CY 2024 Real World Test (RWT) Plan for TechCare® Electronic Health Records System

 

Executive Summary – RWT Overview

This is the CY 2024 Real World Test Plan (RWT) for NaphCare, Inc.’s TechCare Electronic Health Records (EHR) System, a certified EHR solution. We will be testing functionality built into TechCare’s core business logic, which supports all versions of the application deployed to our user community.

This RWT plan is intended to verify the capabilities of TechCare’s certified functionality. This plan outlines our process for conducting and measuring observations of interoperability and data exchange. To accomplish this, we are utilizing certification criteria, represented below as use cases in a Correctional Health Care setting. The purpose of this test is to validate the adoption of the underlying interfaces and EHR capabilities and to provide evidence of TechCare’s usability within the Correctional Health Care environment.

We have updated this RWT Plan from the 2023 previous version to include updates to testing approaches, technologies utilized, criteria added, and testing timelines.

 

Click the hyperlinked Use Case Name below to navigate directly to the specific Use Case.

 

Use Case 1: Care Coordination and Electronic Exchange

·         § 170.315(b)(1)c Transitions of Care (Cures Update)

·         § 170.315(h)(1) Direct Project

 

Use Case 2: Data Export

·         § 170.315(b)(6) Data export

 

Use Case 3: Clinical Quality Measures (CQM)

·         § 170.315(c)(1) Record and export

 

Use Case 4: Application Programming Interfaces (API)

·         § 170.315(g)(7) Application access— patient selection

·         § 170.315(g)(9) Application access— all data request

·         § 170.315(g)(10)c Standardized API for Patient and Population Services

General Information

Developer Name	NaphCare, Inc.
Product Name(s)	TechCare EHR
Version Number(s)	5.0
Certified Health IT	2015 Edition
Product List (CHPL) ID(s)	15.04.04.2813.Tech.05.00.0.191208
Developer RWT Page URL	https://devportal.techcareehr.com/RWTP

 

Pre-Test Information

Each Use Case addressed in this RWTP includes the elements below. TechCare EHR is deployed to Correctional Health Care Settings within county, state, and federal correctional facilities, which are the only care settings where TechCare v.5.0 is used.

Testing Methodology

TechCare’s Reporting/Logging features will be used to examine functionality performed in the system and the accuracy of the tested measures within each use case.

·         Demonstrate real world interoperability and conformance to criterion requirements

·         Include patient care scenario and use case focused testing

Description

·         How the test is performed

·         How conformance is demonstrated

Schedule

·         Key Real World Testing Milestones

Measurement/Metric

·         All measures used to validate criteria will be presented with numerator/denominator or percentage-based calculations

Justification for the Health IT Developer’s Real World Testing Approach

·         Description of how the measurement/metric selected reflects the adoption of each required Real World Testing element

Expected Outcome

·         Based on feature adoption during current time

 

 

TechCare Overview

TechCare is a comprehensive, integrated software solution comprising all key components necessary for a fully functional, Corrections-specific EHR, alleviating the need to manage multiple software products. TechCare tracks the health care activities of each patient upon incarceration, creating standardized treatment processes (with the appropriate documentation) from intake through discharge. It identifies patients’ medical and behavioral health needs and ensures timely intervention with appropriate care. TechCare EHR includes the following functionality:

·         Electronic Health Records ·         Customizable Encounter Forms ·         Receiving and Intake/Discharge ·         Offsite Medical Scheduling/Offsite Medical Services Tracking ·         CIWA-Ar Detoxification Tool ·         Chronic Care Management ·         Grievance Tracking ·         Quality Assurance ·         Screening Tools (Intake, TB, Mental Health) ·         Specialty Care (Dental, OB, Optical, etc.) ·         Behavioral Health (Screening, Evaluation, Suicide Alerts) ·         Electronic Drug Orders with Real-Time Contraindications ·         Perpetual Medication Inventory

·         Discharge/Community Re-Entry Support and Documentation ·         Transfer Support and Documentation for inmates ·         Interface Connections (JMS, Pharmacy, X-Ray, Laboratory, etc.) ·         Medication Administration Record/Electronic Medication Administration Record ·         Sick Call and Health Needs Request Workflow ·         Flags & Alerts ·         Queues/Dashboards (Doctor, Nurse, Pharmacy) ·         Infectious Disease Control ·         Detailed Compliance Support and Logging ·         Business Intelligence, Statistical Heuristics, and Ad-Hoc and Curated Reports

Timelines and Milestones for Real World Testing CY 2024

·         4^th Quarter 2023 – During the 4^th Quarter of 2023, the CY 2024 Real World Test Plan will be completed according to ONC and ONC-ACB requirements. The test plan will be prepared for submission by November 1^st, 2023. We are using USCDI v1 in our C-CDAs and API support during CY 2024.

 

·         1^st Quarter 2024 – Confirm active TechCare facilities’ buy-in to the project plan and participation in Real World Testing. The goal is to have partner facilities committed for Real World Testing by March 31^st, 2024.

 

·         2^nd Quarter 2024 - Complete Attestation to Conditions of Certification.

 

·         2^nd Quarter & 3^rd Quarter 2024 – During the 2^nd and 3^rd Quarters of 2024, NaphCare will schedule and confirm Real World Testing with partner facilities. NaphCare will work with Subject Matter Experts (SMEs) from our partner facilities to prepare for testing activities. Results of the testing will be documented in the test results section of the test methods, and used to build the test report. If any non-conformances are observed, we will notify ONC-ACB of the findings and make the required necessary changes.

 

·         4th Quarter 2024 - During the 4^th Quarter of 2024, the CY 2024 Real World Test Plan will be executed according to ONC and ONC-ACB requirements.  NaphCare will also complete the CY 2025 Real World Test Plan.

 

Standards Version Advancement Process (SVAP) Updates

For CY 2024, we are not planning to make any version updates on approved standards through the SVAP process.

Standard (and version)	None
Updated certification criteria and associated product	N/A
Health IT Module CHPL ID	N/A
Method used for standard update	N/A
Date of ONC-ACB notification	N/A
Date of customer notification (SVAP only)	N/A
Conformance measure	N/A
USCDI-updated certification criteria (and USCDI version)	N/A

 

Real World Testing Use Cases

Please note that Use Case # 1 and Use Case # 4 include testing for multiple criteria.

 

Use Case #1: Care Coordination and Direct Project

Criteria Covered

·         § 170.315(b)(1) Transitions of Care

·         § 170.315(h)(1) Direct Project

Testing Methodology

Validate the adoption of certified EHR functionality that contributes to a patient’s care coordination and electronic exchange of information when Telehealth is leveraged during patient encounters.

Goal: Measure the user adoption rate of:

·         Transitions of Care Workflow

·         Direct Project

 

Scenario/Use Case – A patient remains on campus within a correctional facility and Telehealth care is used by specialty care providers (via a 3^rd party EHR) to manage conditions that the facility is otherwise unable or ill-equipped to manage. TechCare user will generate C-CDA documents, including all required data elements. TechCare user will save the outside EHR's C-CDA documents. The C-CDA will be sent to the specialty care providers using Direct messaging (via POP3 Edge Protocol). Users identified by permitted roles will generate C-CDA based on the time period required by the receiving facility.

 

Measurement Description

This use case is associated with two different criteria and tracking two different metrics.  It will be used to track and count how many C-CDAs are created successfully, and then sent and received via Direct Project connecting to a HISP for successful transmission.

·         Test Performed 1:

o    Capture total number of C-CDAs created for patients receiving Telehealth care during the test period.

o    Capture the total number of Telehealth visits scheduled and complete during the test period.

·         Test Performed 2:

o    Compare with total C-CDAs shared with the specialty Telehealth clinic electronically via Direct Secure Protocol transmission.

o    Capture the total number of C-CDAs.

·         Test Performed 3:

o    Capture the total of C-CDAs received from the specialty Telehealth clinic upon completion of their Telehealth encounter.

o    Capture the total number of Telehealth visits scheduled and complete during the test period.

Schedule

·         September 1^st, 2024 – Run query to gather all required numerator and denominator values.

·         September 30^th, 2024 – Complete adoption rate analysis.

 

Meausurements/Metric

Test 1

·         Numerator – All patients with files saved and sent of Type like ‘CCD’ between 8/31/2023 and 6/1/2024.

·         Denominator – All Telehealth visits scheduled and completed between 8/31/2023 and 6/1/2024.

Test 2

·         Denominator - Total C-CDAs shared with Telehealth Care providers electronically via Direct Secure Protocol Transmission between 8/31/2023 and 6/1/2024.

·         Numerator - Total number of C-CDAs between 8/31/2023 and 6/1/2024.

Test 3

·         Numerator - The total of C-CDAs received from the Telehealth Care provider’s 3^rd party EHR between 8/31/2023 and 6/1/2024.

·         Denominator - All Telehealth visits scheduled and complete between 8/31/2023 and 6/1/2024.

 

Justification

·         Capture the total Transition of Care documents completed, compared with total summaries provided to the Telehealth Care provider via Direct Message.

·         Capture the total number C-CDAs received from the clinic upon completion of the Telehealth event.

 

Expected Outcome

·         95% of patients seen for a Telehealth encounter by a specialty care provider had a C-CDA created.

·         66% of C-CDAs created are sent electronically to the Telehealth Care provider electronically.

·         66% of patients receive a C-CDAs from Telehealth Care provider electronically upon completion of the scheduled Telehealth event.

 

Use Case #2: Data Export

Criteria Covered

·         § 170.315(b)(6) Data Export

Testing Methodoligy

Goal: Validate the adoption of certified EHR functionality that contributes to the export of Release Summaries/C-CDAS are exported as patient records are made ready for transition to another EHR system.

Goal: Measure the entity adoption rate of:

·         Data Export

 

Scenario/Use Case – A facility is changing EHR vendors from one Certified Complete EHR to another. An export of the entire eligible patient population must be performed by the incumbent EHR for continuity of care purposes.

 

Measurement Description

This use case is tracking a complete batch export comparing the number of actual patients with a health information record (within the EHR system) to the number of electronically exported C-CDAs created using the EHR export functionality.

·         Test Performed 1:

o    Capture total number of batch C-CDAs exported.

o    Capture total number of eligible patients with encounter information in their health record.

Schedule

·         July 1^st, 2024 – Run query to gather all required denominator values.

·         July 1^st, 2024 – Begin batch export of data.

·         > September 30^th, 2024 – Complete adoption rate analysis.

Meausurements/Metric

·         Numerator – Total number of successfully generated C-CDAs from facilities’ EHR system.

·         Denominator – Total number of eligible (non-“test”, or only those with health information recorded) patients.

Justification

·         Capture the total number successfully produced C-CDAs and compare it to the total number of eligible patients in the EHR.

Expected Outcome

·         100% of eligible C-CDAs are exported in bulk.

 

 

Use Case # 3: Clinical Quality Measures (CQM)

Criteria Covered

·         § 170.315(c)(1) Record and Export

Testing Methodology

Goal: Validate the adoption of certified EHR functionality to capture clinical quality measure data.

 

Scenario/Use Case

Required health data for CQM will be collected and stored in the EHR database. Data for the requested time period will be exported.  

 

Measurement Description

This use case tracks the number of CQM data that is exported and compares it to the number of data elements the users enter.  This test focus is primarily to determine whether the user is correctly entering the required data.  Test results not meeting the expected outcome indicate that user training is required.

·         Test Performed 1:

o    Total number of CQM data exported.

o    Total number of required data elements collected.

Schedule

·         September 30^th, 2024 – Run query to gather all required numerator and denominator values.

·         > November 1^st, 2024 – Complete adoption rate analysis.

Meausurements/Metric

·         Numerator – Total number of CQM data exported between 3/1/2024 and 9/30/2024.

·         Denominator – Total number of required data elements collected between 3/1/2024 and 9/30/2024.

Justification

·         Capture the total number of exported CQM and compares it to the total number of required data elements.

Expected Outcome

·         35% of exported CQM exported will contain the required data elements.

 

Use Case #4: Application Programming Interfaces (APIs)

Criteria Covered

·         § 170.315(g)(7) Application access — patient selection

·         § 170.315(g)(9) Application access — all data request

·         § 170.315(g)(10)c Standardized API for Patient and Population Services

Testing Methodology

Goal: Validate the adoption of certified EHR functionality to securely provide patient health data through application interfaces.

 

Scenario/Use Case

Patients in our unique Health Care environment are consistently admitted to neighboring facilities that use the TechCare EHR platform. The ability for one facility receiving a patient to call an API to pull in health records will result in more efficient user processes, and overall patient care will be made markedly more proactive and consistent. One TechCare EHR instance is validated against another and granted access to API. Users identified by permitted roles will request API generated C-CDAs based on patient demographic matching criteria.

 

Measurement Description

This use case is associated with three criteria and tracking three different metrics. It will be used to track and count how many C-CDAs are requested successfully by the receiving facility, how many C-CDAs are delivered successfully by the sending facility from which the patient was discharged, and what percentage of patients have been in more than one facility, providing insights into regional recidivism rates.

·         Test Performed 1:

o    Capture the total of C-CDAs received into the patient profiles of the intaking facility during the test period.

o    Capture the total number of intakes during the test period.

·         Test Performed 2:

o    Capture total number of C-CDAs sent from the discharge facility during the test period.

o    Capture the total number of discharges during the test period.

·         Test Performed 3:

o    Capture total of successful C-CDAs shared via API upon patient demographic match.

o    Capture the total number of C-CDA requests.

Schedule

·         October 31^st, 2024 – Run query to gather all required numerator and denominator values.

·         December 1^st, 2024 – Complete adoption rate analysis.

Meausurements/Metric

Test 1

·         Numerator – All C-CDAs successfully requested via API between 1/1/2024 and 10/31/2024.

·         Denominator – All patients with one unique booking date 1/1/2024 and 10/31/2024.

 

Test 2

·         Numerator – All C-CDAs successfully delivered via API between 1/1/2024 and 10/31/2024.

·         Denominator – All patients will a discharge date and no re-entries between 1/1/2024 and 10/31/2024.

 

Test 3

·         Numerator – Total number of C-CDAs transmitted electronically via API between 1/1/2024 and 10/31/2024.

·         Denominator – Total of C-CDAs requests made between 1/1/2024 and 10/31/2024.

 

Justification

·         Capture the total number of validated API request that resulted in received (intake) or generated (discharge) C-CDA records, compared with total opportunities to ingest or send useful information from a neighboring system.

·         Capture the total number of patients received in one facility following health care delivery in another.

Expected Outcome

·         25% of patients received into a new facility will have a health history transferable via electronic C-CDA.

·         25% of patients released from a facility will be rebooked in different facility and have records requested of them.

·         75% of patients will either not have been booked before, or will not be released and rebooked within the reporting period in a neighboring facility.

 

Developer Attestation

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.

Authorized Representative Name: Mr. Jason Douglas, Chief Technology Officer

Authorized Representative Email: jdouglas@naphcare.com

Authorized Representative Phone: 205-536-8445

Authorized Representative Signature: Jason Douglas

Date: 10/26/2023