1. Laika 2009 Concept of Operations

2. EHR Certification Testing Workflows EHR Laika Test Environment Initialization EHR PIX Feed EHR PIX Query EHR PDQ Query EHR XDS Query EHR XDS Store EHR C32 Display & File EHR C32 Generate & Format

3. EHR Test Environment Initialization – Step 1: Reset AWS Instance with Start Image Objectives – Reset Laika environment back to known starting point Actions – Use AWS tools/scripts to reload AWS instance with Start Image. (TBD)

4. EHR Test Environment Initialization – Step 2: CCHIT Staff Login to Laika 2009 Objectives – Ensure CCHIT staff are in control of test environment. Actions – CCHIT Test Manager executing interoperability tests logs into Laika using pre-established login account defined in the Start Image: “Test@CCHIT.org” Notes – The “Test Manager” account is predefined in the Start Image as: Email: test@cchit.orgtest@cchit.org Password: laika Name: Test Manager Org: CCHIT Role: Admin – All official testing will be conducted with the Test Manager account. No additional accounts are necessary.

5. EHR Test Environment Initialization – Step 3: Ensure Pre-defined Test Data Present Objectives – Ensure CCHIT Laika test environment is initialized with the specified Patient Templates, PIX/PDQ/XDS data entries. Actions – CCHIT Test Manager clicks on Patient Templates and inspects entries. – CCHIT Test Manager clicks on PIX tab and inspects PIX Mgr entries. – CCHIT Test Manager clicks on PDQ tab and inspects PDQ Source Mgr entries. – CCHIT Test Manager clicks on XDS tab and inspects XDS Registry/Repository entries. Notes (TBD)

6. EHR Test Environment Initialization – Step 4: Ensure Vendor EHR Communications with Laika Objectives – Ensure vendor EHR system is communicating with the correct instance of Laika test environment. Actions – TBD (TBD)

7. EHR PIX Testing EHR Under Test for Certification PIX Mgr Laika 2009 MLLP over IPSec VPN Instance of Laika 2009 Environment [ITI-8] Patient Identity Feed [ITI-9] PIX Query

8. EHR PIX Feed Test – Step 1: View Available Patients in PIX Mgr Objectives – Ensure predefined patients are loaded in the PIX Mgr Actions – CCHIT Test Manager clicks on PIX tab to obtain a list of the currently loaded patients in the PIX Mgr. Notes – Choice of which demographics elements to display in this summary is probably not critical. Key is for Test Manager to distinguish between patients. – Display of the fully qualified Global ID in [CX] format for patients is probably not necessary -- as the PID fields for the Global Assigning Authority is a static value for all patients and all tests. Only the unique (first field) portion of the PID is necessary to display. – Entries can be deleted or edited in the Laika PIX Mgr by selecting the appropriate Action links – New entries can be added to the Laika PIX Mgr by selecting a Patient Template from pull-down list and clicking “Create new entry” button.

9. EHR PIX Feed Test – Step 2: Selecting Patient Objectives – Select a patient for the EHR vendor to generate a PIX feed to the PIX Mgr. – CCHIT Test Manager must ensure the patient exists in both the vendor EHR system and the Laika PIX Mgr., but not already cross referenced to the EHR vendor’s Local PID. Actions – CCHIT Test Manager clicks on a patient in PIX summary page (previous screen) and is presented with detailed PIX Mgr information for that patient. – CCHIT Test Manager verifies (visually) the patient has not already been assigned cross reference entries to the EHR vendor’s Local PID. – CCHIT Test Manager verbally gives the name of the patient to EHR vendor Notes – Display of all PIDs in fully qualified [CX] format is essential – Very high value to have an option here to “Remove” Local cross-referenced PIDs. This enables CCHIT Test Manager to manually cleanup the PIX Mgr entries without having to reload entire Laika instance. – Also high value to “Add” Local cross-reference PIDs, mainly for subsequent PIX Query testing. – Would be nice to be able to edit the demographics data in this screen to be reflected back in the PIX Mgr. Not critical though, because alternate workflow is to make changes in original Patient Template and then “Create new entry” (on previous screen).

10. EHR PIX Feed Test – Step 3: Assigning Test Case Objectives – Construct a PIX Feed test case on the Dashboard associated with the proper Inspection Actions – CCHIT Test Manager clicks the “assign” link of the PIX Mgr patient entry selected in the previous step. – CCHIT Test Manager selects the appropriate Inspection, Test = PIX Feed, and the appropriate test owner. Notes – Might make sense to allow this assign function to also be performed on the previous screen.

11. EHR PIX Feed Test – Step 4: Execute Test Case Objectives – Enter the expected Local Patient ID values and compare with results in PIX Mgr for correctness. Actions – EHR vendor executes the PIX Feed [ITI-8] transaction using the patient selected in Step 2, and informs the CCHIT Proctor of the Local Patient ID used in the cross- reference. – CCHIT Test Manager clicks the “execute” link of the test case. Laika prompts for the PID cross reference values to look for in the PIX Mgr. – CCHIT Test Manager clicks the “Execute” button and Laika performs the comparison between expected PID cross-reference values, and the actual mapping in the PIX mgr for this patient. Results are summarized in the Errors/Warnings columns. Notes – Should be consistent behavior/feedback with the C32 Generate and Format test. – Note the renaming of the C32 tests under the “Test Type” column. – Would be nice to have a “Configuration” tab to enter the Local Assigning Authority OID used by the EHR vendor system. This would alleviate the need to enter here, or at least provide a convenient default value for the input field on this screen. – It is not clear if EHR systems generate Local PID values at the same point within ADT workflows, but assumption here is Local PID was created prior to the start of testing.

12. EHR PIX Feed Test – Step 5: Inspect Results Objectives – Display summary of test results, and enable access to detailed report. Actions – After CCHIT Test Manager clicks the “Execute” button and Laika summarizes results in the Errors/Warnings columns. – CCHIT Test Manager can access detailed results report by clicking on the “inspect” link associated with this test case. Notes – “failed” is reported if the values forming the cross- reference entry in the PIX Mgr do not match the expected values entered at the point of executing the test.

13. EHR PIX Feed Test – Step 6: Inspect Results Objectives – Provide details to CCHIT Test Manager on the results of test executed in Step 5. Actions – CCHIT Test Manager clicks on the “inspect” link on the Dashboard test case entry. Laika responds with the page shown. Notes – Highlighting of mismatches bewteen expected and actual values is highly valuable.