: Elected to Receive Reminders via Mail Patient record includes historical data. Information in Appendix A is to be entered as previous visits for this patient at this practice. There must be a patient record for Will Haynes Birthdate: 11/4/2008 Mother: Marilyn Haynes Father: Joseph Haynes Address: 16167 King Street, Alexandria, Virginia Telephone: 703-555-0111 (home) Patient ID: PID#41205325 Preference for Reminders: Elected to Receive Reminders via Mail Patient record includes historical data. Information in Appendix A is to be entered as previous visits for this patient at this practice. There must be a patient record for Jennifer A. Thompson Birthdate: 4/10/1978 Address: 2300 Commonwealth Avenue, Anytown, MA 02111 Telephone: 617-555-1212 (home) Jennifer‟s cell: 617-555-1234 Husband‟s cell: 617-555-2121





Patient ID: PID#00000111 Patient record includes historical data. Information in Appendix B is to be entered as previous visits for this patient at this practice. There must be a patient record for Theodore S. Smith Birthdate: 11/08/1931. Address: 2300 Commonwealth Avenue, Anytown, MD 22222 Telephone: 240-555-1212 Mobile email: [email protected] Patient ID: PID#00000222 Patient record includes historical data. Information in Appendix C is to be entered as previous visits for this patient at this practice. There must be a patient record for David Carter Birthdate: 03/02/2001 Address: 1234 Willow Way, Silver Spring, MD 20902 Telephone: 301-555-0144 Patient ID: PID#41205328 There must be a patient record for Jim Grayson Birthdate: 09 March 1943 Address: 834 Ocean Vista Avenue, Apt. 202, Santa Monica CA 90401 Telephone: 310-555-2233 Email: [email protected] Patient ID: PID#00000333 There must be a patient record for Chester Pain Birthdate: 29 January 1945 Address: 1060 W. Addison Avenue, Chicago IL 60613 Telephone: 773-555-1908 Email: [email protected] Patient ID: PID#41205330 There must be a patient record for Agatha Bloom Birthdate: 26 February 1982

mailto:[email protected]







Address: 742 Evergreen Terrace, Springfield IL 62701

Telephone: 217-555-4242

Cell Phone: 217-555-9643

Email: [email protected]

Patient ID: PID#41205331

Agatha‟s most recent blood pressure reading is from 10 January 2006.

System

Enable audit logs to log, at a minimum, the events required in Appendix D (found in Security Test Script).

Environment

There must be a printer connected to the system. There must be a scanning device connected to the system. There must be an electronic faxing capability connected to the system. Alert functionality must be set to show all alerts (i.e. not just display “severe” interactions, but also display “mild” interactions). The system must be configured so that the base guideline for a reminder for a mammogram is 50 years of age.

Note to Applicants:

These scenarios are meant to test specific functional requirements; they are not meant to reflect the complete care that might be provided to a patient. In some cases, the procedure may ask for an action that the Applicant does not feel to be clinically correct; please proceed with the procedure.

Scenarios are intended to be run consecutively, 1 through 4. If the Applicant wishes to run scenarios in a different order, or if the Applicant chooses to execute test steps contained within the scenarios in a different order to accommodate workflow of the application, the Applicant must advise CCHIT Proctor in advance. For clinical scenarios, Applicants should note that some elements of the test script are time compressed from what would normally occur in clinical practice setting. This is to accommodate testing of the criteria in a timely manner. Similarly, some test steps may be accomplished by a user other than would normally do a function in a clinical practice setting. Again, this is to accommodate testing of the criteria in a timely manner.

Following this test, the Applicant is expected to conduct the Security Test Script.






Prior to beginning clinical scenarios, these administrative steps will be carried out.

Procedure Expected Result Actual Result Pass/Fail Criteria and Reference Comments

ADM.01

Login as required. Login successful.

ADM.02

In the Diabetes One order set, modify the order set to include the following items:

Basic metabolic panel; and

Non stress test.

The additional orders are added to the order set “Diabetes One.” Order set now includes:

RhoGAM;

HgbA1c;

Nutritional referral;


Non stress test.

Pass Fail FN 10.02 The system shall provide the ability to modify order sets.

FN 10.03 The system shall provide the ability to include in an order set order types including but not limited to medications, laboratory tests, imaging studies, procedures and referrals.

ADM.03

Logout. Logout successful.

Test Script Scenario #1 – Summary:

This Clinical Test Scenario involves a routine well-child visit to his Primary Care Physician for immunization, examination and prescription creation.


1.01 Login as Reception user and create a patient record for Joe Gardner (Joe Gardner‟s Patient ID is 41205332).

Login successful; patient record for Joe Gardner is created.

1.02 Look up patient demographic record by last name SMITH

3 patient records found.

Joe Smith

Joe Smith

Theodore S. Smith

Pass Fail AM 01.01 The system shall create a single patient record for each patient

AM 01.02 The system shall associate (store and link) key identifier information with each patient record

FN 01.02 The system shall capture and maintain demographic information as discrete data elements as part of the patient record.

Proctor to update Audit Trail Worksheet (Appendix D).






1.03 Re-do the search; look up patient by another method (using a different identifier) and select appropriate patient record.

Patient record for correct Joe Smith (second record, mother is Jessica, from Maryland) is found and can be selected. Any other identifier can be used to locate patient record.

Pass Fail AM 01.03 The system shall provide the ability to store more than one identifier for each patient record.

FN 01.01 The system shall provide the ability to access demographic information such as name, date of birth and gender, needed for patient care functions.

FN 02.01 The system shall provide the ability to query for a patient by more than form of identification.

1.04 This Joe Smith and Joe Gardner (patient chart created at login) are the same person. Merge the patient information from the two records into a single patient record. Note that the correct record to keep is the record for Joe Gardner.

A single record is created for patient Joe Gardner.

Pass Fail AM 01.05 The system shall provide the ability to merge patient information from two patient records into a single patient record.

The intent is to merge information for a single patient; this would include discrete data elements from both patient records.

1.05 Show age for Joe Gardner.

Joe Gardner‟s age is expressed in years and months. Years and months will vary depending on inspection date based on birth date of 7/1/1998.

Pass Fail CH 01.01 The system shall allow the recording of date and time of birth (hour and minutes if known) and subsequently be able to express age in hours for the first 4 days of life, then in days from the 5th day of life through the first 28 days, then in weeks beginning on the 29th day of life through the first three completed months of life, and then in months beginning with the 4th month of life through age 2 years. Subsequent expressions of age may be expressed by year and month (2 years 6 months) or with a decimal place for expressing part of years (i.e. 2.5 years old) through age 18.

This step applies only to CHILD HEALTH certification.






1.06 Mother has remarried; and address has changed.

Update Mother‟s last name to Gardner

Update address to 1234 Maplewood Drive, Bethesda, MD, 20810.

Demographic information is to be stored in separate discrete data fields.

Updated demographics are displayed and include:

Updated mother‟s last name;

Updated address. Demographic information is stored in separate discrete data fields.

Pass Fail FN 01.02 The system shall capture and maintain demographic information as discrete data elements as part of the patient record.

AM 02.04 The system shall provide the ability to modify demographic information about the patient.

AM 02.05 The system shall store demographic information in the patient medical record in separate discrete data fields, such that data extraction tools can retrieve these data.

NOTE – if system is tied to an address database that verifies street addresses and zip codes, Applicant is not required to override preloaded address information to match the test script; show that address can be updated, and use a “real” address and zip code if necessary. Proctor to update Audit Trail Worksheet (Appendix D).

1.07 Show how system maintains historical information for prior names and addresses.

Applicant shows historical demographic information. Original field values are displayed including patient prior last name (Smith) and previous address (1600 Rockville Pike, Rockville, Maryland).

Pass Fail AM 02.02 The system shall provide the ability to maintain and make available historic information for demographic data including prior names, addresses, phone numbers and email addresses.






1.08 Enter information for Joe‟s grandmother:

Joanne C. Smith

Address 152 Taylor Street, Chevy Chase, MD, 20815

Telephone 301-555-4321

Name and address of Joe Gardner‟s grandmother is documented.

Pass Fail CH 09.03 The system shall provide the ability to document the names and addresses for patient‟s personal representatives (for example: parent, guardian, surrogate, financial guarantor) and personal relationships (foster parents, biological parents) with contact information for each to include one or more telephone numbers and address.


1.09 Logout as Reception. Logout successful.

1.10 Login as Nurse and select patient record for Joe Gardner.

Login successful. Proctor to update Audit Trail Worksheet (Appendix D).

1.11 Record no family history of smoking, and positive family history of heart disease (father died of heart attack at age 34).

Information added to patient history.

Pass Fail AM 06.02 The system shall provide the ability to capture structured data in the patient history.

AM 06.04 The system shall provide the ability to capture patient history as both a presence and absence of conditions, i.e. the specification of the absence of a personal or family history of a specific diagnosis, procedure or health risk behavior.






1.12 Review required immunization boosters. This display is based on setup data provided for previous immunizations and demographic information of the patient and should display automatically. If system has already displayed notification of immunizations due, this step may have already been observed.

System displays immunizations due at this visit:

Tdap

Varicella

Pass Fail AM 22.01 The system shall provide the ability to establish criteria for disease management, wellness, and preventive services based on patient demographic data (minimally age and gender).

AM 22.02 The system shall provide the ability to display alerts based on established guidelines.

AM 23.01 The system shall provide the ability to identify preventive services, tests or counseling that are due on an individual patient.

AM 23.02 The system shall provide the ability to display reminders for disease management, preventive, and wellness services in the patient record.

AM 23.03 The system shall provide the ability to identify criteria for disease management, preventive, and wellness services based on patient demographic data (age, gender).

AM 23.06 The system shall provide the ability to notify the provider that patients are due or are overdue for disease management, preventive, and wellness services.

Link to the CDC schedule shows that an 11 year old would be eligible for a Tdap and a varicella http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm

1.13 Review allergies in chart.

Allergy to penicillin indicated.

Pass Fail FN 05.13 The system shall provide the ability to capture, maintain and display, as discrete data, lists of medications and other agents to which the patient has had an allergic or other adverse reaction.

1.14 Mother indicates Joe has never taken penicillin; she listed it as an allergy because she is allergic to penicillin. Inactivate penicillin from the list of allergies, or mark erroneous.

Penicillin is inactivated from the list of allergies displayed or noted as erroneous.

Pass Fail FN 05.01 The system shall provide the ability to modify or inactivate an item on the allergy and adverse reaction list.

"Remove" in this context implies specifying that an allergy or allergen specification is no longer valid or active as opposed to deleting the information from the database entirely.

http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm









1.15 Mother indicates Joe is allergic to peanuts but not to any medications.

Add “peanuts” to the list of allergies.

Allergy to peanuts indicated.

Pass Fail FN 05.13 The system shall provide the ability to capture, maintain and display, as discrete data, lists of medications and other agents to which the patient has had an allergic or other adverse reaction.

1.16 Specify type of allergic or adverse reaction to peanuts to be “hives,” in a discrete data field. Note that other terms would be acceptable; the system does not have to use the term “hives.”

System allows specification of “hives” as type of reaction; must be captured in a discrete data field.

Pass Fail FN 05.04 The system shall provide the ability to specify the type of allergic or adverse reaction in a discrete data field.

1.17 Show identity of user [nurse] who inactivated penicillin from the allergies list (in step 1.14; the drug penicillin should be listed as removed or inactivated).

Nurse displays as the user who made the change and penicillin is marked identified as removed or inactivated. Note: It is acceptable to show the identity of the user that made the change in the audit log.

Pass Fail FN 05.05 The system shall provide the ability to capture and maintain, as discrete data, the identity of the user who added, modified, inactivated or removed items from the allergy list, including attributes of the changed items. The user ID and date/time stamp shall be recorded.

Attributes include the name of the allergen and the action (added, modified, inactivated or removed).






1.18 Using a template, record vital signs at

BP 130/90

Height 58”

Weight 80 lbs

Temperature 98.6 (F)

Pulse 124

Respiratory rate 30 If applicant does not use template to input vital signs data in a structured format, please execute the test procedure by inputting vital signs, and then demonstrating use of a template to input other data in a structured format.

Items are captured and displayed as discrete data elements. Temperature, weight and height should display in both English and metric units. Discrete data means that each separate element of the data needs to be stored in its own field. Jurors will look for a separate data field for each element. Notification will be provided that the values for pulse, blood pressure, and respiration are abnormal. NOTE that CCHIT recognizes that this Blood Pressure value is not normal, and in clinical situation would require attention; this value is for testing purposes only.

Pass Fail AM 08.13 The system shall provide the ability to capture patient vital signs, including blood pressure, heart rate, respiratory rate, height, and weight, as discrete data.

AM 08.14 The system shall provide the ability to capture and display temperature, weight and height in both metric and English units.

AM 08.15 The system shall be capable of indicating to the user when a vital sign measurement falls outside a preset normal range as set by authorized users.

AM 08.19 The system shall provide templates for inputting data in a structured format as part of clinical documentation.

CH 02.01 The system shall capture patient growth parameters: including weight, height or length, head circumference; and vital signs including (but not limited to): blood pressure, temperature, heart rate, respiratory rate, oxygen saturation and severity of pain as discrete elements of structured data.

CH 04.01 The system shall include the ability to use pediatric-specific reference ranges for vital signs (examples: pulse, blood pressure, respiration, temperature) based on age, gender, and length/height/weight as appropriate.

For Child Health Certifications, CH 02.01 and CH 04.01 apply at this step in addition to the Ambulatory criteria. With respect to AM 08.14, the criterion requires that the system be able to display both metric and English units; it does not require that both are able to display on the same screen at the same time. Templates may include any patient encounter note documentation tools that provide a pre-set collection of clinical findings or fields, including macros driven by speech recognition technology, branching logic. This list is not necessarily all inclusive of all the technology that may arrive in future.






1.19 Calculate and display body mass index.

Body mass index of 16.7 displays.

Pass Fail AM 08.25 The system shall provide the ability to calculate and display body mass index (BMI).

1.20 Document that there is no pain (i.e. pain level = 0 or any scale that the system provides). Illustrate pain level. Pain level is to be captured as discrete data.

Pain level is captured in discrete data as a numeric pain scale.

Pass Fail CH 02.01 The system shall capture patient growth parameters: including weight, height or length, head circumference; and vital signs including (but not limited to): blood pressure, temperature, heart rate, respiratory rate, oxygen saturation, and severity of pain as discrete elements of structured data.


1.21. AM

Conduct this step if you are seeking AMBULATORY Certification without Cardiovascular certification. Review graphical display of height and weight since birth.

Graph displays; shows height and weight over time. Two graphs are acceptable.

Pass Fail AM 08.24 The system shall provide the ability to graph height and weight over time.

This may be demonstrated in either a single graph that displays both height and weight over time since birth or in separate graphs.






1.21. CV

Conduct this step if you are doing Ambulatory Certification AND CARDIOVASCULAR Certification. Review graphical display of height and weight since birth. These include measurements that were not made at the physician‟s office.

Graph displays; shows height and weight over time. Two graphs are acceptable. Includes weights recorded from outside patient encounter (data from two visits outside this practice are included in the Appendix).

Pass Fail AM 08.24 The system shall provide the ability to graph height and weight over time.

CV 11.02 The system shall provide the ability to document and display vital sign measurements collected outside of the current patient encounter.

CV 11.03 The system shall provide the ability to include vital sign measurements collected outside a patient encounter in trend worksheets

This may be demonstrated in either a single graph that displays both height and weight over time since birth or in separate graphs. For Cardiovascular Certifications, CV 11.02 and CV 11.03 apply at this step in addition to the Ambulatory criteria. This step applies only to CARDIOVASCULAR certification

1.22 Plot Joe‟s height and weight on a growth chart and display.

Growth chart displays with data values entered today and from appendix A. Two graphs are acceptable.

Pass Fail CH 02.02 The system shall display growth charts. Growth data (weight, length or height, head circumference and body mass index) should be graphed against normal data. Growth data (weight, length or height, head circumference and body mass index) should be on a graph that includes normative data plotted against population-based normative curves (e.g. cdc.gov/growth charts) by the age ranges and gender of the respective normative data (e.g. females 0-36 months).


1.23 Logout as Nurse. Logout successful.

1.24 Login as Nurse Practitioner Ellen Thompson.

Login successful






1.25 Access chart for patient Joe Gardner and display the allergy list, including date of entry.

Allergies display; allergic to peanuts with a reaction of “hives.” Date of entry is today.

Pass Fail FN 05.12 The system shall provide the ability to display the allergy list, including date of entry.

It must be possible for a user to view the date of entry for any allergy on the allergy list, but it is acceptable if that is viewed on another screen, e.g. a 'details' screen.

1.26 Display the information that was inactivated or removed from the allergy list.

Information displays indicating that Penicillin is inactivated or removed.

Pass Fail AM 05.03 The system shall provide the ability to display information which has been inactivated or removed from the allergy and adverse reaction list.

1.27 Review allergies for this patient, and document that allergy list was reviewed.

System provides the ability to document that allergies were reviewed.

Pass Fail FN 05.07 The system shall provide the ability for a user to explicitly capture and maintain, as discrete data, that the allergy list was reviewed. The user ID and date/time stamp shall be recorded with the allergies reviewed option is selected.

This requires the user to explicitly select this option documenting that they have reviewed the allergies with the patient.

1.28 Show how the system captures the date and time the review of allergies was performed and the ID of the user performing that review. If a different user is required to execute this step, login as that user.

System shows date and time (today) that the review was performed and the ID of the user (Ellen Thompson, CFNP) performing the review.

Pass Fail FN 05.07 The system shall provide the ability for a user to explicitly capture and maintain, as discrete data, that the allergy list was reviewed. The user ID and date/time stamp shall be recorded with the allergies reviewed option is selected.

It is acceptable to show the identity of the user and the date/time in the audit log.

1.29 Logout as Nurse Practitioner Ellen Thompson.

Logout successful.






1.30 Login as Nurse. Login successful.

1.31 Print a consent form (for parent to provide consent to immunize the patient).

Consent form is printed. Pass Fail AM 15.02 The system shall provide the ability to store, display and print patient consent forms.

Note that consent forms stored in the system that are capable of being signed by the patient with an electronic pen or digital signature once widely available will meet the criterion.

1.32 Mother completes consent form. Scan the completed consent document (provides consent to immunize).

Completed consent document is scanned and displays. The document that was printed in the previous step is now completed by hand and scanned into the system.

Pass Fail AM 09.03 The system shall provide the ability to save scanned documents as images.

AM 15.01 The system shall provide the ability to capture scanned paper consent documents (covered in DC 1.1.3.1).

AM 15.04 The system shall provide the ability to store and display administrative documents (e.g. privacy notices).

1.33 Index the scanned document; associated date is today and document type is “consent.”

Scanned documents can be indexed; date and document type are associated with the scanned document.

Pass Fail AM 09.05.01 The system shall provide the ability to index scanned documents and associate a date and document type to the document.

Indexing implies associating a scanned document with an individual patient record.

1.34 Retrieve the indexed “consent” documents.

Indexed documents of document type “consent” can be retrieved.

Pass Fail AM 09.05.02 The system shall provide the ability to retrieve indexed scanned documents based on document type and date.






1.35 Display consents for this patient chronologically.

Completed consent documents display chronologically. There should be at least three documents, one from today and two previously entered as in Appendix A (consents should be present for immunizations administered at the following visits): 06/15/2000; 07/12/2003 Today

Reverse chronological order is acceptable.

Pass Fail AM 15.05 The system shall provide the ability to chronologically display consents and authorizations.

1.36 Document administration of the immunizations:

Tdap (0.5mL IM left deltoid, lot number F2345, expiration date January 2012, manufacturer sanofi pasteur)

Varicella (0.5mL, subcutaneous right arm, lot number L6870, expiration date September 2012, manufacturer Merck).

Documentation accepted. The following elements must be captured as discrete data: 1) the immunization type

and dose; 2) date and time of

administration; 3) route and site; 4) lot number and

expiration date; 5) manufacturer; and 6) user ID. It is acceptable to review these details in the audit log.

Pass Fail FN 16.03 The system shall provide the ability to capture immunization administration details as discrete data, including: (1) the immunization type and dose; (2) date and time of administration; (3) route and site; (4) lot number and expiration date; (5) manufacturer; and (6) user ID.






1.37 Review required immunization boosters

System displays no immunizations due at this visit as they have already been administered at this visit.

Pass Fail AM 22.09 The system shall provide the ability to document that a preventive or disease management service has been performed based on activities documented in the record (e.g., vital signs taken).

1.38 Retrieve the current immunization record from the EHR view and print report.

Report is created that shows summary of immunizations. Report includes complete history of all immunizations given including: immunization; date given; patient name; patient identifier; and patient demographic information. Report prints.

Pass Fail AM 02.01 The system shall provide the ability to include demographic information in reports.

AM 29.02 The system shall provide the ability to generate reports consisting of all or part of an individual patient‟s medical record (e.g. patient summary).

AM 29.05 The system shall provide the ability to access reports outside the EHR application.

AM 30.02 The system shall provide the ability to generate hardcopy or electronic output of part or all of the individual patient‟s record.

AM 30.05 The system shall provide the ability to create hardcopy and electronic report summary information (procedures, medications, labs, immunizations, allergies and vital signs).

This report should include immunizations administered in step 1.36). Proctor to update Audit Trail Worksheet (Appendix D).

1.39 The patient has had a reaction to the Tdap. Capture the reaction in a discrete field: “redness, swelling.” Note that this can be captured in more than one field if necessary.

Allergy/adverse reaction to a specific immunization can be captured in a discrete field.

Pass Fail FN 16.02 The system shall provide the ability to capture, in a discrete field, an allergy/adverse reaction to a specific immunization.

This may be recorded in the allergy/adverse reaction section of the patient record if the applicant chooses to do that, but is not required.

1.40 Record the date and time of this reaction

Date and time are recorded.

Pass Fail CH 14.02 The system shall provide the ability to record the date and time (if known) of vaccine reaction or allergic occurrence.








1.42 Login as Nurse Practitioner Ellen Thompson and select patient record for Joe Gardner.

Login successful; patient record selected.

1.43 Enter prescription:

Search for Proventil from list of medications.

Search for Albuterol from list of medications and select.

Prescribe Albuterol, 2 puffs every four hours as needed for wheezing.

Medication list is available for search and selection. Search is conducted for each of the brand name and generic drugs; only one is selected. Medication information is updated in the EHR, including prescribing date.

Pass Fail AM 04.03 The system shall provide the ability to maintain medication ordering dates.

AM 04.04 The system shall provide the ability to maintain other dates associated with medications including start, modify, renewal and end dates as applicable.

FN 07.04 The system shall provide end users the ability to search for medications by generic or brand name.

1.44 Access general prescribing information for Albuterol. This step may be combined with the previous step.

Link to general prescribing information is available at the point of prescribing.

Pass Fail FN 07.05 The system shall provide the ability to access reference information for prescribing/ordering.

Acceptable sources of general prescribing information could be 3rd-party drug databases, links to external websites, etc.






1.45 Complete prescription and electronically fax to the pharmacy (CCHIT Test Proctor will provide „pharmacy fax number‟). Note that execution of this step may differ for SureScripts/RxHub certified Applicants.

Prescription is electronically faxed to the number provided by the CCHIT Test Proctor. If the applicant is complying with e-prescribing requirements by submitting a SureScripts/RxHub certificate, has implemented “one-button” e-prescribing and

IS using the SureScripts/RxHub Fax Gateway, SureScripts/RxHub will have set up the CCHIT pharmacy as a fax-only pharmacy so that any prescriptions sent will automatically be faxed to CCHIT

IS NOT using the SureScripts/RxHub Fax Gateway, the applicant is responsible for updating their own pharmacy directory with the CCHIT fax information ahead of time so that the pharmacy can be selected and the prescription will be automatically faxed once the provider clicks “submit.”

Pass Fail AM 11.08 The system shall provide the ability to print and electronically fax prescriptions.

AM 26.01 The system shall have the ability to provide electronic communication between prescribers and pharmacies or other intended recipients of the medication order.

Applicants may meet the requirement by faxing directly from their application to the CCHIT Test Pharmacy Fax number. It is not required to utilize a third party ePrescribing network or partner.






1.46 Electronically fax the prescription for Albuterol to the pharmacy again. Note that execution of this step may differ for SureScripts certified Applicants, as in the previous step.

Prescription resent to pharmacy fax (number provided by CCHIT Test Proctor) without re-entry of prescription details.

Pass Fail AM 11.09 The system shall provide the ability to re-print and re-fax prescriptions.

Applicants may meet the requirement by faxing directly from their application to the CCHIT Test Pharmacy Fax number. It is not required to utilize a third party ePrescribing network or partner.

1.47 Access medication information for Albuterol to provide to the patient.

Medication information is accessible, either within the system or through links to external sources.

Pass Fail FN 17.01 The system shall provide the ability to access and review medication information (such as patient education material or drug monograph). This may reside within the system or be provided through links to external sources.

1.48 Configure subsequent prescriptions to include the text “printed from an EHR.” If a different user is required to execute this step, login as that user.

The fixed text “printed from an EHR” prints on all subsequent prescriptions.

Pass Fail AM 11.15 The system shall provide the ability to allow the user to configure prescriptions to incorporate fixed text according to the user's specifications.






1.49 Enter prescription Vitamin B6 at ½ of one 50 mg tablet daily for six months (enter stop date or duration). Other indicator of “fractional amount,” for example “0.5” is acceptable. Show a print preview of this prescription.

Medication information is updated in EHR. End date or duration is properly reflected. System allows entry of a fractional amount of medication. The print preview shows that the fixed text “printed from an EHR” will appear on the printed prescription.

Pass Fail AM 04.04 The system shall provide the ability to maintain other dates associated with medications including start, modify, renewal and end dates as applicable.

AM 11.13 The system shall provide the ability to prescribe fractional amounts of medication (e.g. 1/2 tsp, 1/2 tablet).

AM 11.15 The system shall provide the ability to allow the user to configure prescriptions to incorporate fixed text according to the user's specifications.

1.50 Review current medications list.

Current medications display:

Albuterol, 2 puffs every four hours as needed for wheezing

Vitamin B6 at 25 mg daily (½ of one 50 mg tablet) for six months

Pass Fail FN 06.01 The system shall provide the ability to update and display a patient-specific medication list based on current medication orders or prescriptions.

1.51 Create site-specific care plan: Enter note “recommend an EKG and ECHO prior to sports because of family history of sudden death of father at a young age.” A text note will be acceptable.

Note added to chart indicating need for future tests.

Pass Fail AM 17.02 The system shall provide the ability to create site-specific care plan, protocol, and guideline documents.






1.52 Sign off on clinical note. Ellen Thompson completes her portion of the note. Identity of user signing off on the note is captured, along with date and time.

Pass Fail AM 08.05 The system shall provide the ability to record the identity of the user finalizing each note and the date and time of finalization.

Date and time must be system generated and recorded automatically. Proctor to update Audit Trail Worksheet (Appendix D.)

1.53 Logout as Nurse Practitioner Ellen Thompson.

Logout successful.

1.54 Login as Dr. Alexander and select the record for Joe Gardner.

Login successful; Joe Gardner‟s patient record selected.

1.55 Place an order for HgbA1c for Joe Gardner.

Order is placed. Note that this order will not be fulfilled in this scenario; it will be used later in the test script.

No criterion is listed here, as this order is entered in preparation for a subsequent step.






1.56 Dr. Alexander cosigns the note.

Cosignature is added to the record, including date and time of the signing. The note is now finalized (i.e. the status of the note is changed to “complete” so that any subsequent changes to the note are recorded as changes to a completed note). Signature may either be visible in the record or in an audit log. In either case, the signature must be date/time stamped by the system. User may not enter the date and time in text form to meet AM 8.06.

Pass Fail AM 08.04 The system shall provide the ability to finalize a note, i.e. change the status of the note from in progress to complete so that any subsequent changes are recorded as such.

AM 08.05 The system shall provide the ability to record the identity of the user finalizing each note and the date and time of finalization.

AM 08.06 The system shall provide the ability to cosign a note and record the date and time of signature.

1.57 Display the identities and credentials of all users who entered part of the note (the note that is signed by Dr. Alexander in the previous step).

Dr. Alexander and Ellen Thompson, along with their credentials, display as users who were involved in the creation of this note.

Pass Fail PC 08.01 The system shall have the ability to record and display the identity and credentials of all users who entered part of a note, even if they did not finalize the notes.

This criterion does not require that the system identify or display which portion or portions of a final note were entered by each user but rather that the system records and displays which users were involved in any part of the creation of the note.






1.58 Exit Joe Gardner‟s chart and attempt to access chart for Ellen Thompson.

Access for Dr. Alexander is denied to Ellen Thompson‟s chart.

Pass Fail AM 36.05 The system shall provide the ability to prevent specified user(s) from accessing a designated patient's chart.

1.59 “Break the glass” and access the chart for Ellen Thompson.

Access for Dr. Alexander is allowed to Ellen Thompson‟s chart.

Pass Fail AM 36.06 When access to a chart is restricted, the system shall provide a means for appropriately authorized users to “break the glass” for emergency situations.

Proctor to update Audit Trail Worksheet (Appendix D).

1.60 Exit chart for Ellen Thompson, and select patient Will Haynes. Review Will Haynes‟ age.

Will Haynes‟ age is expressed in months. Number of months will vary depending on inspection date.



1.61 Enter today‟s weight for Will Haynes (9.5 kilograms) and temperature of 104 degrees.

Patient weight and temperature entered.

Pass Fail AM 08.14 The system shall provide the ability to capture and display temperature, weight and height in both metric and English units.

CH 02.01 The system shall capture patient growth parameters: including weight, height or length, head circumference; and vital signs including (but not limited to): blood pressure, temperature, heart rate, respiratory rate, oxygen saturation, and severity of pain as discrete elements of structured data.

With respect to AM 08.14, the criterion requires that the system be able to display both metric and English units; it does not require that both are able to display on the same screen at the same time.






1.62 Will has an ear infection; enter prescription for Amoxicillin 250 mg/5ml, 15ml, 4 times a day.

System alerts that dosage is incorrect based on the patient weight. Do not complete the prescription.

Pass Fail CH 17.04 The system shall, when a maximum individual or daily dose exist, alert the provider when weight-based or BSA-based dosing would cause these to be exceeded.


1.63 Display dose calculator for patient specific dosing based on weight.

For Amoxicillin prescription the dose-per-weight is 80 mg/kg and the patient weight is 9.5 kg (entered previously.

Dose calculator displays. Patient weight (9.5 kilograms) entered at step 1.61 is used in calculation, either automatically or through repeated input by the user. Dosage is calculated using the calculator. The criterion does not require that the dose is calculated automatically, and it does not require that the results auto-populate the sig. The corresponding dose could be represented as total dosage e.g. 760mg/day.

Pass Fail AM 11.11 The system shall provide the ability to display a dose calculator for patient-specific dosing based on weight.

CH 17.02 The system shall provide weight-based dosing when doses based on weight (e.g. mg/kg) are available for a medication.

The intent is to allow input of dose-per-weight and patient weight and calculate the corresponding dose. The dose-per-weight might be directly inputted by a user at the time the dose calculation is to occur, or might have been inputted previously as the default for a particular medication. The output may be in terms that take into account a particular strength and dosage form of a medication (e.g. "5ml" or "2 tablets") OR may be simply in terms of the amount of the active drug component, (e.g. "250"). It is not required that the dose calculator automatically populate fields in the prescription itself.






1.64 Prescription for Amoxicillin is created to make up the dose at 250 mg/5 mL

Sig will be one teaspoon three times per day for 10 days.

Associate prescription with problem “right otitis media.” Medication information must be stored as discrete data; at a minimum, there must be one field for each of the following: 1. Medication name,

form and strength; 2. Dispense quantity; 3. Refills; and 4. Sig.

Prescription is created. Identity of prescriber (Dr. Alexander) is available to review. Medication information must be stored as discrete data; at a minimum, there must be one field for each of the following: 1. Medication name, form

and strength; 2. Dispense quantity; 3. Refills; and 4. Sig.

Pass Fail AM 03.07 The system shall provide the ability to associate orders, medications, and notes with one or

more problems / diagnoses.

FN 09.04 The system shall provide the ability to capture and maintain, as discrete data, a diagnosis/problem code or description associated with an order of any (type including prescriptions and medications ordered for administration).

AM 04.02 The system shall provide the ability to record the prescribing of medications including the identity of the prescriber.

AM 04.07 The system shall store medication information in discrete data fields. At a minimum, there must be one field for each of the following: - medication name, form and strength; - dispense quantity; - refills; and - sig.

AM 11.01 The system shall provide the ability to create prescription or other medication orders with sufficient information for correct filling and dispensing by a pharmacy.

AM 11.02 The system shall provide the ability to record user and date stamp for prescription related events, such as initial creation, renewal, refills, discontinuation, and cancellation of a prescription.

AM 11.03 The system shall provide the ability to capture the identity of the prescribing provider for all medication orders.

AM 11.04 The system shall provide the ability to capture common content for prescription details including strength, sig, quantity, and refills to be selected by the ordering clinician.

Common drug databases supply medication information with name, form and strength combined as a single unit, therefore, name, form and strength can be included together in a single discrete data field.






1.65 Print prescription for Amoxicillin.

Prescription prints and includes associated problem or diagnosis.

Pass Fail AM 11.08 The system shall provide the ability to print and electronically fax prescriptions.

AM 11.17 The system shall provide the ability to display the associated problem or diagnosis (indication) on the printed prescription.

1.66 Reprint the prescription for Amoxicillin.

Prescription reprints without re-entry of prescription details.

Pass Fail AM 11.09 The system shall provide the ability to re-print and re-fax prescriptions.

1.67 Exit chart for Will Haynes and select patient Alice Brown. Review Alice Brown‟s age.

Alice Brown‟s age is expressed in days. 10 days.



1.68 Exit chart for Alice Brown and select patient Charlie Green. Review Charlie Green‟s age.

Charlie Green‟s age is expressed in hours. Will vary based on inspection date; should be two days ago.



1.69 Exit Charlie Green‟s chart and logout as Dr. Alexander.

Logout successful.






A woman who is 29 weeks pregnant presents for a routine maternity visit to her Obstetrician. She was diagnosed in week 21 with Gestational Diabetes.


2.01 Login as Dr. McCoy and select patient record for Jennifer Thompson.


2.02 Review allergies. Allergies display: NKDA or NKA. The indication that the patient has no known drug allergies must be in discrete data.

Pass Fail FN 05.09 The system shall provide the ability to explicitly indicate in a discrete field that a patient has no known drug allergies or adverse reactions.

2.03 Record that patient is checking her blood sugars 4 times a day: fasting and 1 hour after breakfast, lunch and dinner. She has a record of her blood sugars. Enter (not scan) data into EHR. (Data in Appendix B.)

Data from Appendix B entered (not scanned in). If record of blood sugars is entered using an interface, values may differ from those appearing in Appendix B; this would meet the criterion.

Pass Fail AM 06.05 The system shall provide the ability to capture history collected from outside sources.

2.04 Update patient history:

Patient reports that her maternal aunt just diagnosed with breast cancer.

Display patient history.

Patient history displays with update.

Pass Fail AM 06.01 The system shall provide the ability to capture, store, display, and manage patient history.

AM 06.03 The system shall provide the ability to update a patient history by modifying, adding or removing items from the patient history as appropriate.






2.05 Record history of pneumonia including a standard code for pneumonia.

Patient history updated. The patient history must be captured in structured data.

Pass Fail AM 06.02 The system shall provide the ability to capture structured data in the patient history.

AM 06.06 The system shall provide the ability to capture patient history in a standard coded form.

Not all data elements may currently be represented in existing standard coding schemes. An example would be diagnostic and procedural history using ICD-9, CPT, or SNOMED codes. As an example, ICD-9 code 486.

2.06 Enter diagnosis: High Risk Pregnancy. Use whatever coding scheme is appropriate for the system.

System accepts data as entered. High Risk Pregnancy is added to the problem list.

Pass Fail AM 03.09 The system shall provide the ability to maintain a coded list of problems / diagnoses.

Examples of ICD-9 codes provided: 648.8 (gestational diabetes); V23.9 (high risk pregnancy).

2.07 Display Problem List. Problem List displays (onset date of each problem indicated):

Pregnancy

Gestational Diabetes

High Risk Pregnancy Problem list entries must be in discrete data.

Pass Fail FN 04.02 The system shall provide the ability to capture, maintain and display, as discrete data elements, all problems / diagnoses associated with a patient.

AM 03.03 The system shall provide the ability to maintain the onset date of the problem / diagnosis.

Pregnant state could be captured someplace other than in the Problem List. Examples of ICD-9 include 648.8 (gestational diabetes).






2.08 Access patient educational materials for Gestational Diabetes and print to provide for patient.

Patient educational materials accessed and printed.

Pass Fail FN 14.01 The system shall provide the ability to produce patient instructions and patient educational materials which may reside within the system or be provided through links to an external source.

2.09 Physician determines that patient is at high risk for breast cancer; change mammography screening alert to begin at age 30.

System provides the ability to individualize the alert at the patient level. Alert is set to indicate that this patient requires mammography screening to begin at age 30.

Pass Fail AM 22.11 The system shall provide the ability to individualize alerts to address a patient‟s specific clinical situation.

2.10 Access test and procedure instructions for mammogram, and modify to include “do not use lotion or deodorant prior to mammogram.” Print these instructions and provide to the patient.

Test and procedure instructions can be accessed, modified, and given to the patient.

Pass Fail AM 10.03 The system shall have the ability to provide access to patient-specific test and procedure instructions that can be modified by the physician or health organization; these instructions are to be given to the patient. These instructions may reside within the system or be provided through links to external sources.

There is no need to order a mammogram for this step.






2.11 Jennifer disagrees with the assessment that she is at high risk for breast cancer and would like her disagreement recorded in the chart. Record comment “Jennifer disagrees that she is at high risk for breast cancer.”

System captures the information “Jennifer disagrees that she is at high risk for breast cancer.”

Pass Fail AM 08.21 The system shall be capable of recording comments by the patient or the patient‟s representative regarding the accuracy or veracity of information in the patient record (henceforth „patient annotations‟).

AM 36.02 The system shall provide a means to document a patient's dispute with information currently in their chart.

This does not imply that the patient can document directly in their chart. Some methods include but are not limited to allowing the patient a view only access to their record, printing a copy of the record for a patient to review. Methods to include the information in the chart could be as a note, a scanned copy of patient comments, an addendum to the note or other method not described.






2.12 Show how the patient annotation is distinguished from other content in the system.

Applicant shows how the information is distinguished from other content.

Pass Fail AM 08.22 The system shall display patient annotations in a manner which distinguishes them from other content in the system.

A patient annotation in free-text or scanned-document form, when displayed, should indicate that it comes from a patient. This could be a text label on the screen or part of the free-text note itself. It is not necessary to make patient annotations visible from any and all sections of the patient record.

2.13 Select the order set “Diabetes One.”

Order set “Diabetes One” is selected, and includes:

RhoGAM;

HgbA1c;



Non stress test.

Pass Fail FN 10.01 The system shall provide the ability to define a set of items to be ordered as a group.

2.14 The physician intends to order the modified order set Diabetes One for Jennifer Thompson. For Jennifer Thompson, deselect the order for RhoGam.

RhoGAM is deselected. Selected items in the order set now include:

HgbA1c;



Non stress test.

Pass Fail FN 11.01 The system shall provide the ability for individual orders in an order set to be selected or deselected by the user.






2.15 For Jennifer Thompson, select order for HgbA1c and modify order to include an instruction that says “collect in a 4 mL EDTA (purple top) tube.”

Order for HgbA1c is amended to show physician entered changes.

Pass Fail AM 10.04 the system shall have the ability to provide access to patient-specific test and procedure instructions that can be modified by the physician or health organization; these instructions are to be given to the filler of the order. These instructions may reside within the system or be provided through links to external sources.

These instructions may reside within the system or be provided through external links.

2.16 Place all orders in the order set for Jennifer Thompson.

The orders in order set Diabetes one are ordered and relayed to their respective destinations either via an appropriate printer, work queue or interface:

HgbA1c – modified with instruction to “collect in a 4ml EDTA (purple top) tube;



Non stress test.

Pass Fail AM 12.05 The system shall provide the ability to relay orders for a diagnostic test to the correct destination for completion.

Proctor to update Audit Trail Worksheet (Appendix D.)

2.17 Show the orders in order set Diabetes One individually.

The orders in “Diabetes One” display individually.

Pass Fail FN 11.04 The system shall provide the ability to display orders placed through an order set either individually or as a group.






2.18 Create a referral to a dietitian as part of the encounter. Referral date is today, Nutritionist is Mary Smith, RN, CDNE, address 1234 Elm Street, Anytown USA, telephone 555-555-1212. The creation of this referral order may have already occurred in conjunction with the order set above.

Referral order can be reviewed to ensure adequate detail is present, as well as the date/time stamp for the entry by the physician. For example, the referral may be displayed using a print preview function or template. If the referral user ID and date/time do not show in the GUI, the applicant shall demonstrate where in the system these items have been recorded, for example, in an audit trail. It must be clear that this information is associated with the referral.

Pass Fail AM 21.01 The system shall provide the ability to create referral orders with detail adequate for correct routing.

AM 21.02 The system shall provide the ability to record user ID and date/time stamp for all referral related events.

Adequate detail includes but is not limited to:

Referral date

Patient name and identifier

“Refer to” specialist name, address and telephone number

“Refer to” specialty

Reason for referral

Referring physician name






2.19 Create three tasks for Reception:

To schedule follow up appointment for Jennifer Thompson in one week.

To send a letter to patient when all test results are received.

To schedule visit with the dietitian.

The notification to schedule the visit with the dietitian may have already occurred in conjunction with the order set above.

Notification sent to Reception with the following tasks:

To schedule follow up appointment in one week.



Pass Fail AM 24.01 The system shall provide the ability to create and assign tasks by user or user role.

2.20 Enter some information to be identified as “confidential,” for example, that the patient had once been a victim of domestic violence, into the chart and designate as accessible only to Physician Users.

Confidential information entered into chart. Details of what the confidential information is are left to the Applicant; the example provided may be used.

Pass Fail AM 36.04 The system shall provide the ability to identify certain information as confidential and only make that accessible by appropriately authorized users.

This may be implemented by having a "confidential" section of the chart.






2.21 Show how the system provides assistance in selecting the appropriate CPT E&M billing code. For example, select procedure (CPT): 99213 (E and M code for managing diabetes care and counseling).

The system provides assistance in selecting appropriate CPT E&M codes based on codified clinical information in the encounter.

Pass Fail AM 32.01 The system shall have the ability to provide a list of financial and administrative codes.

AM 32.02 The system shall provide the ability to select an appropriate CPT Evaluation and Management code based on data found in a clinical encounter.

AM 32.03 The system shall have the ability to provide assistance with selecting an appropriate CPT Evaluation and Management billing code based on codified clinical information in the encounter.

For AM 32.03, criterion satisfaction will require that the system can automatically count elements in the history and examination documentation to accomplish this calculation. MDM complexity may still require specification by the provider/coder.

2.22 Show active orders for Jennifer Thompson.

Active orders for Jennifer Thompson display:

HgbA1c – modified with instruction to “collect in a 4ml EDTA (purple top) tube;



Non stress test.

Pass Fail AM 12.06 The system shall have the ability to provide a view of active orders for an individual patient.






2.23 Display all orders for HgbA1c. Display outstanding orders for all patients.

Outstanding orders display, and include orders for HgbA1c for both Jennifer Thompson and Joe Gardner. (Other patients may appear on this list if the Applicant has entered other information; that is acceptable.) A report may satisfy this criterion.

Pass Fail AM 12.08 The system shall provide the ability to display outstanding orders for multiple patients (as opposed to outstanding orders for a single patient).

2.24 Logout as Dr. McCoy. Logout successful.

2.25 Login as Reception. Login successful.

2.26 Review tasks. Three tasks are received:

To schedule follow up appointment in one week.



Pass Fail AM 24.02 The system shall provide the ability to present a list of tasks by user or role.

2.27 Re-assign the following task to Nurse:


Scheduling task is routed to Nurse.

Pass Fail AM 24.03 The system shall provide the ability to re-assign and route tasks from one user to another user.

2.28 Logout as Reception. Logout successful

2.29 Login as Nurse. Login successful.






2.30 Access tasks; receive notification to schedule visit with dietician. Complete task and designate task as completed.

Task is displayed as completed.

Pass Fail AM 24.03 The system shall provide the ability to re-assign and route tasks from one user to another user.

AM 24.04 The system shall provide the ability to designate a task as completed.

2.31 Attempt to access the confidential information entered at step 2.20.

The confidential information is inaccessible to this user. Note that depending on system setup this user may not be aware or may not be advised that confidential information exists.

Pass Fail AM 36.04 The system shall provide the ability to identify certain information as confidential and only make that accessible by appropriately authorized users.






Test Script Scenario 3A – Interoperability Testing – Laboratory Results


3.01 Login as Dr. Butler. Login successful.

3.02 Receive lab results for Jennifer Thompson electronically.

Lab results in data files provided by CCHIT are received into the EHR and the lab test name, result (value), and unit are correctly displayed as discrete data (vs. report format). Based on the data files provided by CCHIT, the system should differentiate normal from abnormal results. Discrete data means that each separate element of the data needs to be stored in its own field. Jurors will look for a separate data field for each element.

Pass Fail IO-AM 07.01 The system shall provide the ability to receive and store general laboratory results using the HL7 v.2.5.1 ORU message standard

AM 14.01 The system shall provide the ability to indicate normal and abnormal results based on data provided from the original data source.

Applicants must refer to the document CCHIT Certified 2011 Interoperability Testing Guide for detailed information on the execution of this scenario. Jurors will be provided with the expected results for each Applicant‟s test file that will be used for the inspection.






3.03 Receive lab results for Theodore Smith. Note that the cholesterol results (total cholesterol, LDL and HDL) will be expected to appear in graphing functions in step 4.15.










3.04 For Applicants that are also conducting the Cardiovascular inspection: Receive lab results for Jim Grayson electronically. Note that the cholesterol results (total cholesterol, LDL and HDL) will be expected to appear in a subsequent step. .





This step applies only to Cardiovascular certification.

3.05 Logout as Dr. Butler. Logout successful.






This scenario involves a preventive care visit for a male Veteran with multiple chronic problems including poorly controlled diabetes, hypertension, hyperlipidemia, Gastroesophageal Reflux Disease, Degenerative Joint Disease and drug allergies. Data from this case is used for a quality improvement initiative.


4.01 Login as Dr. Butler and select patient record for Theodore Smith.


4.02 Check patient‟s medical eligibility; this should indicate that “patient is eligible for coverage through the upcoming year.”

System displays medical eligibility obtained from patient‟s insurance carrier. This can be accomplished by a text note following telephone verification.

Pass Fail AM 33.01 The system shall provide the ability to display medical eligibility obtained from patient‟s insurance carrier, populated either through data entry in the system itself or through an external application interoperating with the system.

4.03 Note that patient has an advance directive; the type of advanced directive is a living will.

EHR reflects the presence of an advance directive, and indicates that the type of advance directive is a living will.

Pass Fail AM 16.01 The system shall provide the ability to indicate that a patient has completed advance directive(s).

AM 16.02 The system shall provide the ability to indicate the type of advance directive, such as living will, durable power of attorney, or a “Do Not Resuscitate” order.

4.04 Show how system indicates when advance directives were last reviewed.

Information is presented that indicates advance directives were last reviewed on today‟s date.

Pass Fail AM 16.03 The system shall provide the ability to indicate when advance directives were last reviewed.

This may be recorded in non-structured data or as discrete data.

4.05 Indicate that the Dr. Butler is the principal care provider for this patient (physician of record).

Patient record identifies Dr. Butler as the principal care provider.

Pass Fail FN 03.02 The system shall provide the ability to capture and maintain, as discrete data elements, the principal provider responsible for the care of an individual patient






4.06 Review health maintenance services for this patient.

System indicates that PSA is due. System indicates that patient should have a pneumovax as he is over 65.

Pass Fail AM 22.01 The system shall provide the ability to establish criteria for disease management, wellness, and preventive services based on patient demographic data (minimally age and gender).

4.07 Demonstrate how preventive services/wellness guidelines and associated reference material are updated. For example, change the guidelines to show PSA due at age 40 and create a new reference called “AUA updated recommendations.” If a different user is required to execute this step, please login as that user.

Applicant demonstrates process for updating preventive service/wellness guidelines and associated reference material. Example provided may be used.

Pass Fail AM 22.05 The system shall provide the ability to update preventive services/wellness guidelines and any associated reference material.

AM 35.02 The system shall provide the ability to update clinical decision support guidelines and associated reference material.

Associated reference material can be within the system or accessed through links to external sources.

4.08 PSA:

Patient does not want the PSA test. Override the prompt and enter reason “patient preference.” Reason to be captured as discrete data.

System provides the ability to document the reason; reason is captured as discrete data.

Pass Fail AM 22.06 The system shall provide the ability to override guidelines.

AM 22.07 The system shall provide the ability to document reasons disease management or preventive services/wellness prompts were overridden.

FN 18.02 The system shall provide the ability to capture and maintain, as discrete data, the reason for variation from rule-based clinical messages (for example alerts and reminders).






4.09 Pneumovax:

Patient indicates he had this vaccine at a local clinic. Document the date of the vaccine (the previous Tuesday).

Documentation accepted; the vaccine was given at an outside clinic the previous Tuesday.

Pass Fail AM 22.10 The system provides the ability to document that a disease management or preventive service has been performed with associated dates or other relevant details recorded.

This service was provided external to the practice.

4.10 Modify parameters for pneumovax alert for this patient; change it to require the vaccine once every 10 years.

Parameters for pneumovax alert for this patient can be modified to “once every 10 years.”

Pass Fail AM 22.08 The system shall provide the ability to modify the rules or parameters upon which guideline-related alerts are based.






4.11 Add history of tobacco abuse to problem list Review problem list including current and inactive/resolved problems. If a different user is required to identify the user ID and date of updates to the problem list, please login as that user to show that portion of the expected result.

Problem list displays:

Positive for type 2 diabetes, elevated cholesterol, hypertension, GERD, BPH, Hypothyroidism, and arthritis

Tobacco abuse is added to problem list along with appropriate coding.

System records user ID and date of this update to the problem list.

Resolved problems include:

Appendicitis, cholecystitis and a cataract.

Resolution date for Appendicitis is September 12, 2004

Problem list must be captured as discrete data.

Pass Fail AM 03.04 The system shall provide the ability to maintain the resolution date of a problem / diagnosis.

AM 03.06 The system shall provide the ability to record the user ID and date of all updates to the problem / diagnosis list.

AM 03.09 The system shall provide the ability to maintain a coded list of problems / diagnoses.

FN 04.02 The system shall provide the ability to capture, maintain and display, as discrete data elements, all problems / diagnoses associated with a patient.

For example, ICD-9 CM code V15.82






4.12 Document tobacco consumption as discrete data. For example, 20 year history of two packs per day. Any quantitative measure of amount of consumption is acceptable.

Quantitative tobacco consumption is captured as discrete data.

Pass Fail AM 08.16 The system shall provide the ability to capture other clinical data elements as discrete data.

CV 06.06 The system shall be capable of documenting current and past tobacco use in a quantitative fashion.

Any quantitative measure of amount of consumption, date of start, date of stop, or total duration is acceptable. For Cardiovascular Certification, CV 06.06 applies at this step in addition to the Ambulatory criterion.

4.13 Document tobacco cessation counseling provided.

Tobacco cessation counseling is documented.

Pass Fail AM 08.16 The system shall provide the ability to capture other clinical data elements as discrete data.

CV 06.06.01 The system shall be capable of documenting that tobacco cessation counseling was provided, including a date stamp.

4.14 Show active problems. Display a view of the problem list based on status of the problem (active).

Problem list displays:

Positive for type 2 diabetes, elevated cholesterol, hypertension, GERD, BPH, Hypothyroidism, and arthritis, tobacco abuse

Pass Fail FN 04.06 The system shall provide the ability to display different views of the problem / diagnosis list based upon the status of the problem.

For example, active, all, resolved or charted in error.






4.15 Display cholesterol lab results (total cholesterol, LDL and HDL) graphically. These can be separate graphs.

Graph displays with distinct data points by date and event. Graph should include four data points as entered from appendix and one from lab result received today. These can be separate graphs.

Pass Fail AM 09.07 The system shall provide the ability to accept, store in the patient's record, and display clinical results received through an interface with an external source.

AM 14.02 The system shall provide the ability to display numerical results in flow sheets and graphical form in order to compare results, and shall provide the ability to display values graphed over time.

4.16 Display lab results for LDL for this patient sorted by test date.

LDL results display as per Appendix C, sorted by test date.

Pass Fail AM 09.07 The system shall provide the ability to accept, store in the patient's record, and display clinical results received through an interface with an external source.

AM 14.05 The system shall provide the ability to filter or sort results by type of test and test date.

4.17 Display all lab results for this patient sorted by type of test (e.g. WBC, HDL Cholesterol, etc.)

Results display as per Appendix C, sorted by type of test.

Pass Fail AM 09.07 The system shall provide the ability to accept, store in the patient's record, and display clinical results received through an interface with an external source

AM 14.05 The system shall provide the ability to filter or sort results by type of test and test date.

4.18 Change the interval for lipid testing to annually for this patient.

The care plan for this patient can be modified.

Pass Fail AM 17.03 The system shall provide the ability to modify site-specific care plan, protocol, and guideline documents obtained from outside sources.






4.19 Begin encounter documentation: Patient indicates knee pain is limiting his activity. It is worse on the left than the right. He is taking Aleve for this. Add non-prescription drug Aleve to medication list, with start date of 3 months prior to today.

Clinical documentation of patient-provided information captured. System allows entry of non-prescription drug Aleve into medication profile, and captures start date.

Pass Fail AM 04.04 The system shall provide the ability to maintain other dates associated with medications including start, modify, renewal and end dates as applicable.

FN 06.01 The system shall provide the ability to update and display a patient-specific medication list based on current medication orders or prescriptions.

FN 06.06 The system shall provide the ability to capture and maintain, as discrete data elements, all current medications including over the counter and complementary medications such as vitamins, herbs and supplements.

AM 08.01 The system shall provide the ability to create clinical documentation or notes (henceforth “documentation”).

AM 08.02 The system shall provide the ability to display documentation.






4.20 He developed a recurrence of chest pain which had previously been attributed to GERD and controlled with Zantac 150 mg a day. He started taking chewable Tums 750 mg several times a day. Add non-prescription drug Tums, 750 mg several times a day, to medication list.

System allows entry of non-prescription drug Tums with dose and frequency into medication profile. Entry of Tums triggers drug interaction with previously entered Synthroid.

Pass Fail FN 06.01 The system shall provide the ability to update and display a patient-specific medication list based on current medication orders or prescriptions.

AM 04.04 The system shall provide the ability to maintain other dates associated with medications including start, modify, renewal and end dates as applicable.


FN 12.01 The system shall provide the ability to check for potential interactions between medications to be prescribed/ordered and current medications and alert the user at the time of medication prescribing/ordering if potential interactions exist.

FN 12.08 The system shall provide the ability to prescribe/order a medication despite alerts for interactions and/or allergies/intolerances being present.

Any form of notification, message or color coding is acceptable; pop up notification is not required.






4.21 View current medications list.

All current medications display:

Actos 30 mg once daily

Aleve

Glucosamine chondroitin

Lipitor 20 mg a day

Lisinopril 5 mg twice a day

Saw palmetto

Synthroid 0.112 mg a day

Tums 750 mg several times a day

Zantac 150 mg a day Generic drug names would be acceptable.

Pass Fail FN 06.02 The system shall provide the ability to display a view that includes only current medications.

Clarification – Medication lists must be data lists and not free text.

4.22 Conduct follow up actions related to problem list: Diabetes –

Find notes for this patient with associated diagnosis “Diabetes.”

Notes from at least two previous visits (as entered from appendix information) are available.

Pass Fail AM 08.12 The system shall provide the ability to filter, search or order notes by associated diagnosis within a patient record.

This is intended to be the coded diagnosis and not free text in the body of a note.






4.23 Show how system provides the ability to create provider specific medication lists; list to include default route, dose, frequency and quantity.

Applicant demonstrates this function. It is acceptable to either show a look-up using physician preferences or creating a new saved list.

Pass Fail AM 11.19 The system shall provide the ability to create provider specific medication lists of the most commonly prescribed drugs with a default route, dose, frequency and quantity.

It is suggested that Applicants have saved a “favorites” list prior to their inspection, and demonstrate that items can be added to this list.

4.24 Create prescription for “diabetes wonder drug.”

System allows entry of uncoded medication. System alerts that no interaction checking will be performed against the uncoded medication.

Pass Fail AM 04.09 The system shall provide the ability to enter uncoded or free text medications when medications are not on the vendor-provided medication database or information is insufficient to completely identify the medication.

FN 07.01 The system shall provide the ability to alert the user at the time a new medication is prescribed/ordered that drug interaction, allergy, and formulary checking will not be performed against the uncoded medication or free text medication.

FN 07.02 The system shall provide the ability to prescribe/order uncoded and non-formulary medications.






4.25 Patient‟s hypertension is not well controlled. He has been taking an NSAID that may have contributed to this. He will stop the Aleve. Enter medications list and discontinue Aleve; capture the reason for discontinuing this medication.

Medication list reflects that Aleve is discontinued, and reason for discontinuing.

Pass Fail FN 06.03 The system shall provide the ability to exclude a medication from the current medication list (e.g. marked inactive, erroneous, completed, discontinued) and document reason for such action.

Inactive medications must display in a medication list - either in a medication history of all medications (active and inactive) or in a separate list of inactive medications. It is not required that current medications and past medications display on the same screen.

4.26 Show identity of user who made this change to the medication list and the date of changes. If a different user is required to execute this step, login as that user.

Identity of user and date of change to medication list displays.

Pass Fail AM 04.11 The system shall provide the ability to record the date of changes made to a patient's medication list and the identity of the user who made the changes.

Changes are to be recorded at the level of the individual medication. Date is recorded automatically by the system. May not be key-entered. It is not specified where this information shall be displayed; it could appear in the GUI or in the audit trail.






4.27 Hypothyroidism –

Renew Synthroid. If interaction between Synthroid and Diabetes does not appear, the Applicant shall demonstrate how the system provides drug-disease interaction alerts using a different combination.

System checks for drug-drug, drug-allergy and drug-disease interactions. Interaction with Tums displays. Interaction with Diabetes displays.

Pass Fail FN 06.06 The system shall provide the ability to capture and maintain, as discrete data elements, all current medications including over the counter and complementary medications such as vitamins, herbs and supplements.

AM 11.07 The system shall provide the ability to reorder a prior prescription without re-entering previous data (e.g. administration schedule, quantity).

FN 12.01 The system shall provide the ability to check for potential interactions between medications to be prescribed/ordered and current medications and alert the user at the time of medication prescribing/ordering if potential interactions exist.

FN 12.10 The system shall provide the ability to check for potential interactions between medications to be prescribed and medication allergies listed in the record and alert the user at the time of medication prescribing/ordering if potential interactions exist.

FN 13.01 The system shall provide drug-diagnosis interaction alerts at the time of medication prescribing/ordering.

Any form of notification, message or color coding is acceptable; pop up notification is not required. NOTE: Entry of non-prescription medications as per FN 06.06 is important for interaction checking, associating symptoms with supplements.

4.28 View the rationale for the drug interaction alert.

Rationale is viewable. Pass Fail FN 12.05 The system shall provide the ability to view the rationale for a drug interaction alert.






4.29 Override the alert. Document reason for overriding the drug-drug interaction warning as a structured response. An example of the reason is “combination taken previously.” Any reason entered in a structured response will be acceptable for verification purposes.

System accepts entry of reason for overriding the allergy warning in a structured response.

Pass Fail FN 12.06 The system shall provide the ability to capture and maintain at least one reason for overriding any drug-drug or drug-allergy/intolerance interaction warning triggered at the time of medication prescribing/ordering.

FN 12.07 The system shall provide the ability to enter a structured response when overriding a drug-drug or drug-allergy/intolerance warning.

4.30 Proceed with renewal of Synthroid.

Prescription is renewed. Pass Fail FN 12.08 The system shall provide the ability to prescribe/order a medication despite alerts for interactions and/or allergies/intolerances being present.

4.31 View current medications list.

All current medications display:


Diabetes wonder drug


Lipitor 20 mg a day


Saw palmetto

Synthroid 0.112 mg a day – renewed today


Zantac 150 mg a day Aleve does not display.

Pass Fail AM 04.06 The system shall provide the ability to capture medications entered by authorized users other than the prescriber.


FN 06.02 The system shall provide the ability to display a view that includes only current medications.






4.32 DJD Knees –

Enter diagnosis “bilateral DJD (knees)” Use whatever coding scheme is appropriate

Added to problem list. Problem list entry must capture concept of “osteoarthritis of the knees” in some way.

Pass Fail AM 03.09 The system shall provide the ability to maintain a coded list of problems / diagnoses.

Examples of codes to capture the concept of osteoarthritis of the knees include: 715.96 or 715.98 or 715.36

4.33 Save the note in progress as a draft.

System allows the note to be saved in progress prior to finalizing the note.

Pass Fail AM 08.03 The system shall provide the ability to save a note in progress prior to finalizing the note.

PC 04.08 The system shall provide the ability to save a note in progress prior to finalizing the note.

4.34 Order x-ray of knees. Demonstrate that system provides instructions and/or prompts created by the user when ordering diagnostic tests or procedures. Prompt advises that the x-ray will expose the patient to radiation; for example “A knee x-ray exposes the patient to 0.75 mRads of radiation.”

X-ray is ordered. Identity of ordering provider is captured. Order entry details are captured. Instructions and/or prompts demonstrated. Note for Jurors: Content of the prompt may vary by Applicant.

Pass Fail AM 12.01 The system shall provide the ability to order diagnostic tests, including labs and imaging studies.

AM 12.02 The system shall provide the ability to capture the identity of the ordering provider for all test orders.

AM 12.03 The system shall provide the ability to capture appropriate order entry detail, including associated diagnosis.

AM 12.04 The system shall have the ability to display user created instructions and/or prompts when ordering diagnostic test or procedures.






4.35 Order for knee x-ray is associated with a problem reflecting the diagnostic concept of osteoarthritis of the knees.

System allows association of order with problem. Diagnosis/problem code or description must be captured in discrete data.

Pass Fail AM 03.07 The system shall provide the ability to associate orders, medications, and notes with one or more problems / diagnoses.

AM 03.08.01 The system shall provide the ability to associate orders and medications with one or more codified problems / diagnoses.

FN 09.01 The system shall provide the ability to require problem / diagnosis as an order component.

FN 09.04 The system shall provide the ability to capture and maintain, as discrete data, a diagnosis/problem code or description associated with an order of any (type including prescriptions and medications ordered for administration).

Examples of codes to capture the concept of osteoarthritis of the knees include: 715.96 or 715.98 or 715.36






4.36 Review patient‟s medication history profile.

All medications display (active and inactive):


Aleve (discontinued)

Diabetes wonder drug


Lipitor 20 mg a day


Saw palmetto

Synthroid 0.112 mg a day – renewed today


Zantac 150 mg tablet a day

Pass Fail AM 04.05 The system shall provide the ability to display medication history for the patient.

AM 04.06 The system shall provide the ability to capture medications entered by authorized users other than the prescriber.


FN 06.03 The system shall provide the ability to exclude a medication from the current medication list (e.g., marked inactive, erroneous, completed, discontinued) and document reason for such action.


Inactive medications must display in a medication list - either in a medication history of all medications (active and inactive) or in a separate list of inactive medications. It is not required that current medications and past medications display on the same screen. Medication history includes all medications captured in the EMR system including prescription and non prescription drugs.






4.37 Add a patient-specific reminder to check hepatic profile in 3 months.

Reminder added. Pass Fail AM 11.20 The system shall provide the ability to add reminders for necessary follow up tests based on medication prescribed.

Does not imply that this must be an automated process. It is acceptable if the system requires an action by the user, separate from the action of prescribing the medication, to configure the system to issue future reminders related to follow-up tests for the medication.

4.38 Complete and sign off note. Print a copy for the patient. Print preview is acceptable for verification.

Note is retrieved from “draft” status, updates to note are captured, and note accepts sign off. System captures identity of the user and date/time of finalization.

Pass Fail AM 08.04 The system shall provide the ability to finalize a note, i.e. change the status of the note from in progress to complete so that any subsequent changes are recorded as such.

AM 29.02 The system shall provide the ability to generate reports consisting of all or part of an individual patient‟s medical record (e.g. patient summary).

AM 30.02 The system shall provide the ability to generate hardcopy or electronic output of part or all of the individual patient‟s record.

Date and time must be system generated and recorded automatically.






Test Script Scenario #4 – Follow up:

In a continuation of scenario 4, we are now dealing with the follow up actions to the visit with the primary care physician.


4.40 Login as Dr. Butler and select record for Theodore S. Smith.

Login successful and patient record selected.

4.41 Review outstanding orders for x-rays (may be referred to as “diagnostic imaging,” “radiology,” “x-ray” or however the system categorizes these).

Order displays; is identified as being for patient Theodore Smith, and is categorized by test/procedure description (e.g. “diagnostic imaging” or “x-ray”).

Pass Fail AM 12.07 The system shall have the ability to provide a view of orders by like or comparable type, e.g., all radiology or all lab orders.

May include filters or sorts.

4.42 Review status information for Theodore Smith‟s x-ray.

Status displays. Description of status may vary by Applicant (for example, may be “completed,” “in progress,” “ordered”).

Pass Fail FN 09.02 The system shall provide the ability to view status information for ordered services.

Status may be electronically or manually updated.






4.43 Receive x-ray report. Link results to original order (order in step 4.34). Enter results into EHR. Review x-ray report:

Knee x-rays show severe arthritis with total loss of joint space on the left.

Note that the x-ray report is to be provided by the Applicant; CCHIT will not be providing results files for these tests.

Results entered into EHR; X-ray report is displayed. Results are linked to the original order.

Pass Fail AM 09.01 The system shall provide the ability to capture and store external documents.

AM 09.04 The system shall provide the ability to receive, store in the patient‟s record, and display text-based outside reports.

AM 14.03 The system shall provide the ability to display non-numeric current and historical test results as textual data.

AM 14.08 The system shall provide the ability to link results to the original order.

Note that any mechanism for capturing the report is acceptable: OCR, PDF, image file of report, etc. It is acceptable if certain data received through an interface, if not relevant to the end user, are not displayed in the application. Linking could be accomplished by changing the status of the order from „pending‟ to „completed‟.

4.44 Step removed.






4.45 Show how the system can access clinical images. The image is to be provided by the Applicant, and will simulate the knee x-ray. Applicant is to either incorporate a link containing a URL image reference into the patient‟s medical record, or attach an actual image file to the medical record. Either method is acceptable; for validation purposes, the Applicant must open and display the image from within the patient record to the jurors.

Clinical image can be accessed; it is accessible from within the patient‟s chart. Image is labeled and date-time stamped or, if stored within the system, the image is to be included in a patient encounter document. The image could be accessed through a link in the patient record.

Pass Fail AM 09.06 The system shall provide access to clinical images. They must be accessible from within the patient's chart and labeled and date-time stamped or included in a patient encounter document. These images may be stored within the system or be provided through direct linkage to external sources.

The date/time stamp may be the date/time of image creation or acquisition, the date/time of image importation/incorporation into the system, date/time of the clinical encounter with which the image is associated, or manually entered by the user.






4.46 Associate this image with the x-ray report from step 4.43. If the Applicant did not attach the image in step 4.45 to the medical record, use any other image available in the system to demonstrate how the system provides the ability to associate images with non-numerical results.

Image can be associated with the non-numerical result.

Pass Fail AM 14.10 The system shall provide the ability to associate one or more images with a non-numerical result.

Through direct storage or links to the data.

4.47 Add text annotation to the x-ray report from step 4.43: “much worse than before.”

System accepts and displays text note as annotation to the x-ray report from step 4.43.

Pass Fail AM 14.09 The system shall provide the ability to enter a free text comment to a result that can be seen by another user who might subsequently view that result.

4.48 Patient is to be referred to Orthopedics. Append the last progress note (from step 4.38) to document that the x-ray was abnormal and that the patient was referred to Ortho.

Note accepts the additional information and the information is clearly identifiable as new, for example “addendum,” “update,” “additional information,” etc. Identity of user who addended the note, along with date and time of change are recorded and displayed.

Pass Fail AM 08.07 The system shall provide the ability to addend and/or correct notes that have been finalized.

AM 08.09 The system shall provide the ability to record and display the identity of the user who addended or corrected a note, as well as other attributes of the addenda or correction, such as the date and time of the change.

Date and time must be system generated and recorded automatically.






4.49 Demonstrate the retrieval of the completed (final) note from step 4.38 that shows any modifications or addenda made to the final note. If a different user is required to execute demonstrate this, login as that user.

The full content of the modified note can be identified, both the original content and the content resulting after the changes. This could be demonstrated in a fashion which is similar to that which is seen in a word processing document with “Final Showing Markup” selected.

Pass Fail AM 08.08 The system shall provide the ability to identify the full content of a modified note, both the original content and the content resulting after any changes, corrections, clarifications, addenda, etc. to a finalized note.

PC 01.11 The system shall provide the ability for a clinical or other authorized user to view the full content of a finalized note. The full content of a finalized note includes the finalized note and any finalized modifications to that note including finalized changes referred to as corrections, clarifications, addenda, etc. Finalizing is the act of publishing into the system in a way that others may access information that has changed.

Different approaches to achieving the same result are acceptable.

4.50 Forward the results from the knee x-rays to Dr. Alexander.

Results are forwarded to Dr. Alexander (will be confirmed in a future step).

Pass Fail AM 14.07 The system shall provide the ability to forward a result to other users.






4.51 Patient wants to defer visit to Orthopedics until after vacation. Physician injects the knee with a mixture of Celestone and Marcaine. Capture medication administration details as discrete data:

Celestone Soluspan: 1) dose: 1 ml = 6 mg Betamethasone sodium phosphate (3mg) and betamethasone acetate (3mg) 3) route and site: Intraarticular, right knee 4) lot number and expiration data: 068027 / 06-2010 5) manufacturer: Schering Corp.

Marcaine: 1) dose: 1 ml Bupivicaine HCl 0.5% Injection, USP (AKA Sensorcaine) 3) route and site: Intraarticular, right knee 4) lot number and expiration data: PL2227 / 08-12 5) manufacturer: AstraZeneca

Medication administration details are captured as discrete data. Clinical documentation is available for viewing. Note that “date and time of administration” are not provided; these would be dependent upon the test date and time. These should be the current date and time (now).

Pass Fail FN 15.01 The system shall provide the ability to capture medication administration details as discrete data, including; 1) the medication name and dose; 2) date and time of administration; 3) route and site; 4) lot number and expiration data; 5) manufacturer; and 6) user ID.






4.52 Add a free text comment associated with the problem bilateral DJD (knee): “x-ray again at next visit.”

Free text comment is associated with the problem/diagnosis.

Pass Fail FN 04.01 The system shall provide the ability to capture, maintain and display free text comments associated with the problem/diagnosis.

4.53 Logout as Dr. Butler Logout successful.

4.54 Login as Dr. Alexander. Login successful.

4.55 Receive notification that results of knee x-ray for Theodore Smith are available for review.

System notifies Dr. Alexander that new results are available for review, as forwarded to him in step 4.50.

Pass Fail AM 14.04 The system shall provide the ability to notify the relevant providers (ordering, copy to) that new results have been received.

Examples of notifying the provider include but are not limited to a reference to the new result in a provider "to do" list or inbox.

4.56 Logout as Dr. Alexander.

Logout successful.

4.57 Login as Dr. Butler. Select patient record for Theodore S. Smith.

Login successful. Patient record selected.






4.58 This step to be performed only by applicants utilizing a 3rd Party ePrescribing Partner Query the system for Theodore S. Smith‟s medication history

Medication history request is sent; Theodore Smith‟s historical medication information is received from payer and includes:


Lipitor 20 mg a day


Synthroid 0.112 mg a day

Zantac 150 mg a day

Warfarin sodium 5 mg daily

Celebrex 200 mg once daily

Pass Fail IO-AM 9.15 The system shall provide the ability to send a query for medication history to PBM or pharmacy to capture and display medication list from the EHR.

4.59 Step removed.

4.60 Step removed.

4.61 Step removed.






4.62 Record history:

The patient called to report that he was bitten by a mosquito on the same leg just below the knee that was injected.

The knee developed pain and increased swelling and there were red streaks running up and down the leg from the site of the bite.

Create a prescription for Ceftin, 500 mg by mouth twice daily for 7 days #14 no refills. (This prescription will be sent electronically in step 4.65)

History updated with patient-provided information. System alerts to a cross allergy with penicillin. Note: When creating the prescription, checking interactions, and reviewing medication lists, any of the following will disqualify a hybrid product as not having sufficient workflow integration:

Evidence that the user has to log in a second time to a separate application.

Evidence that the user must look up the patient again from a separate patient list.

Evidence that the user must select the prescribed drug more than once, from separate lists.

Evidence that the user must enter the patient's medications or allergies more than once, in separate lists.

Pass Fail AM 08.01 The system shall provide the ability to create clinical documentation or notes (henceforth “documentation”).

AM 08.02 The system shall provide the ability to display documentation.

AM 11.04 The system shall provide the ability to capture common content for prescription details including strength, sig, quantity and refills to be selected by the ordering clinician.

FN 12.01 The system shall provide the ability to check for potential interactions between medications to be prescribed and current medications and alert the user at the time of medication ordering if potential interactions exist.

FN 12.10 The system shall provide the ability to check for potential interactions between medications to be prescribed and medication allergies listed in the record and alert the user at the time of medication prescribing/ordering if potential interactions exist.

Any form of notification, message or color coding is acceptable; pop up notification is not required.






4.63 Override the warning described in step 4.62.

System allows override of warning in step 4.62.

Pass Fail FN 12.08 The system shall provide the ability to prescribe/order a medication despite alerts for interactions and/or allergies/intolerances being present.

4.64 Document reason for overriding the drug-allergy interaction warning; for example “The patient has tolerated this medication before.” Override reason must be entered in a structured response. The text of the structured response may differ.

System accepts reason (in structured response) and displays.

Pass Fail AM 11.02 The system shall provide the ability to record user and date stamp for prescription related events, such as initial creation, renewal, refills, discontinuation, and cancellation of a prescription.

FN 12.06 The system shall provide the ability to capture and maintain at least one reason for overriding any drug-drug or drug-allergy/intolerance interaction warning triggered at the time of medication prescribing/ordering.

FN 12.07 The system shall provide the ability to enter a structured response when overriding a drug-drug or drug-allergy/intolerance warning.

This step may be completed simultaneously with step 4.63.






4.65 Complete the prescription and send it electronically to the CCHIT Test Pharmacy. View patient‟s medication list in the EHR. Setup Information:

Pharmacy Name: CCHIT Test Pharmacy Two

NCPDP ID: 9123453

Pharmacy Address: 200 S Wacker Drive, Suite 3100, Chicago, IL, 60606

Prescriber Registered with CCHIT Pre-Approved ePrescribing Network: Dr. Internist E. Butler MD.

Prescription is created and sent to the CCHIT Test Pharmacy electronically. None of the disqualifying behaviors listed in 4.62 have occurred during steps 4.62, 4.63, 4.64, or 4.65. Patient‟s medication list in the EHR application is updated and includes the newly prescribed medication (Ceftin).

Pass Fail AM 11.01 The system shall provide the ability to create prescription or other medication orders with sufficient information for correct filling and dispensing by a pharmacy.


IO-AM 09.06 The system shall provide the ability to send an electronic prescription to a pharmacy






4.66 When he called, the patient also indicated that he had had an allergic reaction to enalapril. Enter allergy to enalapril.

Entry of allergy to enalapril triggers a drug-allergy alert with the previously entered Lisinopril.

Pass Fail FN 12.11 The system shall provide the ability, when a new allergy is documented, to check for a potential interaction between the newly-documented allergy and the patient's current medications, and alert the user if such interactions exist.

4.67 Show how potential interactions relating to items on the medication list can be displayed now, as opposed to alerts that display during medication ordering.

System has the ability to display potential interactions at a time other than medication prescribing. The following interactions are shown:

Drug-drug interaction between synthroid and tums

Drug-allergy interaction between ceftin and penicillin

Drug-allergy interaction between lisinopril and enalapril

Pass Fail FN 12.04 The system shall provide the ability to display, on demand, potential drug-allergy interactions, drug-drug interactions and drug diagnosis interactions based on current medications, active allergies and active problems.

This is an “on demand” display, not in response to any medication being prescribed at the time. This does not require running an algorithm or report. Any method of displaying potential interactions is acceptable.

4.68 Review encounter notes; filter, search or order by provider.

System provides the ability to filter, search or order notes by the provider who finalized the note. (Notes for this patient include visits with Dr. Butler and with Dr. Jones.)

Pass Fail AM 08.11 The system shall provide the ability to filter, search or order notes by the provider who finalized the note.






4.69 Display all encounters for this patient:

Filter by date of service; and

Filter by provider.

Encounters display, and are first filtered by date of service and then filtered by provider. Note that this is two separate filters of the same information.

Pass Fail AM 31.04 The system shall have the ability to provide filtered displays of encounters based on encounter characteristics, including date of service, encounter provider and associated diagnosis.


4.71 Login as Office Manager.

Login successful.

4.72 The physician is enrolled in a quality improvement initiative and has been collecting data for submission on the quality measures pertaining to heart disease. Create a report that captures all patients with a diagnosis of coronary artery disease with a prior MI (diagnosis 410.11) who are on a beta blocker, including age and gender. Note: Report may be created prior to the test.

Report displays, includes Jim Grayson and Chester Pain. Report includes patient name, age and gender as requested. Format of the output determined by the Applicant (e.g. printed report, HL7 message, delimited file, etc.).

Pass Fail AM 29.01 The system shall provide the ability to generate reports of clinical and administrative data using either internal or external reporting tools.

AM 29.03 The system shall provide the ability to generate reports regarding multiple patients (e.g. diabetes roster).

AM 29.04 The system shall provide the ability to specify report parameters (sort and filter criteria) based on patient demographic data and clinical data (e.g. all male patients over 50 that are diabetic and have a HbA1c value of over 7.0 or that are on a certain medication).

AM 39.01 The system shall provide the ability to export (extract) pre-defined set(s) of data out of the system.

4.73 Access patient record for Chester Pain; mark this patient “exempt from reporting functions.”

System provides ability to mark patient “exempt.”

Pass Fail AM 01.04 The system shall provide a field which will identify patients as being exempt from reporting functions.






4.74 Run report (as in step 4.72) again.

Report displays, includes Jim Grayson. Chester Pain does not appear as he is marked exempt from reporting functions in step 4.73.

Pass Fail AM 01.04 The system shall provide a field which will identify patients as being exempt from reporting functions.

AM 29.01 The system shall provide the ability to generate reports of clinical and administrative data using either internal or external reporting tools.

4.75 Create an electronic version of a report for Joe Gardner that shows:

The most recent visit; and

All visits in the past three years.

Show a print preview of this report, to demonstrate that hardcopy output can be generated.

An electronic file is created that shows:

The most recent visit; and

All visits in the past three years.

The report should display the patient encounters or visits but does not need to include the notes from those visits. A print preview is also displayed.

Pass Fail AM 30.03 The system shall provide the ability to generate hardcopy and electronic output by date and/or date range.

Any electronic file format is acceptable.

4.76 Create a report that captures all patients over the age of 20.

Report displays, includes Theodore Smith, Joe Smith, Jim Grayson and Jennifer Thompson. Chester Pain does not appear as he is marked exempt from reporting functions in step 4.73.

Pass Fail AM 29.04 The system shall provide the ability to specify report parameters (sort and filter criteria) based on patient demographic data and clinical data (e.g. all male patients over 50 that are diabetic and have a HbA1c value of over 7.0 or that are on a certain medication).

4.77 Save the report parameters from step 4.76.

System allows parameters to be saved.

Pass Fail AM 29.07 The system shall provide the ability to save report parameters for generating subsequent reports.






4.78 Access the saved report parameters from step 4.76. Remove the identifiers and from the report; run that report again and export the file.

Report of patients over the age of 20 displays; includes Theodore Smith, Joe Smith, Jim Grayson and Jennifer Thompson; Chester Pain does not appear as he is marked exempt from reporting functions in step 4.73. Identifiers are removed for each patient. File is exported.

Pass Fail AM 29.07 The system shall provide the ability to save report parameters for generating subsequent reports.

AM 30.04 The system shall provide the ability to export structured data which removes those identifiers listed in the HIPAA definition of a limited dataset. This export on hardcopy and electronic output shall leave the actual PHI data unmodified in the original record.

Identifiers that shall be removed are: 2. Postal address information, other than town or city, state and zip code; 3. Telephone numbers; 4. Fax numbers; 5. Electronic mail addresses; 6. Social security numbers; 7. Medical record numbers; 8. Health plan beneficiary numbers; 9. Account numbers; 10. Certificate/license numbers; 11. Vehicle identifiers and serial numbers, including license plate numbers; 12. Device identifiers and serial numbers; 13. Web Universal Resource Locators (URLs); 14. Internet Protocol (IP) address numbers; 15. Biometric identifiers, including finger and voice prints; and 16. Full face photographic images and any comparable images.






4.79 Access the saved report parameters from step 4.76, and modify to include only patients under the age of 20.

Report of patients under the age of 20 displays; includes Joe Gardner, Emily Jones, Will Haynes, Alice Brown, Charlie Green and David Carter.

Pass Fail AM 29.08 The system shall provide the ability to modify one or more parameters of a saved report specification when generating a report using that specification.

4.80 Create and display a report of all patients who have not had a blood pressure measured in the past 12 months.

Report displays, and includes Agatha Bloom. Other patients as entered in the system by the Applicant may also display.

Pass Fail AM 29.06 The system shall provide the ability to produce reports based on the absence of a clinical data element (e.g., a lab test has not been performed or a blood pressure has not been measured in the last year).






4.81 Generate reminder letters for patients who are due or overdue for DTaP immunization booster: Either automatically generate a letter to a patient (either Emily Jones or Will Haynes) that automatically includes content specifying what services are due; Or automatically generate a letter to all patients who are due for a specified service (DTaP). For verification purposes use print preview, or print and fax to CCHIT proctor.

Based on the option the Applicant chooses to demonstrate: A letter to either Emily Jones or Will Haynes is automatically generated and displayed, indicating that this patient is due for a DTaP. Or: Letters are automatically generated for Emily Jones and Will Haynes indicating that these patients are due for a DTaP.

Pass Fail AM 23.09 The system shall provide the ability to automatically generate reminder letters for patients who are due or are overdue for disease management, preventive or wellness services.

The term 'automatically' means that the system is able to generate patient recalls for all due or overdue reminders for an individual patient based on the current date, regardless of whether a user initiates this action, or if the action triggered by pre-set parameters in the system. An example would be generating a letter to all patients overdue for a screening mammography. It is acceptable if the output allows generation of letters, such as a mail merge file.






4.82 To demonstrate how the guidelines that trigger the reminders would be modified, change MMR to be due at 15 months instead of 12 months. If a different user is required to execute this step, please login as this user.

Guidelines that trigger the reminders can be modified; MMR is changed to be due at 15 months instead of 12 months.

Pass Fail AM 23.05 The system shall provide the ability to modify the guidelines, criteria or rules that trigger the reminders.

4.83 Orthopedist requests Theodore Smith‟s medical record. The report used as the formal health record for disclosure purposes is generated for Theodore Smith.

Formal health record can be defined for disclosure purposes. The Applicant shows the set of documents that are defined as the formal health record.

Pass Fail AM 30.01 The system shall provide the ability to define one or more reports as the formal health record for disclosure purposes.






4.84 Document the disclosure of Theodore Smith‟s record. The date of the

disclosure / report: today

The name of the person making the disclosure: Dr. Alexander

Reported to: Dr. Dem Bones, Orthopedics

Recipient‟s address: 456 Anytime Lane, Annapolis MD 21405

Information disclosed: – Patient‟s name –

Theodore Smith – Address – 2300

Commonwealth Avenue, Anytown MD 22222

– Phone: 240-555-1212

– date of birth: 11/08/1931

– Medical record

Purpose of the Disclosure: referral

Applicant documents the following information to record the disclosure:

The date of the disclosure;

The name of the person making the disclosure;

The name of the entity or person who received the protected health information;

The address of such entity or person;

The name of the person making the disclosure;

A brief description of the information disclosed; and

A brief statement of the purpose of the disclosure.

Free text (e.g. text note) or structured fields are sufficient to satisfy this requirement.

Pass Fail AM 30.06 The system shall have the ability to provide support for disclosure management in compliance with HIPAA and applicable law.

4.85 Logout as Office Manager.

Logout successful.

4.86 Login as Dr. Alexander. Select patient record for Joe Smith (birthdate 3/23/1967).

Login successful. Patient record selected.






4.87 Review medication list; the patient takes no medications.

System indicates that this patient currently takes no medications.

Pass Fail FN 06.05 The system shall provide the ability to display that the patient takes no medications.

AM 04.10 The system shall provide the ability to enter or further specify in a discrete field that the patient takes no medications.

4.88 Dispense a sample of Ceftin. Lot number is F20457 and the expiration date is November 2013.

System allows for identification of sample dispensed; lot number F20457 and expiration date November 2013 display. Note that the medication dispensed is a sample.

Pass Fail AM 11.12 The system shall provide the ability to identify medication samples dispensed, including lot number and expiration date.

Lot numbers and expiration date could be entered in free text or encoded.

4.89 Logout as Dr. Alexander.

Logout successful.





Functionality requires that the EHR system supports multiple concurrent users through application, OS and database. The following steps will demonstrate concurrent use requirements. 4.90 Login to the EHR

system as Dr. Butler and access and view Theodore Smith‟s patient record.

Login successful.

4.91 Keeping Dr. Butler‟s session active and open, login to the EHR System as Dr. Alexander and access and view Theodore Smith‟s patient record.

Login successful Pass Fail AM 40.01 The system shall provide the ability for multiple users to interact concurrently with the EHR application.

4.92 With both sessions open, demonstrate that the users can view the same patient record for Theodore Smith. NOTE: For instance, Applicant could demonstrate a networked EHR system and show how multiple users are able to simultaneously access the same patient record using different work stations. This would require additional set up by the Applicant to demonstrate this step.

The Applicant demonstrates that Dr. Butler and Dr. Alexander are able to simultaneously view the patient record for Theodore Smith.

Pass Fail AM 40.02 The system shall provide the ability for concurrent users to simultaneously view the same record.





4.93 With both sessions open, demonstrate that the users can view the same clinical documentation:

Dr. Butler accesses and views clinical documentation in Theodore Smith‟s patient record; and

Dr. Alexander accesses and views clinical documentation in the same patient record.

The Applicant demonstrates that Dr. Butler and Dr. Alexander are able to simultaneously view the same clinical documentation.

Pass Fail AM 40.03 The system shall provide the ability for concurrent users to view the same clinical documentation or template.





4.94 Dr. Butler begins modifying an element (e.g., progress note, medication list, or blood pressure) in Theodore Smith's patient record. Before that entry is complete, Dr. Alexander attempts to modify the same element as Dr. Butler. The system uses some mechanism (e.g. record-level locking, field-level locking, or other protection) to maintain the integrity of clinical data when multiple users access and attempt to modify the same element of the same patient record.

Dr. Alexander is allowed to see the patient record, but is not permitted to modify the same element being modified by Dr. Butler. Either record-level locking (Dr. Alexander is blocked from making any changes to the record), field-level locking (Dr. Alexander is blocked from changing only the element being modified by Dr Butler), or another mechanism (e.g., Dr. Alexander or Dr Butler receive a warning of the conflict before they complete their entry) are acceptable.

Pass Fail AM 40.04 The system shall provide protection to maintain the integrity of clinical data during concurrent access.

4.95 Logout Dr. Butler and Logout Dr. Alexander.

Logout successful for both users.





ADMINISTRATIVE scenario


ADM.04

Login as required. Login successful. If a different user from the logged in user is required to execute any step, please login as that user.

ADM.05

Show where medication codes are maintained in the system (e.g. in the user interface, database table, etc.).

Applicant shows where in the system codes are attached to medication list. There is no requirement that the codes show in the GUI. The Applicant can simply show their tables where a code is associated with each medication.

Pass Fail FN 07.03 The system shall provide the ability to maintain a coded list of medications including a unique identifier for each medication.

This functional requirement does not require a national system of coding for medications.






ADM.06

At this step the proctor will provide you with a data element to add to or remove from a clinical template; customize the template by adding or removing that data element.

The template can be customized with an addition or removal.

Pass Fail AM 08.20 The system shall provide the ability to customize clinical templates.

Templates may include any patient encounter note documentation tools that provide a pre-set collection of clinical findings or fields, including macros driven by speech recognition technology, branching logic. This list is not necessarily all inclusive of all the technology that may arrive in future. Customization at the level of clinical content is satisfactory.

ADM.07

Show how the system identifies providers associated with the patient encounter for Joe Gardner.

Providers associated with this encounter can be identified, and include Dr. Alexander, Nurse Practitioner Ellen Thompson, and Nurse.

Pass Fail FN 03.01 The system shall provide the ability to capture and maintain, as discrete data elements, the identity of all providers associated with a specific patient encounter.

ADM.08

Specify, using structured data, that Dr. O‟Brien is the primary care provider for Jim Grayson.

Applicant shows how the system provides the ability to specify the provider‟s role.

Pass Fail AM 34.02 The system shall provide the ability to specify the role of each provider associated with a patient, such as encounter provider, primary care provider, attending, resident, or consultant using structured data.

This is meant as a means to define the provider role; display of the data is not addressed.






ADM.09

Show how the alerts for disease management (for example, for Gestational Diabetes) are setup (show the setup of the rules to trigger an alert).

System provides the ability to identify criteria for disease management.

Pass Fail AM 23.04 The system shall provide the ability to identify criteria for disease management, preventive, and wellness services based on clinical data (problem /diagnosis list, current medications, lab values).

ADM.10

Demonstrate how disease management guidelines and associated material are updated.

Applicant demonstrates process for updating disease management guidelines and associated reference material.

Pass Fail AM 22.04 The system shall provide the ability to update disease management guidelines and any associated reference material.

ADM.11

Access directory of users and show identifiers required for licensed clinicians to support the practice of medicine.

At a minimum, the system shall maintain a directory of state medical license, DEA, and NPI.

Pass Fail AM 27.02 The system shall provide the ability to maintain a directory which contains identifiers required for licensed clinicians to support the practice of medicine including at a minimum state medical license, DEA, and NPI.

ADM.12

Show directory of clinical personnel external to the organization who are not users of the system. Applicant can use examples provided in set up data, or other data as exists.

System maintains a directory of clinical personnel external to the organization who are not users of the system to facilitate communication and information exchange.

Pass Fail AM 27.04 The system shall provide the ability to create and maintain a directory of clinical personnel external to the organization who are not users of the system to facilitate communication and information exchange.

ADM.13

Show how the severity level at which drug interaction warnings appear to providers can be set/changed.

Applicant can show how severity level can be set.

Pass Fail AM 19.05 The system shall provide the ability to set the severity level at which drug interaction warnings should be displayed.






ADM.14

Add VACCINE XYZ to the system. Other data as required to store the vaccine may be entered. After entering the vaccine to the system, show this vaccine in the immunization database.

Vaccine that was added is available in the immunization database.

Pass Fail CH 13.01 The system shall provide the ability (at the user/administrative level) to add all new vaccine products and antigens to the system‟s immunization (tracking) data base.


ADM.15

Logout as required. Logout successful.





THE FOLLOWING SCENARIO IS REQUIRED FOR CARDIOVASCULAR CERTIFICATION This scenario involves a 66 year old male, Jim Grayson who is status post MI, CABG and CRT. He presents to the office in moderate respiratory distress; the primary cardiologist is on vacation and the covering physician needs to review the patient‟s history as well as current and past lab results.


CV.01 Login as Dr. Green and select patient record for Jim Grayson.

Login successful






CV.02 Display a default summary screen of CV specific patient data for this patient.

The default summary screen displays the following CV specific patient data when Jim Grayson‟s patient record is viewed: Problem List: Hypertension; Hyperlipidemia; Obesity; Type II diabetes

mellitus; Nicotine Dependence; Class III CHF CAD; and Atrial Fibrillation. Medications: Aldactone; Amiodarone; ASA; Coreg; Coumadin; Lasix; Lipitor; Lisinopril; and Metformin. Expected result continues below…

Pass Fail CV 12.01 The system shall provide the ability to display a summary screen (or screens) of CV-relevant patient information when a patient record is viewed. The following constitutes a minimum list of the types of patient information that shall be available through the summary view. 1) Problem List 2) Medications 3) Allergies 4) Labs 5) Cardiovascular Tests and Procedures (Diagnostic) 6) Cardiovascular Tests and Procedures (Therapeutic) 7) Implants/Devices

Individual systems may choose to display more than the minimum requirements stated in this criterion. Category headings within the summary view may not be exactly as listed; however all information of the types listed should be available from within this view.






CV.02 cont‟d

…Expected result continued from above. Allergies: No Known Allergies Labs: Lab values from

06/01/2003 (entered as in Appendix) o Fasting Blood

Sugar (FBS) 222; o HbA1C 10.2%; o Total Cholesterol

(TC): 260; o Triglycerides (TG):

310; o LDL 182; and o HDL: 30

Lab values from today,

as imported in the Ambulatory Test

Expected result continues below…






CV.02 cont‟d

…Expected result continued from above. Procedures: Cardiac Catheterization

(1/1/2000); PCI (1/1/2000); CABG (Coronary

Artery Bypass Graft) (3/10/2000);

Cardiac Resynchronization Therapy (CRT) w/ ICD (6/2/2003)

Imaging: Exercise Nuclear

Stress Test (7/10/2000);

Echocardiogram (7/10/2000; 6/1/2003)

Implants: CRT-D (6/2/2003)






CV.03 Demonstrate the ability to configure the sorting of the problem list at the level of user specialty. If a different user is required to execute this step, login as that user now.

Problem list is sorted to display cardiac related problems at the top of the list.

Pass Fail CV 08.01 The system shall provide the ability to configure the sorting/view of the diagnosis/problem list at the level of the specialty.

The intent is that for different specialties, the problem list would display differently. The cardiac problems would be on the top of the problem list when the cardiologist signs in, and if an orthopedist signed in, he would see orthopedic problems at the top of the list.

CV.04 Review CV specific risk factor panel/display. .

CV specific risk factor panel/display is available for review, and includes: Prior MI; Diabetes;

Tobacco use; Hypertension; Hyperlipidemia; Family history

Family history is available; will be reviewed in detail in next step.

Pass Fail CV 10.01 The system shall provide the ability to create a CV specific risk factor panel/display. This should include, but is not limited to the following: diabetes, hyperlipidemia, hypertension, history of cardiovascular disease, family history, tobacco use.

The intent of this criterion and test step is to ensure that the items listed in the criterion are displayed. Some may be redundant with the summery view (e.g., Diabetes, if it is a risk factor may also be on the problem list) but this step is included to ensure that there is a display of each of these items.






CV.05 Review family history. Family history is available for review and includes: Father died of

myocardial infarction (MI) at age 55;

Brother has coronary artery disease (CAD) and had a percutaneous coronary intervention (PCI) at age 50;

Sister had a coronary artery bypass graft (CABG) at age 60;

Paternal aunt had sudden coronary death (SCD) at age 30.

Pass Fail CV 10.02 The system shall provide the ability to create a CV specific family history panel/display. This should include, but is not limited to the following: coronary disease, sudden death.

CV.06 Search for cardiac catheterization result from 01/01/2000 by procedure name or date of procedure.

Studies/procedures related to Jim Grayson based on date or name of study/procedure are available for review: cardiac catheterization 01/01/2000.

Pass Fail CV 01.02 The system shall provide the ability to search for a particular study/procedure for a given patient based on date or name of study/procedure

CV.07 Review details of cardiac catheterization. A scanned report or attached file (e.g. pdf or other file) of the procedure data is acceptable. Discrete data must be demonstrated for Date of procedure

Details of previous cardiac catheterization are available for review: Date of procedure

(01/01/2000) CPT coded test type

(93510, 93543, 93545, 93555, 93556) PCI: 92982

Type of intervention: Left Heart

Pass Fail CV 06.03 The system shall provide the ability to store the following data elements for cardiac catheterization as discrete data: 1) Date of procedure 2) CPT coded test type (multiple selection capability required) 3) Procedure name 4) Type of intervention(s) (selected from customizable list of options; multiple selection capability required) 5) ID of physician(s) performing procedure (multiple input capability required) 6) Pressures (RA and LA – A wave, V wave,

Physician ID type is not specified and can be name, local system ID, national provider ID (NPI), etc. The data elements in this list represent a minimum requirement rather than a






CPT coded test type

Type of intervention ID of physician

performing the procedure

Pressures Saturations LV diastolic and

systolic volume Narrative summary.

Catheterization; Angioplasty (acute PCI)

ID of physician(s) /personnel involved with performing procedure. ID#1; ID#2; ID#3

Pressures (RA 4; LA: 7; RPW: 12; LPW: 12RV: 15; LV: 120; PA: AO Peak:120 Diastolic: 80 Mean: 100

mean; Right and left pulmonary, wedge; RV and LV – peak, early diastolic, end diastolic; PA, Ao (location) – peak, diastolic, mean 7) Saturations (IVC, SVC, RA, RV, PA, LA, LV, Aortic, AV 02 difference, cardiac output, cardiac index, and shunt fraction) 8) LV Ejection Fraction 9) LV diastolic and systolic volume 10) Narrative summary.

comprehensive list of all discrete cardiothoracic surgery data that may be available. Items highlighted in green are required only for CV advanced reporting capability certification.






CV.07 cont‟d

Expected result continued from above… Saturations (IVC: 70%;

SVC: 66%; RA: 66%; RV: 68%; PA: 64%

LV Ejection Fraction: 20%

LV Diastolic Volume: 173 ml, Systolic Volume: 120 ml

Narrative summary: Severe multivessel CAD; 100% proximal LAD-culprit vessel Multiple tubular 80% LCx stenosis in proximal and mid vessel 100% RCA lesion-RCA fills from L to R collaterals from LCx

CV.08 Show how the procedure data for the cardiac catheterization is linked to the diagnosis of myocardial infarction (MI).

The cardiac catheterization procedure is linked with the diagnosis of myocardial infarction (MI).

Pass Fail CV 07.02 The system shall provide the ability to link procedure data with patient diagnosis.






CV.09 View final report of cardiac catheterization procedure done on 01/01/2000.

The final report of this procedure can be viewed through the UI. The report may include the following data, that were included in the Appendix (note that depending on the source of the data the display may differ): Provider ID#1, ID#2

and ID#3 Procedure Date:

1/1/2000 Procedure: left heart

catheterization with PCI

Cardiac catheterization findings include: Severe multivessel

CAD; 100% proximal LAD-culprit vessel

Multiple tubular 80% LCx stenosis in proximal and mid vessel

100% RCA lesion-RCA fills from L to R collaterals from LCx

Pass Fail CV 01.01 The system shall provide the ability to import (and/or directly enter) the final report of studies/procedures from systems external to the EHR

CV 02.01 The system shall provide access to view through the UI of the EHR the final report of studies/procedures imported from external sources (and/or directly entered into the EHR).

The report may be a file of any type attached to the patient record. Physician ID type is not specified and can be name, local system ID, national provider ID (NPI), etc






CV.10 Export the final report of cardiac catheterization procedure viewed in the previous step. For verification purposes, a print preview of the exported file can be displayed (in plain text or PDF) or the file can be exported, printed, and faxed to the CCHIT proctor.

The final report of the cardiac catheterization procedure as viewed in the step above is exported.

Pass Fail CV 03.01 The system shall provide the ability to export the final report of studies/procedures stored in the EHR






CV.11 Review history of previous stress test.

Details of previous stress test are available for review. Date of study

(7/10/2000) Test type (Exercise

Nuclear) CPT = 93015 Result (abnormal) Total exercise time: 9

minutes Resting heart rate: 92

and BP: 146/90; Peak heart rate: 190

and BP: 190/100; Ejection Fraction 35% Interpreting physician:

Physician ID #1 Narrative summary:

“Abnormal stress test. Physician of record notified of results.”

Pass Fail CV 06.01 The system shall provide the ability to store the following data elements for a Stress Test as discrete data: 1) Date of study 2) Test type - list to include at least: Exercise treadmill, Exercise echo, Dobutamine echo, Exercise nuclear, Adenosine nuclear, Dobutamine nuclear, Dipyridamole nuclear, Adenosine MRI, Dobutamine MRI, Adenosine PET/CT, Dipyridamole PET/CT 3) CPT coded test type 4) Result: normal, abnormal, indeterminate 5) Total exercise time (where applicable) 6) Resting heart rate and BP 7) Peak heart rate and BP 8) Ejection Fraction (for modalities where it is measured) 9) Interpreting physician 10) Narrative summary.

Items highlighted in green are required only for CV advanced reporting capability certification. CV.11 refers to an EF measured by a stress test, therefore the EF% will be higher than a regular echocardiogram (35% vs. 30% in CV.22)

CV.12 Review details of previous cardiothoracic surgery.

Details of surgery are available for review: Date of procedure

(03/10/2000) CPT 33536 Procedure(s)

performed (Coronary Artery Bypass Graft (CABG))

ID of physician(s) performing procedure (ID #3)

Pass Fail CV 06.04 The system shall provide the ability to store the following data elements for cardiothoracic surgeries as discrete data elements: 1) Date of procedure 2) CPT coded test type (multiple selection capability required) 3) Procedure(s) performed (selected from customizable list of options; multiple selection capability required) 4) ID of physician(s) performing procedure (multiple input capability required)






CV.13 Review history of Electrophysiology (EP) procedures.

Details of EP procedure are available for review; the following will be stored as discrete data elements: Date of procedure

(06/02/2003)

CPT code: 33249 Procedure(s)

performed (CRT by way of EP. Device was implanted.)

ID of physician(s) performing procedure (ID #2)

Pass Fail CV 06.02 The system shall provide the ability to store the following data elements for invasive Electrophysiology (EP) Procedures as discrete data: 1) Date of procedure 2) CPT coded test type (multiple selection capability required) 3) Procedure(s) performed (selected from customizable list of options; multiple selection capability required) 4) ID of physician(s) performing procedure (multiple input capability required)

CV.14 Review history of implant/device data. Device data should be linked to procedure.

Device data is linked to procedure and can be reviewed. Device data includes: Date of

implant/procedure (06/02/2003);

CPT Code: 33249, 93012

Dual Chamber Pacemaker Implant

Types of device(s) Generator CRT-D;

St. Jude Medical; Model # 3207-36; Ser# 412211

LV Lead; St. Jude Medical; Model #1056T; Ser#; GXO-24401

Pass Fail CV 06.05 The system shall provide the ability to store the following implant/device data elements as discrete data: 1) Date of implant/procedure 2) CPT coded procedure type 3) Procedure name 4) Type of device (selected from customizable list of options) 5) Product name (selected from customizable list of options) 6) Device manufacturer (selected from customizable list of options) 7) Product specifications (e.g. diameter, length) 8) Product serial number 9) Manufacturer model number 10) Leads type (for pacemaker) 11) Date removed 12) Physical location of device implant 13) Lead location 14) Pacing Threshold (V, msec) 15) Sensing (mV) 16) Impedance (ohms)

CV 07.01 The system shall provide the ability to link data regarding device implanted (captured in CV 06.05) to the implantation procedure and display both

Items highlighted in green are required only for CV advanced reporting capability certification.





Procedure Expected Result Actual Result Pass/Fail Criteria and Reference Comments sets of data in surgical summaries and reports.

CV.14 cont‟d

Expected Result continued from above…

RV Lead; St. Jude Medical; Model # 7020; Ser# ADG-11322

RA Lead: St. Jude Medical; Model # 1699TC; Ser# EPO-14757

Location: R anterior chest

Lead Location: Standard

Threshold: Atrial: 2.66v / 0.40 ms Ventricular: 1.64 v / 0.40 ms

Sensing: Atrial: .50 mV Ventricular 2.80 mV

Impedence: Atrial 487 ohms Ventricular 554 ohms






CV.15 Review history of Echocardiogram from 7/10/2000 admission. Results are displayed in discrete fields versus large narrative text paragraphs.

Previous Echocardiogram data is available to view: Date of procedure:

7/10/2000 CPT code: 93303 Procedure name:

Transthoracic M-mode: LVEDD

5.0mm; LVESD 3.6mm LV posterior wall thickness: 1.0mm; Septal thickness 1.0mm

Doppler gradients: Aortic: 30mmHg; Mitral: 4

LA area: 23 cm2 AV area: 3 cm2 MV area: 1.8 cm2 LV diast vol: 173 LV syst vol: 120 LV mass: 116g ID of interpreting phys:

ID#3 Narrative summary:

Echocardiogram; moderate systolic dysfunction; 30%, qualitative results

The results are displayed in defined, quantitative fields.

Pass Fail CV 06.07 The system shall provide the ability to store the following data elements for an Echocardiogram as discrete data: 1) Date of procedure 2) CPT coded test type (multiple selection capability required) 3) Procedure name - list to include: transthoracic, transesophageal, stress, ICE, IVUS, fetal (cardiac only) 4) M-mode measures - list to include: LVEDD, LVESD, Aortic root, LA, RVDD, LV posterior wall thickness, septal thickness 5) Doppler gradients - list to include: RV-RA systolic gradient, RA-RV diastolic gradient, RV-PA systolic gradient, LA-LV diastolic gradient, LV-Ao systolic gradient 6) Left Atrial area 7) Aortic valve area 8) Mitral valve area 9) LV diastolic volume 10) LV systolic volume 11) LV mass 12) ID of interpreting physician(s) 13) Narrative summary

Results must be presented in defined fields; narrative text including quantitative results is not acceptable. A narrative summary must be included in a defined field indicating summary data. Items highlighted in green are required only for CV advanced reporting capability certification.






CV.16 Review details of Electrocardiograms (ECG) from 3/1/2000 admission. Results are displayed in discrete fields versus large narrative text paragraphs.

Previous Electrocardiogram (ECG) data is available to view:

Date & time obtained: 3/1/2000; 13:30

CPT code: 93010

Type: 12-lead

Interval: PR: .12; QT: .40; QTc: .5; QRS duration: .10; QRS Axis: +80 degree

Interpretation: Sinus rhythm w/ isolated PAC.Q waves noted in anterior precordial leads. Poor R wave progression; Rate 100bpm

Ordering physician: ID #1

Reviewing physician: ID #2

Date reviewed 3/1/2000

The results are displayed in defined, quantitative fields.

Pass Fail CV 06.08 The system shall provide the ability to store the following data elements for Electrocardiogram (ECG) as discrete data: 1) Date and time ECG obtained 2) CPT coded test type (multiple selection capability required) 3) Type of ECG performed ( 4) Date ordered 5) Interval (PR, QT, QTc, QRS Duration, P Axis, QRS Axis, T Axis) 6) ECG Interpretation 7) Ordering physician 8) Reviewing physician 9) Date reviewed

Results must be presented in defined fields; narrative text including quantitative results is not acceptable. A narrative summary must be included in a defined field indicating summary data. Items highlighted in green are required only for CV advanced reporting capability certification.






CV.17 Review Non invasive EP Procedure from 6/2/2003 admission. Results are displayed in delineated fields versus large narrative text paragraphs.

Previous non-invasive EP procedure data is available to view: The results are displayed in defined, quantitative fields. 1) 06/02/2003 2) 93012 3) 24-hour Ambulatory ECG recording 4) Physician ID #1

Pass Fail CV 06.09 The system shall provide the ability to store data elements for non-invasive EP procedures, which would include ambulatory ECG monitoring, as well as remote transmission of data retrieved from implantable devices. The following data elements should be captured as discrete data: 1) Date of procedure 2) CPT coded test type (multiple selection capability required) 3) Procedure(s) performed (selected from customizable list of options; multiple selection capability required) 4) ID of physician(s) signing off on procedure (multiple input capability required)

Items highlighted in green are required only for CV advanced reporting capability certification.

CV.18 Review LDL and HDL including target range. Show how the system provides the ability to document target range for this test customized for this patient. LDL and HDL results will include values entered from the Appendix as well as results imported during the Ambulatory Test Script. To demonstrate how the target range is customizable for this patient, modify target values for Jim Grayson to LDL <90 and HDL >60.

LDL and HDL results are available for review. Applicant can demonstrate how target range is customizable for this patient. Initial target range as presented in appendix data is LDL < 110 and HDL >55. Customized target range for Jim Grayson is saved.

Pass Fail CV 08.02 The system shall provide the ability to document, in structured fields, a target range for lab results, a target maximum, or a target minimum for lab results, customized to patient for the following lab values: 1) INR; 2) Total Cholesterol; 3) LDL; 4) HDL 5) Triglycerides; and 6) HbA1c.






CV.19 Show how the system provides the ability to identify lab values outside custom target ranges. Enter the following values for Jim Grayson: LDL 95; HDL 40.

The system indicates that these values for Jim Grayson are outside his custom target values.

Pass Fail CV 09.01 The system shall provide the ability to indicate when the patient is outside their custom target for the following lab values: 1) INR; 2) Total Cholesterol; 3) LDL; 4) HDL 5) Triglycerides; and 6) HbA1c.

CV.20 Review an ECG tracing.

(ECG file will be provided by CCHIT proctor to vendor prior to certification testing.) ECG tracing is displayed.

Pass Fail CV 13.01 The system shall provide the ability to display the accurate (i.e. non-distorted) tracing from any ECG stored in the system or imported from another system.

1. The EHR must be able to receive and store ECG files from commercial ECG systems.

2. The EHR must display these ECG files as an integral function of the EHR (without invoking

the originating

ECG management system).

3. The ECG must display as a non-distorted image: measurement of the length of any number of squares in the x-axis direction will equal the length






of the same number of squares in the y-axis direction. (Note: there are five 0.2 sec minor squares per each 1 sec major square in the x-axis direction.) The image must remain non-distorted regardless of the aspect ratio of the monitor (e.g., 16:9 or 4:3).






CV.21 Transmit image displayed in previous step to proctor (proctor will provide the transmitted image to Jurors). Compare image received to image stored (from previous step).

Image is received. Image received is not visibly altered from the image stored in the system (stored image may have to be redisplayed upon receipt of transmitted image). Image must be readable, without significant changes in scale, and does not require modification or adjustment on the receiving side.

Pass Fail CV 15.02 The system will provide the ability to emergently transmit specific patient data, reports, and accurate, clinically interpretable images to alternate providers/facilities.

1. The EHR must be able to transmit an ECG file (e.g. via fax or FTP server, or as an attachment in an email.) Saving the file externally and sending through an external email client is not allowed as this method introduces the possibility for errors.

2. The ECG file must be identical to the file originally sent to the EHR from a commercial ECG management system.






CV.22 Review Ejection Fractions from previous admissions. Both quantitative and qualitative results will display. Results from multiple studies, including Ejection Fraction, date and modality are viewable simultaneously.

Previous Ejection Fraction data is available to view: 1/1/2000; Angiogram;

20% 7/10/2000;

Echocardiogram; moderate systolic dysfunction; 30%

6/1/2003; Echocardiogram; 15%

The results from multiple studies/procedures are displayed in one view (simultaneously).

Pass Fail CV 04.01 The system shall provide the ability to capture the following data elements for Ejection Fraction as discrete data: 1) Date of test; 2) Modality of test; 3) Quantitative value as percent; and 4) Qualitative value (narrative).

CV 05.01 The system shall provide the ability to retrieve and display ejection fraction results from multiple studies/procedures/modalities in one view (simultaneously), inclusive of EF (quantitative or qualitative), date and modality.

CV.22 refers to an EF measured by a regular echocardiogram.

CV.23 Graphically display ejection fraction results reviewed in the previous step (may be combined with the previous step).

Ejection fraction results from multiple studies/procedures/ modalities can be graphically displayed in one view.

Pass Fail CV 05.02 The system shall provide the ability to graphically display ejection fraction results from multiple studies/procedures/modalities in one view (simultaneously).

CV.24 Logout as Dr. Green. Logout successful.





Test Script Scenario 3B – Interoperability Testing – Clinical Documentation


3.06 The following actions are conducted by the CCHIT Test Proctor: 1. CCHIT Test Proctor emails patient summary documents to the Applicant.

Patient summaries will be selected from a set of pre-built test cases; basic demographic information will match existing patient charts that have been created by the Applicant for use in this Test Script

2. CCHIT Test Proctor shares inspection checklists with Juror Checklists will describe document content to look for in Applicant‟s EHR, based on the content of the documents generated.

3. CCHIT Test Proctor selects patient record to update. Patient record will be selected from a set of pre-built test cases; basic information will be updated in the following sections: medications and allergies. Applicant transmits patient summary file to CCHIT Test Proctor.

4. CCHIT validates the document for xml coding and compliance, proper use of coded terminologies and vocabularies, and updated content information

3.07 Login as required. Login successful.






3.08 Receive the HITSP C32 file from Proctor. Match the patient summary file to the correct chart in the EHR. Store the file as an intact document in that chart. Display the content of the HITSP C32 document. The required display elements are: Patient Name, Birth

Date, and Gender; and

Section labels (title) and associated narrative text for the patient demographics, medication list, medication allergy list.

The HITSP C32 file is received. The document is filed in the appropriate chart by matching the patient registration information contained in the document to the appropriate test patient chart in the system. The system displays the correct narrative (human readable) information contained in the HITSP C32 document. The required display elements are: Patient Name, Birth

Date, and Gender from the Registration Information HITSP C32 module; and

Section labels (title) and associated narrative text for patient demographics, medication list, medication allergy list.

Pass Fail IO-AM 10.10 The system shall provide the ability to display HITSP C32/CCD documents and file them as intact documents in the EHR. Summary patient record content information will include: patient demographics, medication list, medication allergy list,

The data is structured, exchanged using a standard format, filed (not thrown away), and displayed, but discrete data import is not required. It is acceptable to display calculated age of patient rather than date of birth. For further guidance, see the CCHIT Certified 2011 Interoperability Testing Guide.






3.09 Applicant will notify the proctor as to what version of patient summary will be generated by their system. Before the patient summary document is generated, the CCHIT Proctor will select a pre-existing patient from the system and request the applicant to open the record, verify the demographic information and then add information to the record before creating the document. The updated patient summary is generated by the Applicant and transmitted to the CCHIT Proctor.

Applicant may generate HITSP C32 v2.3 or HITSP C32 v2.5 documents. The following sections of the summary patient record will be updated: medications, allergies. Once the file is received, CCHIT will validate the xml compliance, use of correct coded terminologies and vocabularies, and verify that the updated content information is present in the generated document.

Pass Fail IO-AM 10.20 The system shall provide the ability to generate and format patient summary documents per the following specifications:

HITSP C32 (v2.3 or v2.5)

Summary patient record content information will include: patient demographics, medications, medication allergies

Generated xml documents must demonstrate use of industry-standard vocabularies/terminologies.

The intent is to test the Required (R) fields, including the product coded terminology for the medication and medication allergy.

For further guidance, see the CCHIT Certified 2011 Interoperability Testing Guide.






3.10 Validate the patient summary file successfully for xml coding compliance and correctness based upon the version of the document generated.

File is validated by CCHIT and contains no xml coding errors. Structured entries, narrative text and specified coded terminologies are required for the following patient summary sections: patient demographics, medication list, medication allergy list;






For further guidance, see the CCHIT Certified 2011 Interoperability Testing Guide.

3.11 Verify that the generated patient summary demonstrates use of industry-standard vocabularies and coded terminologies.

File is validated by CCHIT to demonstrate correct usage of coded terminologies and vocabularies. Structured entries, narrative text and specified coded terminologies are required for the following patient summary sections: patient demographics, medication list, medication allergy list.






Vocabularies C32

Medications: RxNORM/NDC

C32 Allergies: RxNORM, UNII






3.12 Verify that the generated patient summary contains the updated content information.

File is displayed by CCHIT using a stylesheet, and the updated patient summary information is verified by examining the narrative text for the following sections: Patient Demographics

(Name, date of birth, and gender)

Medication List Medication Allergy List






Structured entries, narrative text and specified coded terminologies are required for the following patient summary sections: patient demographics, medication list, medication allergy list; Narrative text and specified coded terminologies are required (structured entries are optional) for the following patient summary sections: immunizations, problem list, procedures, and diagnostic test results

3.13 Logout as required. Logout successful.





Appendix A –

Previous visit entries for Joe Smith, bd 01 July 1998. Appendix information is to be entered as previous visits for this patient at this practice. Problem List – includes asthma 06/15/2000

PCV Immunization given (Applicant to scan consent document for the administration of this immunization; scanned document must be indexed with an associated date of 06/15/2000 and a document type of “consent.”)

07/12/2003

Immunizations (Applicant to scan consent document for the administration of these immunizations; scanned document must be indexed with an associated date of 07/12/2003 and a document type of “consent.”)

o DTaP o MMR o IPV

Height 42”, weight 41.5 lbs

04/01/2007


04/02/2008


02/01/2009

Height 56”, weight 70 lbs

Allergies to Penicillin Data from two visits outside this practice

03/10/2005

Height 46”, weight 49 lbs (this data obtained from a visit outside this practice)

04/03/2006





Height 48.3”, weight 52 lbs (this data obtained from a visit outside this practice)





Previous visit entries for Emily Jones

November 1 – 3, 2008 – birth and related incidents o Birth weight 8 lbs 7 oz, ht 22” o Immunizations

Hep B

December 2, 2008 – 1 month visit o Wt 9 lbs 8 oz, ht 22” o Immunizations

Hep B

Previous visit entries for Will Haynes

November 4, 2008 – birth and related incidents o Birth weight 8 lbs 11 oz, ht 21” o Immunizations

Hep B

December 4, 2008 – 1 month visit o Wt 9 lbs 12 oz, ht 21” o Immunizations

Hep B For Child Health Certification: There must be a patient record for Charlie Green, male, with date of birth two days before inspection date. There must be a patient record for Alice Brown, female, with date of birth ten days before inspection date.





Appendix B Previous visit entries for Jennifer A. Thompson, birthdate 4/10/1978 – Appendix information is to be entered as previous visits for this patient at this practice. For reference:

o LMP – test date minus 29 weeks o EDD – test date plus 11 weeks

6 months ago – visit date is test date minus 24 weeks o Allergies

NKDA o Problem list

Pregnancy

3 months ago – visit date is test date minus 12 weeks o U/S for anatomy and placenta. No anomalies seen; size consistent with EGA.

2 months ago – visit date is test date minus 8 weeks o Problem list

Gestational Diabetes

1 month ago – visit date is test date minus 4 weeks o Lab results

HgA1C 6.2 Record of Blood Sugar Data (to be entered into EHR during step 2.03) Note that if an interface is used to enter the blood sugar information into the EHR, values may differ from those appearing in this appendix; this would meet the criterion.

Date Fasting Post Breakfast Post Lunch Post Dinner

Yesterday (Y) 98 130 133 137

Y minus 1 106 98 120 110

For use in Scenario 2, create an order set called “Diabetes One”. The order set must include orders for RhoGAM, HgbA1c and nutrition referral.





Appendix C Previous visit entries for Theodore S. Smith, bd 11/08/1931. Appendix information is to be entered as previous visits for this patient at this practice. Past Medical History/Problem List: His past medical history is positive for type 2 diabetes, elevated cholesterol, hypertension, GERD, BPH, Hypothyroidism, and arthritis. He has had appendicitis (resolved with an appendectomy on September 12, 2004), cholecystitis (resolved with a cholecystectomy), and a cataract (resolved with a left cataract extraction). There are at least two prior visits for this patient. Previous Visit One problems included diabetes and hypertension; in this visit the provider was Dr. Jones. Previous Visit Two problems included diabetes, hypertension and GERD; in this visit the provider was the Dr. Butler. Allergies: He is allergic to Penicillin G and Sulfamethoxazole. Medications: He is currently on Lipitor 20 mg a day, Zantac 150 mg a day, Actos 30 mg once daily, Synthroid 0.112 mg a day, glucosamine chondroitin, saw palmetto, and lisinopril 5 mg twice a day (0 refills remaining for lisinopril). Labs and vital signs to be preloaded as would have been entered during previous patient visits at this practice (i.e. into the patient record as data elements): NOTE that LOINC Codes have been provided for Cholesterol, HDL and LDL to facilitate step 4.15.

Visit 04/14/2003 o CBC: WBC 9.8, RBC 3.67, HGB 10.9, HCT 33.2, MCV 90.7, MCH 29.7, MCHC 32.7, PLT 304, Neut 75, Lymph 10, Monos 5, Eos 5, Baso 1

3 months ago 6 months ago 9 months ago 1 year ago LOINC CODE

Glucose 185 180 136 128

LDH 151 141 148 152

Cholesterol 172 163 203 287 14647-2

HDL 57 47 62 48 14646-4

LDL 96 98 116 193 13457-7

HGBA1 8.6 10.5 10.1 9.3





Appendix G Previous visit entries for Jim Grayson, bd 09 March 1943. Also includes set up data required for advanced reporting capability certification (these data elements are highlighted in green in the test steps.) Appendix information is to be entered as previous visits for this patient at this practice.

Patient is a Caucasian male who returns for follow-up of CHF.

He has sustained previous MI's (Anterior STEMI 2000), has undergone coronary artery bypass graft in 2000 and cardiac resynchronization therapy in 2003.

Current conditions list: 1) CHF (Class III) ICD9 428.0 2) Multivessel CAD ICD9 414.01 3) Paroxysmal Atrial Fibrillation ICD9 427.31 4) Obesity (BMI 33.2) ICD9 278.00 5) Type II DM ICD9 250.00 6) Nicotine Dependence ICD9 305.1 7) Hypertension 8) Hyperlipidemia

Patient's current meds: Aldactone 25mg qAM; Amiodarone 200mg qAM (w/food); ASA 325mg qAM; Coreg 12.5mg BID; coumadin 5mg qPM; Lasix 20mg BID; Lipitor 20mg qPM (atorvastatin); Lisinopril 20mg qAM; Metformin 1000mg BID,

Family History:

Father died of myocardial infarction (MI) at age 55; Brother has coronary artery disease (CAD), and had percutaneous coronary intervention (PCI) at age 50; Sister had coronary artery bypass graft (CABG) at age 60; Paternal aunt had sudden coronary death (SCD) at age 30.

Previous visits:

01/01/2000

Persistent post MI angina and congestive heart failure with severe left ventricular systolic dysfunction; specifically, an Ejection Fraction of 20% (modality=Angiogram).

Patient presented with MI on the anterior wall of his heart (ICD-9 CM code 410.11) resulting in a cardiac catheterization procedure (angioplasty or acute PCI). Catheterization procedure details and findings include:

CPT codes: Left Heart Cath: 93510, 93543, 93545, 93555, 93556. PCI: 92982. EDC: 93010 Procedure performed by the following cardiologist users: ID#1, ID#2, ID#3





Pressures: RA: 4 LA: 7 Right Pulmonary Wedge (RPW): 12 Left Pulmonary Wedge (LPW): 12 RV: 15 LV: 120 PA: AO Peak: 120 Diastolic: 80 Mean: 100

Saturations: IVC: 70% SVC: 66% RA: 66% RV: 68% PA: 64%

Left Ventricular Ejection Fraction: 20% Left Ventricular Diastolic Volume: 173mL Systolic Volume: 120 mL Narrative summary: Severe multivessel CAD; 100% proximal Left Anterior Descending (LAD)-culprit vessel; Multiple tubular 80% Left Circumflex (LCx) stenosis in

proximal and mid vessel; 100% RCA lesion-RCA fills from L to R collaterals from LCx

03/10/2000

Patient underwent coronary artery bypass surgery (CABG – coronary bypass graft) due to persistent Angina Pectoris (Class III) in the setting of multivessel CAD and Severe LV Systolic Dysfunction

Performed by Physician ID #3 CPT code 33536 ECG Data

Date ordered: 3/1/2000 The date and time obtained 3/1/2000; 13:30 Type: 12-lead Interpretation: Sinus rhythm with isolated PAC. Q waves noted in anterior precordial leads. Poor R wave progression. Rate 100 bpm Interval (PR: .12 QT: .40, QTc: .5 QRS Duration: .10, QRS Axis: +80 degree) Ordering physician: Cardiologist ID #2 Reviewing physician: Cardiologist ID #1





Date reviewed 3/1/2000 CPT code: 93010

07/10/2000

Patient returns for routine CV follow-up No Angina, No CHF: clinically stable EF re-assessed to determine Risk post OP of Sudden Coronary Death

EF assessed via Echocardiogram Procedure name: Transthoracic M-mode: LVEDD 5.0mm; LVESD 3.6mm LV posterior wall thickness: 1.0mm; Septal thickness 1.0mm Doppler gradients: Aortic: 30mmHg; Mitral: 4 LA area: 23 AV area: 3 cm2 MV area: 1.8 cm2 LV diast vol: 173 LV syst vol: 120 LV mass: 116g ID of interpreting phys: ID#3 Narrative summary: Echocardiogram; moderate systolic dysfunction; 30%, qualitative results

Exercise Nuclear (Myoview), results: abnormal Total exercise time: 9 minutes Resting heart rate and BP: 146/90; 92 Peak heart rate and BP: 190/100; 190 Ejection Fraction 35% Interpreting physician: Physician ID #1 Narrative summary: “Abnormal stress test. Physician of record notified of results.”

CPT Codes: 93015

06/01/2003

Patient returns now with clinical signs/symptoms of CHF.

Laboratory reveals FBS (fasting blood sugar) 222mg/dL HbA1C =10.2% TC (Total Cholesterol) =260mg/dL TG (triglycerides) 310mg/dL, LDL 182, HDL 30 Target range for this patient for LDL is < 110 and for HDL is > 55 Echocardiographic EF of 15% indicates worsening left ventricular systolic dysfunction





06/02/2003

Patient underwent cardiac resynchronization therapy (CRT) w/ICD

Performed by Physician ID #2 Implant placed in Right Anterior Chest : Device was implanted with the following product specifications:

Generator – St. Jude Medical (CRT-D) model # 3207-36 SN# 412211 LV Lead -St Jude Medical model #1056 T SN # GXO-24401 RV Lead - St Jude Medical model # 7020 SN #ADG-11322 RA Lead -St Jude Medical model #1699 TC SN # EPO -14757

Lead Location: standard Threshold

Atrial: 2.66 v / 0.40 ms Ventricular: 1.64 V / 0.40 ms

Sensing: Atrial: .50mV Ventricular: 2.80 mV

Impedence: Atrial: 487 ohms Ventricular: 554 ohms

CPT code: 33249 Patient was monitored via 24-hour Ambulatory ECG Recording (CPT: 93012), by Physician ID #1 Previous visit entries for Chester Pain, bd 01/29/1945 Diagnoses - 414.0, 410.11, 428 Medications: Aspirin 325 mg by mouth once daily; Metoprolol 100 mg one tablet by mouth twice daily

CCHIT Certified 2011 Ambulatory EHR Test Script 20100326

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