2022 REAL WORLD TESTING PLAN
BACKGROUND & INSTRUCTIONS
Under the ONC Health IT Certification Program (Program), Health IT Developers are required to conduct Real World Testing of their Certified Health IT (45 CFR 170.556 and 170.523(i)). The Office of the National Coordinator for Health Information Technology (ONC) issues Real World Testing resources to clarify Health IT Developers’ responsibilities for conducting Real World Testing, to identify topics and specific elements of Real World Testing that ONC considers a priority, and to assist Health IT Developers to develop their Real World Testing plans.
Health IT Developers have maximum flexibility to develop innovative plans and measures for Real World Testing. As developers are planning for how they will execute Real World Testing, they should consider the overall complexity of the workflows and use cases within the care settings in which they market their Certified Health IT to determine which approaches they will take. This Real World Testing plan template was created to assist Health IT Developers in organizing the required information that must be submitted for each element in their Real World Testing plan. Health IT Developers must submit one plan for each year of Real World Testing (see resources listed below for specific timelines and due dates). ONC does not encourage updating plans outside the submission timeline and will not post updates on the Certified Health IT Product List (CHPL). If adjustments to approaches are made throughout Real World Testing, the Health IT Developer should reflect these adjustments in their Real World Testing results report. ONC would expect that the Real World Testing results report will include a description of these types of changes, the reasons for them, and how intended outcomes were more efficiently met as a result. This resource should be read and understood in conjunction with the following companion resources, which describe in detail many of the Program requirements referenced in this resource.
- Real World Testing-What It Means for Health IT Developers – Fact Sheet
- Real World Testing Resource Guide – Coming Soon
- Real World Testing Certification Companion Guide
Health IT Developers should also review the following regulatory materials, which establish the core requirements and responsibilities for Real World Testing under the Program.
- 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program final rule, 85 FR 25642 (May 1, 2020) (Century Cures final rule)
- Section VII.B.5 – “Real World Testing”
GENERAL INFORMATION
Plan Report ID Number: [For ONC-Authorized Certification Body use only]
Developer Name: DrFirst, Inc.
Product Name(s): Rcopia4 Web
Version Number(s): 4
Certified Health IT
Product List (CHPL) ID(s): 15.04.04.1375.Rcop.04.00.0.171227
Developer Real World Testing Page URL: www.drfirst.com/realworldtestplan
JUSTIFICATION FOR REAL WORLD TESTING APPROACH
Provide an explanation for the overall approach to Real World Testing, including an outline of the approach and how data will be used to demonstrate successful Real World Testing¹.
All measures should reasonably align with the elements within a Real World Testing plan, the scope of the certification, the types of settings in which the Certified Health IT is marketed, and other factors relevant to the implementation of the Certified Health IT Module(s). The justification should reflect how each element within the plan is relevant to the developer’s overall strategy for meeting the Real World Testing Condition and Maintenance of Certification requirements.
Note: A single Real World Testing Plan may address multiple products and certification criteria for multiple care settings.
Our approach to Real World Testing (RWT) verifies that production users can send and receive electronic prescribing messages without error through system-level transaction monitoring.
STANDARDS UPDATES (INCLUDING STANDARDS VERSION ADVANCEMENT PROCESS-SVAP AND USCDI)
Both required and voluntary standards updates must be addressed in the Real World Testing plan. Real World Testing plans must include all Certified Health IT updated to newer versions of standards prior to August 31 of the year in which the updates were made.
Describe approach(es) for demonstrating conformance to all certification requirements using each standard to which the Health IT is certified. List each version of a given standard separately. For each version of a standard submit the following:
- Identify standard versions
- Indicate what certification criteria in which product(s) has been updated
- If reporting for multiple products, identify the certification criteria that were affected by the updatefor each of the associated products
- CHPL ID for each Health IT Module
- Method used for standard update (e.g., SVAP) Date notification sent to ONC-ACB
- If SVAP, date notification sent to customers
- Measure used to demonstrate conformance with updated standard{s)
- Which certification criteria were updated to USCDI and/or to which version of USCDI was the certification criteria updated?
- We are using NCPDP SCRIPT version 20170715 for all electronic prescribing and medication history
- This update applies to certification criterion 315 (b)(3) Electronic Prescribing.
- The module CHPL ID is 15.04.1375.Rcop.04.00.0.171227 (Rcopia 4).
- The update is covered under SVAP.
MEASURES USED IN OVERALL APPROACH
Each plan must include at least one measurement/metric that addresses each applicable certification criterion in the Health IT Module’s scope of certification. Describe the method for measuring how the approach(es) chosen meet the intent and purpose of Real World Testing.
For each measurement/metric, describe the elements below:
- Description of the measurement/metric
- Associated certification criteria
- Justification for selected measurement/metric
- Care setting(s) that are addressed
- Expected Outcomes
DESCRIPTION OF MEASUREMENT/METRIC
Describe the measure(s) that will be used to support the overall approach to Real World Testing.
- Artifact is a document that captures the values for the measures listed
- All checks measure electronic messages sent or received only using the NCPDP SCRIPT 20170715
- Metric is the percentages of:
- New prescriptions sent electronically and verified all sent
- Pharmacy renewal requests received and verified all received
- Pharmacy renewal responses sent and verified vs. all sent
- Pharmacy change requests received and verified vs. all received
- Pharmacy change responses sent and verified all sent
- Pharmacy fill messages received and verified vs. all received
- Medication history requests sent and acknowledged all sent
- Medication history responses received and acknowledged vs. all received
- New prescriptions sent electronically for juvenile patients, with patient weight without weight.
- New prescriptions sent electronically, with patient diagnosis vs. without
- Controlled substance prescriptions sent electronically printed
ASSOCIATED CERTIFICATION CRITERIA
List certification criteria associated with the measure and if updated to 2015 Edition Cures Update criteria.
- 315 (b)(3} Electronic Prescribing
JUSTIFICATION FOR SELECTED MEASUREMENT/METRIC
Provide an explanation for the measurement/metric selected to conduct Real World Testing.
The ability of a practitioner to communicate with a pharmacy using a standard electronic messaging format is a core feature of Rcopia and is essential for compliance with criterion 170.315 (b)(3). The chosen metric measures the degree to which our system conforms to the NCPDP SCRIPT 20170715 messaging format by displaying the success rate of each type of supported message.
CARE SETTING(S)
The expectation is that a developer’s Real World Testing plan will address each type of clinical setting in which their Certified Health IT is marketed. Health IT Developers are not required to test their Certified Health IT in every setting in which it is marketed for use. Developers should address their choice of care and/or practice settings to test and provide a justification for the chosen approach.
Note: Health IT Developers may bundle products by care setting, criteria, etc. and design one plan to address each, or they may submit any combination of multiple plans that collectively address their products and the care settings in which they are marketed
List each care setting which is covered by the measure and an explanation for why it is included.
| Care Setting | Justification |
| Ambulatory Pediatric Specialty | The pediatric patient population requires medications that are sensitive to patient age and weight. The ability of a practitioner to include patient weight with prescriptions is important to demonstrate in this environment. |
| Ambulatory Internal Medicine | Internal medicine practices treat a varied adult population including many patients who have chronic conditions. Practitioners must be able to prescribe for patients of many different ages and conditions and must be able to communicate patient diagnosis with electronic prescriptions. |
| Ambulatory Behavioral Health | Behavioral health practitioners are heavy prescribers of controlled substances. Although EPCS is not explicitly tested for 170.315 (b){3), it is a feature of Rcopia, and will be included in live testing. |
EXPECTED OUTCOMES
Health IT Developers should detail how the approaches chosen will successfully demonstrate that the Certified Health IT:
- is compliant with the certification criteria, including the required technical standards and vocabulary codes sets;
- is exchanging EHi in the care and practice settings for which it is marketed for use; and/or,
- EHi is received by and used in the Certified Health
(from 85 FR 25766)
Not all of the expected outcomes listed above will be applicable to every Certified Health IT Module, and Health IT Developers may add additional description of how their measurement approach best addresses the ongoing interoperability functionality of their product(s). Health IT Developers could also detail outcomes that should not result from their measurement approach if that better describes their efforts.
Within this section, Health IT Developers should also describe how the specific data collected from their Real World Testing measures demonstrate expected results. Expected outcomes and specific measures do not necessarily have to include performance targets or benchmarks, but Health IT Developers should provide context for why specific measures were selected and how the metrics demonstrate individual criterion functionality, EHi exchange, and/or use of EHi within Certified Health IT, as appropriate.
- We expect electronic transaction success rates to consistently be over 95%.
- We expect the rates of inclusion of juvenile patient weight and of patient diagnoses to increase year over
SCHEDULE OF KEY MILESTONES
Include steps within the Real World Testing plan that establish milestones within the process. Include details on how and when the developer will implement measures and collect data. Key milestones should be relevant and directly related to expected outcomes discussed in the next section.
For each key milestone, describe when Real World Testing will begin in specific care settings and the date/timeframe during which data will be collected.
| Key Milestone | Care Setting | Date/Timeframe |
| Measure of success rates for all electronic transactions | All | January-March 2022 |
| Measure rate of patient weight inclusion | Ambulatory Pediatric Specialty | January-March 2022 |
| Measure rate of patient diagnosis inclusion | Ambulatory Internal Medicine | January-March 2022 |
| Measure rate of EPCS prescribing | Ambulatory Behavioral Health | January-March 2022 |
ATTESTATION
The Real World Testing plan must include the following attestation signed by the Health IT Developer Authorized representative.
Note: The plan must be approved by a Health IT Developer authorized representative capable of binding the Health IT Developer for execution of the plan and include the representative’s contact information.²
This Real World Testing plan is complete with all required elements, including measures that address all certification criteria and care settings. All information in this plan is up to date and fully addresses the Health IT Developer’s Real World Testing requirements.
¹ Certified Health IT continues to be compliant with the certification criteria, including the required technical standards and vocabulary codes sets; Certified Health IT is exchanging EHi in the care and practice settings for which it is marketed for use; and EHi is received by and used in the Certified Health (85 FR 25766)