Test EHR Pilot Program Launch

Oct 21, 2013

Avinash Shanbhag Director of Implementation and Testing Division

Office of National Coordinator

Topics

Pilot Tasks for SITE team

Pilot Contacts and timeline

Summary and Next Steps

2

3

Pilot Task – For SITE Team

• Provide feedback on the draft guidance issued by ONC and CMS for designating Test EHR

• Provide guidance to ONC on any operational issues• Test that the Test EHRs are able to meet the

requirements of the program• Validate the registration process for providers in

the “EHR Randomizer Tool”• Raise any issues that would impact ability to

become a designated “Test EHR”

Topics

Pilot Tasks for SITE team

Pilot Contacts and timeline

Summary and Next Steps

4

5

Pilot Participants

– AthenaHealth• POC: Stephen Jacobs• Email: sjacobs@athenahealth.com

– McKesson • POC: Sally Connally• email: Sally.Connally@McKesson.com

– Meditech• POC: John Valutkevich • email:jmvalutkevich@meditech.com

6

Pilot Support Staff

– Pilot Coordinator• POC: Becky Angeles• Email: rebecca.angeles@esacinc.com

– EHR Randomizer Tool Lead• POC: Kevin Brady• email: Kevin.Brady@nist.gov

– Pilot Lead• POC: Avinash Shanbhag• Email: Avinash.Shanbhag@hhs.gov

7

Pilot Process – Overview

Pilot Participation Finalized

Pilot (Sept 20 – Dec 15)Complete Registration of

Test EHR

Sep Oct

Pilot Kick offPilots Submit

Final Feedback to ONC

Proposed Milestones– Pilot kickoff: Sept 20th – Complete Registration: Oct 30th, Sept. 30th

– Submit feedback to ONC: Nov 22nd, Oct 20th

– ONC schedules debrief session with Pilots: Dec 15th, Oct 30th

ONC Debrief to Pilots

Nov Dec

New Dates – NOT YET FINALIZED

Topics

Pilot Tasks for SITE team

Pilot Contacts and timeline

Summary and Next Steps

8

9

Testing Process

1. After the kickoff, Pilots will receive email from EHR Randomizer Tool team with steps to create new account and register the Test EHR

2. ONC Implementation and testing team will register as “provider” on the Randomizer tool

3. Send Direct Message (with test CCDA) to each of the pilot Test EHR4. SITE team will validate receipt of response matches the process

described in the registration5. Submit report (pass/fail) for each Test EHR and feedback on tool

usage to ONC/NIST6. Pilots can submit individual feedback and/or joint report. Pilot

Coordinator can assist in logistics

10

Summary and Next Steps

• Q1: Are there additional requirement for documentation from Test EHR for successful exchange?

• Q2: Should there be requirements for Test EHR to be member of scalable trust community?

• Q3: Do you suggest any updates to the Developer Participant and Test Instructions requirements?

• Q4: Are there any changes that need to be made towards Test EHR registration using the EHR Randomizer Tool?

11

Thanks!

• Questions?

• Pilot Coordinator• POC: Becky Angeles• Email: rebecca.angeles@esacinc.com

12

Pilot Testing Notes and Feedback from SITE Team

• EHR Randomizer Tool URL used by the SITE Team: https://ehr-randomizer.nist.gov:14081/ehr-randomizer-app/#/home

• EHR Randomizer Tool Website Feedback:– Not Intuitive to click (because no hand or other icons that are typically used in web

pages) and providers may not understand if they should/should not click on something on the page.

– Goal Tab:• Not enough information to describe what the goals are clearly.

– Architectural Overview Tab• It might be good to combine this with the goal tab and describe the goals more clearly.• Suggest to have Goal Tab to be first and the Provider Workflow tab to be something that a

provider can access by clicking the tab.– Provider Workflow:

• Steps need to be better described because providers may not know the language and the terms used on the page. Also having the Goals and Overview on the home page may help to educate providers.

• Step showing downloading a public certificate which is never done in Direct. Public Certificates are always discovered.

13

Provider Registration Process

I think adding a tool tip or something on the purpose of the email, username would help the provider.

14

Provider Registration Process Cont’d

1. No Feedback is provided after accepting the agreement and submit account creation information, don’t know if the account creation succeeded/failed ?

2. It would help to describe some confirmation and say something about What is the next step ?

3. After some time (Within a minute) the Create Account page comes back with blank fields even though the account is created, misleading the provider to potentially recreate the account.

4. Suggest providing feedback upon account creation and ask the user to login and proceed to the next phase.

5. There should be some kind of a work flow or something to tell the user where he is in the process, Use the Provider Workflow and remind the provider what he/she have completed and what remains to be done.

6. I checked my email before I did anything just out of curiosity and I received the following:

Dear nbashyam  Your account has been successfully created. Your username is: nbashyam  Thank you very much  The ehr-randomizer Team

----- The above information is not very useful, we should craft some message to tell the provider what to do.Also the Email is from Fred instead of a preferred NIST Organization inbox

15

Provider Registration Process Cont’d

7. I was on the Create Account Page when I logged in and even after I logged in, the screen displays CreateAccount

- Why would we create an account once the user is logged in already ?

8. Home Page shows the Provider Workflow- Don’t know what to do or where to enter the information that I need to

enter, additional guidance might be useful for providers.

16

Other Web Pages:

SELECTED My CEHRTs

1. Timezone dropdown should be really simplified (Africa and other places are listed which I don’t think are relevant for MU)

--- Should provide information on where to find CHPL ID and how to obtain Id.

2. Developer Dropdown has a list of companies which is very small, Don’t know what this means Because I am in the provider workflow and it does not seem to make sense to me, the name or label should be changed to CEHRT’s maybe using CHPL

3. The label NEW on the left is not intuitive and it seems out of place..(put some text around it and guide the provider)

4.Request a Match…

--- When I request a match, the screen disappears and I don’t know what happens, after sometime the page comes back with a match.

-- It would be better to show some kind of progress indicator.

17

Request Match with No CEHRTs in MYCEHRTs

Bad Text Shown to provider

18

McKesson Test EHR Pilot

1. Availability times should include timezones

2. Add text in the trust anchor section to indicate that it should be downloaded And installed.

3. McKesson has a .7z.SAFE file extension for the trust anchor which for non-technical people Will be challenging to unzip

4. There are four certificates that need to be used, how do we know which one to use• Contacted the vendor.• Maybe we should have only one for providers to download and install.

5. Sent SITE Trust Anchor without zip file that was blocked, so maybe guidance should be provided to vendors to provide their anchor in a zip format so that providers don’t have to decipher these issues.

6. Discovered that McKesson Trust Anchor was incorrect and notified pilot participants to get it corrected.

- Once it was corrected the four trust anchors were removed and replaced by a single trust anchor which is preferable.

- The replaced trust anchor did not conform to Direct Applicability Statement so it was asked to be reworked by Mckessson.

7. *** We should test every TEST EHR using an environment like SITE to address these issues so that providers don’t get annoyed during attestation.

19

Athena Health Test EHR Pilot

Unable to Test because match not obtained due to unavailability of Test EHR

20

Meditech Test EHR Pilot

Unable to Test because match not obtained due to unavailability of Test EHR