Friday, September 28, 2012

Wave 3 of MeaningfulUse Stage2 Tests

I'm behind on evaluating Wave 3, and if they are following the same schedule, Wave 4 will show up tonight (although it may not, I heard something about there being a delay for the next wave).

I'm only going to be looking at two of the test procedures, because only two of them address the need to use interoperability standards per se, and I'm stretching on one of them.

Clinical Information Reconciliation

The first of the test procedures is Clinical Information Reconciliation.  I say this is a stretch because except for the IHE Reconciliation profile and the HL7 EHR Functional Model, there are few "standards" out there that address this.

This is a pretty decent set of tests.  Basically it verifies the EHR's capabilities to display in two separate lists the information to be reconciled, with attribution of the data source, and relevant dates.  There are three separate tests performed for each of the three data categories (problems, medications and allergies).

Display Test

  • The Vendor creates a patient record in their EHR and populates that patient’s record  with ONC supplied medication test data in the medication list
  • The Vendor creates at least one additional medication list for this patient using ONC-supplied medication test data in the(se) medication list(s)
  • The Tester displays the two or more medication lists simultaneously in a single view
  • The Tester verifies that each of the medication lists displays the source of the medication list and the last date each medication was documented, ordered, prescribed, refilled, or edited

The one thing that I think it is missing is ensuring that the two records used in the test are for the same patient.  You can imagine situations where all you have are patient demographics to go on here (e.g., patient transmits a recent record from provider A to another provider B using VDT, and provider B needs to reconcile his/her list with that provided by provider A).

This is something that the IHE Reconciliation profile mandates:
  1. It SHALL present the demographics used to identify the patient provided by each separate source of clinical information to the end user.

Creation Test

Although appearing to be somewhat mislabeled, the point of this test it to ensure that a single unified list can be created, with corrections.
  • The Tester merges the two or more medication lists from the Display test into a single reconciled medication list
  • The Tester consolidates identical medications from these medication lists into one representation of those medications on the single reconciled medication list
  • The Tester removes a medication from the single reconciled medication list
What IHE has to say is a bit more direct:
  1. It SHALL highlight inconsistencies found during the automated reconciliation process and provide the clinician with mechanisms to adjust or correct the input.
  2. It SHALL provide a mechanism for a clinician to add new information to the reconciled results.
Removal is simply one mechanism to adjust or correct.  IHE notes that you could also add new data to the results.

Review, Validate, Confirm, and Submit

This step is about saving the results.
  • The Tester displays the single reconciled medication list generated in the Merge test
  • The Tester reviews the reconciled medication list and validates that the data contained in the list are accurate and complete
  • The Tester confirms and submits the reconciled medication list to the patient’s record in the EHR
  • The Tester views the patient’s active medication list and verifies that it includes all of the reconciled medications and that these medications are accurate and complete
Again, IHE is a bit more direct about some things:
  1. It SHALL authenticate the clinician prior to storage of the reconciled data (this step may be combined with other authentication steps used to finalize the record).
  2. It SHALL store the resulting data for future use by other actors as described below.
Tests for the other information categories are fairly similar.

Ambulatory setting only – clinical summary

This is the big one... creating Consolidated CDA Conforming Documents.  They are using MDHT to do this testing, and given recent results reported at the HL7 Working Group Meeting, this is going to be much better than Schematron (you may recall that Dave Carlson is a Harley Award winner for his work on MDHT).

There's a lot of functional details in this test that finally address one of my favorite issues, relevant and pertinent.  You have to be able to demonstrate the provider's ability to select the relevant data in this test.

I'll have to spend more time with the testing tool to see how it works.  One of the nice features of this tool is that eventually, it will support the specified transports, to test that as well.

It looks like the put my buddy from NIST, Bill Majurski, in charge of this tool, and he's used the testing framework that NIST has been supplying IHE with to deploy this test.   I'm sure he'll be thrilled with all the e-mail this tool is going to be generating for him, especially since they put his e-mail address in the test procedure.  Good luck Bill!

  -- Keith


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