CCHIT Test Scripts For 2008 Certification of Inpatient EHRs by iht11609

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									                                                              2008 Certification of Inpatient EHRs                                                  June 17, 2008
                                 Certification Commission
                                 for Healthcare
                                 Information Technology                                Note: Items that are Provisional for 2008 are highlighted in yellow.




                                                   CCHIT Test Scripts
                                  For 2008 Certification of Inpatient EHRs



                                                            V5.00 – Final version

                                                                June 17, 2008

Product (NUMBER CODE ONLY):_________________________                                                              Date: __________________________

Evaluator: ____________________________________________                                                           Signature: _______________________


2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                           Page 1 of 75
                                                                                        2008 Certification of Inpatient EHRs                                                                                      June 17, 2008
                                             Certification Commission
                                             for Healthcare
                                             Information Technology                                                         Note: Items that are Provisional for 2008 are highlighted in yellow.




Note: The paper size for this document for printing is legal (8.5 x 14 inches).

                                                                                                TABLE OF CONTENTS
    Test Environment Setup Parameters for Script Execution – Please review carefully..................................................................................................................... 3

    Test Script Scenario 1 – Pediatric Inpatient ................................................................................................................................................................................... 8

    Test Script Scenario 2 – Pediatric Inpatient ................................................................................................................................................................................. 38

    Test Script Scenario 3 – Adult Inpatient ....................................................................................................................................................................................... 51

    Appendix A – Additional Information and Order Sets for Scenario 1 and Scenario 2 – Pediatric Inpatient .................................................................................. 71

    Appendix B: Additional Information for Scenario 3 – Adult Inpatient ............................................................................................................................................ 74

    Appendix C: Test Script Scenario 3 – Orthopedic Post-Op Order Set ......................................................................................................................................... 75




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                                                         Page 2 of 75
                                                                   2008 Certification of Inpatient EHRs                                                  June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.



Test Environment Setup Parameters for Script Execution – Please review carefully.
There are three scenarios (Scenarios 1, 2 and 3), in which CPOE and eMAR are included.

Scenario 1 involves an inpatient admission for Elizabeth Benson, a 6-month old who weighs 13 pounds and 14 ounces (6.3 kilograms) and her height is 26 inches
(66 centimeters). She was directly admitted to the hospital by Dr. Michael Ford, but her pediatrician is Dr. Joan Miller. The patient is admitted to the inpatient
pediatric unit with a diagnosis of pneumonia and possible sepsis. During the admission process, Elizabeth’s mother reported during admission, that her baby has
no known drug allergies; however, in a follow-up discussion with a Nurse, the mother reports that Elizabeth does have allergies to Amoxicillin and peanut oil.

Scenario 2 continues to involve Elizabeth Benson.

Scenario 3 involves a male, John McSorley, who was admitted through the Emergency Department post an automobile accident in which he sustained an
unstable distal radius fracture which he is being admitted for an open reduction internal fixation (ORIF) surgical procedure.

   •   Please set up the following medication for Scenario 3 as an Overdue Medication – Narcan 2 mg IV every 30 minutes for two doses – this will be used to
       demonstrate criteria IP 14.05 – “The system shall allow the clinician to identify and display due and overdue medications.” Please validate that the system
       is set up so that an overdue medication is displayed 30 minutes or less past the time the medication was due to be administered.

   •   Specific to Procedure 3.50 – “Receive notification of overdue medication administration task: document pain response for administration of Morphine (step
       3.05).” The Applicant should set assessment of pain level overdue times (clinical decision support) to less than or equal to 30 minutes (will vary depending
       upon the amount of time it takes to perform Procedure 3.05 thru Procedure 3.50.

For all scenarios, please turn on clinical decision support for all checking levels.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                Page 3 of 75
                                                                  2008 Certification of Inpatient EHRs                                                     June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


Users:

For all users, the Applicant should assign a relationship (role) to the patient prior to the inspection process. Also, for the physician users, please have their patient
list created and populated with a few patients.

   •   There must be three Physician type users with valid login. These users must have at least the following permissions: full access to all clinical functions.
           o Dr. Michael Ford – Admitting physician (pediatrician who admits the patient, Elizabeth Benson in Scenario 1)
           o Dr. Joan Miller – Attending Pediatrician for use in Scenario 1 and Scenario 2
           o Dr. Joe Bradley – Orthopedic surgeon for use in Scenario 3
   •   There must be one Nurse Manager type user with valid login. This user must have at least the following permissions: access to all clinical functions.
   •   There must be one Nurse type user with valid login. This user must have at least the following permissions: access to all clinical functions.
   •   There must be one Pharmacist type user with valid login. This user must have at least the following permissions: access to all clinical functions.
   •   There must be one Administrator type user with valid login. This user must have at least the following permissions: Access to all configurable system
       options and organization maintained data files and/or tables.
   •   There must be one Security Administrator type user with valid login. This user must have at least the following permissions: access to all information
       necessary to carry out security administrative tasks; no rights to access clinical data or Protected Health Information (PHI) as defined by the Centers for
       Medicare and Medicaid Services (CMS). See page 8374, section 160.103 Definitions in CMS site:
       http://www.cms.hhs.gov/SecurityStandard/Downloads/securityfinalrule.pdf




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                 Page 4 of 75
                                                               2008 Certification of Inpatient EHRs                                                  June 17, 2008
                                 Certification Commission
                                 for Healthcare
                                 Information Technology                                 Note: Items that are Provisional for 2008 are highlighted in yellow.


Patient for Scenario 1 and Scenario 2: Elizabeth Benson, 6 month old female.

There must be a patient record for Elizabeth Benson, 6-month old female.

Birthdate: Test date minus 6 months.
Mother Name: Jo L. Benson (28 year old)
Father Name: Thomas P. Benson (30 year old)
Street Address: 22 West Elm St
City: Middleton
State: Ohio
Zip: 43085

There must be a patient record for Mary Beth Benson (height 32”, weight 25 lbs).
Birthdate: January 16, 2007
Mother: Cindy Benson
Father: Jamie Benson
Address: 100 Highway, Worthington, Ohio 43023


Information in Appendix A is provided for background and system set-up and for use during Scenario 1 and Scenario 2.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                            Page 5 of 75
                                                               2008 Certification of Inpatient EHRs                                                   June 17, 2008
                                 Certification Commission
                                 for Healthcare
                                 Information Technology                                  Note: Items that are Provisional for 2008 are highlighted in yellow.


Patient for Scenario 3: John McSorley.

There must be two patient records for John McSorley: 1) Current hospital admission; 2) Previous hospital admission. Applicants will be asked during the scenario
to view a previous admission (same hospital and same applications) for John McSorley.

There must be a patient record for John McSorley (current hospital admission)
Birthdate: November 1, 1954
Mother: Stacy McSorley
Father: Joshua McSorley
Address: 9000 Plains Way, Rockville, Maryland

There must be a patient record for John McSorley (Previous hospital admission (same hospital) from March 3 – 10, 2007 for small bowel resection surgery.)
Birthdate: November 1, 1954
Mother: Stacy McSorley
Father: Joshua McSorley
Address: 9000 Plains Way, Rockville, Maryland

There must be a patient record for Patrick McSorley (current hospital admission)
Birthdate: October 18, 1967
Mother: Mary Jones
Father: John McSorley
Address: 76 Wilson Road, Baltimore, Maryland, 21236

There must be a patient record for Suzanne Smith
Birthdate: September 1, 1941
Mother: Stacy Smith
Father: Joshua Smith
Address: 89 Fenland Way, Alexandria, Virginia 21234
Suzanne Smith’s record indicates she has an allergy to penicillin, and that she takes no medications.

Information in Appendix B and C is provided for background and system set-up and for use during Scenario 3.



2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                             Page 6 of 75
                                                                 2008 Certification of Inpatient EHRs                                                   June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.


System
Enable audit logs to log, at a minimum, the events required in Appendix E (found in Security Test Script). .

Environment
There must be an Infant Fever Order Set built that contains various order types. (See Appendix A)
There must be an Infant Pneumonia Order Set built that contains various order types. (See Appendix A)
There must be an Adult Post-Op Orthopedic Order Set that contains various order types. (See Appendix B)
There must be a printer connected to the system.
The system must be able to accept all medication doses as outlined in the script.

Note to Applicants
These scenarios are meant to test specific functional requirements; they are not meant to reflect the complete clinical care that might be provided to a patient. The
scenarios are intended to be run consecutively, 1 through 4. If the Applicant wishes to run scenarios in a different order, or if the Applicant chooses to execute test
steps contained within the scenarios in a different order to accommodate workflow of the application, the Applicant must advise CCHIT Proctor in advance.

For clinical scenarios, Applicants should note that some elements of the test script are time compressed from what would normally occur in clinical practice setting.
This is to accommodate testing of the criteria in a timely manner. Similarly, some test steps may be accomplished by a user other than would normally do a
function in a clinical practice setting. Again, this is to accommodate testing of the criteria in a timely manner.

Following this test, the Applicant is expected to conduct the Security Test Script.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                               Page 7 of 75
                                                                       2008 Certification of Inpatient EHRs                                                                    June 17, 2008
                                     Certification Commission
                                     for Healthcare
                                     Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


Test Script Scenario 1 – Pediatric Inpatient
Scenario 1 involves an inpatient admission for Elizabeth Benson, a 6-month old who weighs 13 pounds and 14 ounces (6.3 kilograms) and her height is 26 inches
(66 centimeters). She was directly admitted to the hospital by Dr. Michael Ford, but her pediatrician is Dr. Joan Miller. The patient is admitted to the inpatient
pediatric unit with a diagnosis of pneumonia and possible sepsis. During the admission process, Elizabeth’s mother reported during admission, that her baby has
no known drug allergies; however, in a follow-up discussion with a Nurse, the mother reports that Elizabeth does have allergies to Amoxicillin and peanut oil.

 Test Script Scenario 1 (Patient admitted to the pediatric inpatient unit)
 Key Features of this scenario are:
 • Patient demographics and bed assignments
 • Provider list management
 • Allergy list
 • Medication list
 • Task list
 • Laboratory, Radiology and Medication orders entered and received by ancillary departments
       o Order sets (See Appendix A) and individual orders
       o Allergy checking
 • Electronic medication administration record
 • Clinical decision support for ordering and administration

           Procedure                       Expected Result             Actual Result      Pass/Fail                            Criteria and Reference                               Comments
 1.001   Login as Administrator.     Login successful.
 1.002   In the Infant Fever         Order set is updated.                                Pass        Fail   FN 10.02   The system shall provide the ability to modify order
         Order Set change                                                                                               sets.
         “CBC” to “CBC + Diff                                                                                IP 09.02   The system shall provide the ability to support the
         once routine” and save                                                                                         management of order sets to track history of updates
                                                                                                                        including date and time.
         this update to the order
         set.
 1.003   Show history of             The history of updates                               Pass        Fail   IP 09.02   The system shall provide the ability to support the
         updates to the Infant       includes the change made in                                                        management of order sets to track history of updates
                                                                                                                        including date and time.
         Fever Order Set.            the prior step, including date
                                     and time. This is not required
         If a different user is      to show in the GUI; audit trail
         required to execute this    is acceptable.
         step, login as that user.

2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                      Page 8 of 75
                                                                  2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                  Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                     Expected Result          Actual Result      Pass/Fail                          Criteria and Reference                                     Comments
 1.004   Set up elapsed time        Elapsed time parameters for                      Pass      Fail   IP 13.08   The system shall provide the ability to set elapsed time
         parameters for “CBC +      purposes of duplicate order                                                  parameters for purposes of duplicate order checking.
         Diff once routine” to 24   checking for CBC are set at
         hours; that is, cannot     24 hours.
         order CBC within 24
         hours of prior order.      Note that duplicate order
                                    checking may not be at the
                                    “order” level; that is
                                    acceptable.
 1.005   Access directory of        Clinicians are uniquely                          Pass      Fail   IP 02.01   The system shall provide the ability to uniquely identify     The intent of the
         users and review user      identified.                                                                  clinicians for the provision of care.                         criterion is to
         attributes.                                                                                                                                                           access the directory
                                                                                                                                                                               of users and review
                                                                                                                                                                               user attributes
                                                                                                                                                                               required to
                                                                                                                                                                               determine the
                                                                                                                                                                               system access level
                                                                                                                                                                               to be granted to
                                                                                                                                                                               each user.
 1.006   Add permission for         Access to order set                              Pass      Fail   IP 09.01   The system shall provide the ability for the hospital to
         Nurse Managers to          management functionality is                                                  define user roles with access to order set management.
         access and edit order      granted to Nurse Manager.
         sets.
 1.007   Configure orders to        Dopamine order (or other                         Pass      Fail   IP 10.15   The system shall have the ability to allow the hospital to    This step is not
         indicate that dopamine     order as determined by the                                                   configure orders that require co-signature.                   testing the ability for
         order (or other order of   Applicant) is configured to                                                                                                                users to require a
         Applicant choice)          require co-signature.                                                                                                                      co-signature; it is
         always require a co-                                                                                                                                                  testing the ability to
         signature.                                                                                                                                                            configure a specific
                                                                                                                                                                               order to require a
                                                                                                                                                                               co-signature.
 1.008   Step deleted.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                    Page 9 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                     Expected Result           Actual Result      Pass/Fail                           Criteria and Reference                                    Comments
 1.009   Show how the system       Applicant can show ability to                     Pass       Fail   IP 12.43    The system shall provide the ability to update the
         provides the ability to   modify reference                                                                reference immunization schedule and guidelines on
                                                                                                                   demand for reasons including but not limited to updates
         update the reference      immunization schedule and                                                       to external guidelines. Note: The provider can update
         immunization schedule     guidelines.                                                                     the immunization schedule as new vaccines are added
         and guidelines to                                                                                         and that the documentation grid can be updated and
         incorporate new or                                                                                        the analysis of missing or due immunizations can then
                                                                                                                   update.
         changed
         immunizations.
 1.010   Show how the system       Applicant can show ability to                     Pass       Fail   IP 12.44    The system shall provide the ability to update the
         provides the ability to   modify immunization decision                                                    analysis-of-needs mechanism (based on immunizations
                                                                                                                   missing or due next) on demand for reasons including
         update the decision       support rules.                                                                  but not limited to updates to external guidelines.
         support rules used to
         determine missing or
         overdue
         immunizations.
 1.011   Restrict access to the    Access to this individual                          Pass      Fail   IP 09.01    The system shall provide the ability for the hospital to
         Infant Fever Order set    order set is restricted.                                                        define user roles with access to order set management.
         to just the Pediatric                                                                         IP 09.18    The system shall allow restricting the access to
         department.                                                                                               individual order sets by user role or department

 1.012   Logout as                 Logout successful.
         Administrator
 1.013   Login as Nurse            Login successful.
         Manager
 1.014   Look up patient           Patient records found and                          Pass      Fail   FN 01.01    The system shall provide the ability to access               Proctor to update
         demographic record by     include Elizabeth Benson;                                                       demographic information such as name, date of birth          Audit Trail
                                                                                                                   and gender needed for patient care functions.
         last name BENSON.         demographic information can                                                                                                                  Worksheet
                                   be viewed for:                                                      FN 01.02    The system shall capture and maintain demographic            (Appendix E).
                                                                                                                   information as discrete data elements as part of the
                                                                                                                   patient record.
                                   •   Mary Beth Benson
                                                                                                       IO-IP 03.01 The system shall provide the ability to receive Patient
                                   •   Elizabeth Benson                                                            Demographics and Administrative Information from
                                                                                                                   inpatient IT systems (e.g., name, age, DOB, gender)




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                    Page 10 of 75
                                                                         2008 Certification of Inpatient EHRs                                                                        June 17, 2008
                                     Certification Commission
                                     for Healthcare
                                     Information Technology                                        Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                      Expected Result                Actual Result      Pass/Fail                           Criteria and Reference                                    Comments
 1.015   View Elizabeth              Bed assignment for Elizabeth                           Pass      Fail   IO-IP 03.02 The system shall provide the ability to receive Patient
                                     Benson is viewed.                                                                   Bed Assignment information from inpatient IT systems
         Benson’s bed                                                                                                    (e.g. registration, bed tracking)
         assignment.

 1.016   Show how Mary Beth          Mary Beth Benson is viewed                             Pass      Fail   IP 01.01    The system shall provide the ability to access bed           For example,
                                     on the screen to be in a                                                            assignment information including temporary bed               holding area, triage,
         Benson is in a                                                                                                  assignment.
         temporary bed               temporary bed assignment,                                                                                                                        etc.
         assignment.                 such as a holding area or
                                     triage.

 1.017   Re-do the search for        Patient record for Elizabeth                           Pass      Fail   FN 02.01    The system shall provide the ability to query for a          The choice of
                                     Benson is found and                                                                 patient by more than one form of identification.             alternate forms of
         Elizabeth Benson using
         an alternate form of        selected.                                                                                                                                        identification is
         identification (used last                                                                                                                                                    flexible, and there
         name in previous step,                                                                                                                                                       can be more than
         choose a different                                                                                                                                                           one (for example,
         identifier here); select                                                                                                                                                     first name, date of
         the appropriate patient                                                                                                                                                      birth, or medical
         record for Elizabeth                                                                                                                                                         record number).
         Benson.
 1.018   Assign Nurse to the         Nurse is assigned to the                               Pass      Fail   IP 02.02    The system shall provide the ability to assign clinicians
         team caring for             appropriate team.                                                                   to appropriate teams, where teams are defined as
                                                                                                                         groups of clinicians who share responsibility for
         Elizabeth Benson.                                                                                               covering the same group of patients.

 1.019   Logout as Nurse             Logout successful.
         Manager.
 1.020   Login as Nurse.             Login successful.
 1.021   Display patient list that   Patient list displays; status for                     Pass       Fail   IP 03.01    The system shall provide for the ability to identify
         includes Elizabeth          Elizabeth Benson is                                                                 patients by status e.g. active, admitted patients or
                                                                                                                         inactive, discharged patients.
         Benson.                     “admitted.”




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                       Page 11 of 75
                                                                     2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                     Certification Commission
                                     for Healthcare
                                     Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                        Expected Result          Actual Result      Pass/Fail                          Criteria and Reference                                    Comments
 1.022   Select patient record       Allergy information is                             Pass      Fail   IP 05.01   The system shall provide the ability to capture the
         for Elizabeth Benson        captured from an external                                                      source of the allergy information.
         and enter information       source and the source is                                            IP 05.03   The system shall provide the ability to indicate that the
         on patient allergies.       accepted (external source is                                                   allergies are “Unknown” or “Unable to Assess
                                                                                                                    Allergies.”
         Enter “unknown” as          the patient’s mother).
         allergy status, and         Allergies are “unknown.”                                            IP 11.04   The system shall provide the ability to accept
         indicate that the source                                                                                   information on patient allergies from an external
                                                                                                                    source.
         of the information is the
         patient’s mother.
 1.023   Enter information on        Information on patient home                        Pass      Fail   IP 11.01   The system shall provide the ability to allow the
         patient home                medications from an external                                                   designation of the source of information on home
                                                                                                                    medications.
         medications from an         source is accepted and
         external source; the        external source is designated                                       IP 11.02   The system shall provide the ability to accept
                                                                                                                    information on patient home medications from an
         external source is          as “patient’s mother.”                                                         external source.
         designated as
         “patient’s mother.”         Home medication is entered:                                         IP 11.04   The system shall provide the ability to accept
                                                                                                                    information on patient allergies from an external
                                                                                                                    source.
         The mother indicates        Poly-Vi-Sol Vitamin Drops
                                                                                                         FN 06.06   The system shall provide the ability to capture and
         Elizabeth is currently      with Iron 1.0 mL once daily.
                                                                                                                    maintain, as discrete data elements, all current
         taking                                                                                                     medications including over-the-counter and
         • Poly-Vi-Sol Vitamin                                                                                      complementary medications such as vitamins, herbs
             Drops With Iron -                                                                                      and supplements.
             1.0 mL once daily




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                   Page 12 of 75
                                                                      2008 Certification of Inpatient EHRs                                                                        June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                      Expected Result             Actual Result      Pass/Fail                           Criteria and Reference                                    Comments
 1.024   Accept current             System can receive Current                           Pass      Fail   IO-IP 01.01 The system shall provide the ability to receive the
         medication list and        Medication List and Allergy                                                       Current Medication List from Pharmacy (directly), PBM
                                                                                                                      (directly) or via intermediary network (e.g. SureScripts,
         Allergy History from       History from one of these                                                         RxHub, etc.)
         Pharmacy, PBM, or via      sources.
                                                                                                          IO-IP 02.01 The system shall provide the ability to receive
         intermediary network.                                                                                        Medication Allergy Information from Pharmacies
                                    For current year, can be                                                          (directly) or via intermediary network (e.g. SureScripts,
         Scanned document is        scanned.                                                                          RxHub, etc.)
         provided in the
         Appendix A; can be         Show the scanned document
         scanned in advance of      attached to this patient chart.
         the test and at this
         step, show the
         scanned document
         attached to this patient
         chart.
 1.025   Update Elizabeth           Allergy to Amoxicillin is                            Pass      Fail   FN 05.13    The system shall provide the ability to capture, maintain    Proctor to update
         Benson’s allergies         captured, with reaction type                                                      and display, as discrete data, lists of medications and      Audit Trail
                                                                                                                      other agents to which the patient has had an allergic or
         (status is currently       of “hives” and severity of                                                        other adverse reaction.                                      Worksheet
         “unknown”); enter:         “mild” indicated.                                                                                                                              (Appendix E).
                                                                                                          FN 05.03    The system shall provide the ability to specify the type
                                                                                                                      of allergic or adverse reaction.
         •   Allergy: Amoxicillin   Allergy to Peanut Oil is                                                                                                                       For the reaction
                                                                                                          IP 05.02    The system shall provide the ability to capture the
         •   Reaction Type:         captured, with reaction type
                                                                                                                      severity of a reaction.
                                                                                                                                                                                   type of Hives, a
             Hives                  of “hives and cough” and                                                                                                                       similar response is
         •   Severity: Mild         severity of “severe” indicated.                                                                                                                acceptable, for
                                                                                                                                                                                   example Rash.
         Add to Elizabeth’s         Allergy to Eggs is captured.
         allergy list:

         •   Allergy to Peanut
             Oil
         •   Reaction type:
             Hives and cough
         •   Severity: Severe

         •   Allergy: Eggs
2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                     Page 13 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


            Procedure                     Expected Result           Actual Result      Pass/Fail                          Criteria and Reference                                     Comments
 1.026   Show how the system       Applicant can show how the                          Pass      Fail   IP 05.08   When the display of the allergy list exceeds the current     Applicant may need
         would indicate that the   system would indicate that                                                      screen or printed page, the system shall indicate that       to add more
                                                                                                                   the list continues.
         list continues, if the    the list continues.                                                                                                                          allergies to the list
         allergy exceeds the                                                                                                                                                    and then delete the
         current screen.                                                                                                                                                        extra ones after
                                                                                                                                                                                demonstration of
                                                                                                                                                                                this step.
 1.027   Display allergy list.     Allergy list displays and the                       Pass      Fail   IP 05.07   The system shall provide the ability to display the          Date and time of
                                   date and time of allergy entry                                                  allergy history, including date and time of entry.           entry may be
                                   is recorded.                                                                                                                                 viewed in the GUI
                                                                                                                                                                                or the audit log.
                                                                                                                                                                                Applicant may log
                                                                                                                                                                                in as a different
                                                                                                                                                                                user type to show
                                                                                                                                                                                the audit log.
 1.028   Print the allergy list.   Allergy list is printed (print                      Pass      Fail   IP 05.09   The system shall provide the ability to print the allergy
                                   preview is acceptable) and                                                      list, including the status of the allergy.
         (Show a print preview     includes the status of the
         of the allergy list for   allergy.
         verification purposes).
 1.029   Logout as Nurse.          Logout successful.
 1.030   Login as Dr. Miller.      Login successful.                                                                                                                            Proctor to update
                                                                                                                                                                                Audit Trail
                                                                                                                                                                                Worksheet
                                                                                                                                                                                (Appendix E).




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                  Page 14 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                      June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                    Expected Result             Actual Result      Pass/Fail                          Criteria and Reference                                   Comments
 1.031   Perform admission        Home medication entered                              Pass      Fail   IP 10.09   The system shall provide the ability for order entry of
         medication               previously displays:                                                             medications that are brought in from home that the
                                                                                                                   Pharmacy is not dispensing.
         reconciliation.
         Document and order       •   Poly-Vi-Sol Vitamin Drops                                         IP 11.07   The system shall provide the ability to display home
                                                                                                                   medications for provider review for medication
         Poly-Vi-Sol                  with Iron 1.0 mL once                                                        reconciliation during writing of admission orders.
         administration to            daily.
         continue during the                                                                            IP 11.08   At admission and discharge from the hospital, the
                                                                                                                   system shall provide the ability to permit the clinician to
         inpatient stay.          Poly-Vi-Sol is converted to an                                                   designate which home medications are being continued
                                  Inpatient order. Manual entry                                                    / discontinued.
                                  of the Poly-Vi-Sol order is
                                                                                                        IP 11.09   At admission, the system shall provide the ability to
                                  acceptable.                                                                      display corresponding inpatient orders for home
                                                                                                                   medications the provider designates as being
                                                                                                                   continued.

 1.032   Open the ordering        Order screen displays and                            Pass      Fail   IP 08.01   The system shall provide the ability to display patient
         function.                includes Elizabeth Benson’s                                                      name, identification number, and age or date of birth on
                                                                                                                   all order screens.
                                  name, identification number,
                                  and age or date of birth.                                             IP 08.04   The system shall provide the ability to have viewable
                                                                                                                   an indicator that the patient has allergies (allergies
                                                                                                                   exist) or no known allergies on all order screens.
                                  There is an indicator for
                                  allergy status (allergies exist
                                  or no known allergies).
 1.033   Order MMR vaccine for    Alert displays due to allergy                       Pass       Fail   IP 12.24   The system shall provide the ability to check
         Elizabeth Benson.        to eggs. Do not complete the                                                     immunization orders against documented patient
                                                                                                                   allergies (medication and non-medication) and inform
                                  order.                                                                           the user during prescribing / ordering.

 1.034   Confirm allergy to       Documentation of clinical                           Pass       Fail   IP 15.07   The system shall provide the ability to document clinical
         eggs; mother indicates   assessment pertinent to                                                          assessment pertinent to immunization administration.
         that was entered in      immunization administration
         error. Document that     is allowed.
         there is no allergy to
         eggs and that vaccine    Allergy to eggs is deleted
         can be administered.     from the allergy list.
         Delete the allergy to
         eggs from the allergy
         list.
2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                    Page 15 of 75
                                                                2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                               Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                     Expected Result        Actual Result      Pass/Fail                          Criteria and Reference                                    Comments
 1.035   Complete order for         Comment to the individual                     Pass       Fail   IP 15.05   The system shall provide the ability to attach a
         MMR vaccine to be          scheduled dose is added.                                                   comment to an individual scheduled dose and include
                                                                                                               as part of the legal medical record.
         administered ASAP.
         Add a comment to the
         eMAR that the mother
         has requested to be
         present during
         administration.
 1.036   Logout as Dr. Miller       Logout successful.
 1.037   Login as Nurse             Login successful.
 1.038   Receive alert that         Due and overdue ordered                       Pass       Fail   IP 15.03   The system shall allow the clinician to identify and         Can use various
         immunization is due.       immunizations display.                                                     display due and overdue ordered immunizations.               methods to identify
                                                                                                                                                                            and display the
                                                                                                                                                                            overdue
                                                                                                                                                                            medications. For
                                                                                                                                                                            example, the nurse
                                                                                                                                                                            receives an alert
                                                                                                                                                                            when logging into
                                                                                                                                                                            the system, or the
                                                                                                                                                                            overdue
                                                                                                                                                                            immunizations are
                                                                                                                                                                            displayed as a
                                                                                                                                                                            different color.
 1.039   View the MMR order.        Immunization order can be                     Pass       Fail   IP 15.06   The system shall provide the ability to view the
                                    viewed.                                                                    immunization order as written during administration.

 1.040   From the eMAR,             Physical location of the                      Pass       Fail   IP 15.08   The system shall provide the ability to indicate from the    For example,
         determine where the        vaccine is indicated.                                                      eMAR where the clinician can locate the vaccine on the       refrigerator,
                                                                                                               unit.
         clinician can locate the                                                                                                                                           dispensing
         vaccine on the unit.                                                                                                                                               machine, or cart.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                             Page 16 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                        June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                      Expected Result           Actual Result      Pass/Fail                          Criteria and Reference                                     Comments
 1.041   Record consent for the    Consent is recorded,                               Pass       Fail   IP 15.12   The system shall have the ability to record the date and
         immunization              including the following                                                         time (to the minute) of the consent, refusal, or deferral
                                                                                                                   status as it relates to the administration of each
         administration.           discrete data elements:                                                         immunization at the time of each encounter, including
                                   decision, name of decider,                                                      the following discrete data elements: decision, name of
                                   status of decider, and                                                          decider, status of decider (e.g. parent, self, legal
                                   date/time.                                                                      guardian, medical power of attorney), and date/time(s).
                                                                                                                   In the event of refusal of an immunization, the system
                                                                                                                   shall allow recording of one or multiple discrete reasons
                                                                                                                   for vaccine refusal.

 1.042   Administer the MMR        MMR is administered; details                       Pass       Fail   FN 16.03   The system shall provide the ability to capture
         vaccination.              are captured:                                                                   immunization administration details as discrete data,
                                                                                                                   including:
                                   (1) the immunization type and                                                   (1) the immunization type and dose;
                                   dose;                                                                           (2) date and time of administration;
                                   (2) date and time of                                                            (3) route and site;
                                   administration;                                                                 (4) lot number and expiration date;
                                   (3) route and site;                                                             (5) manufacturer; and
                                   (4) lot number and expiration                                                   (6) user ID.
                                   date;
                                   (5) manufacturer; and
                                   (6) user ID.
 1.043   Document that Vaccine     System provides the ability to                     Pass       Fail   IP 15.10   The system shall provide the ability for the clinician to
         Information Statement     document that VIS was                                                           document that a Vaccine Information Statement (VIS)
                                                                                                                   was given including the version or edition date of the
         (VIS) was given,          given, including the version                                                    VIS.
         including the version.    date.
 1.044   Create a task to assess   Tasks/assessments                                  Pass       Fail   IP 15.04   The system shall provide the ability to indicate any
         patient for fever and     associated with the                                                             tasks/assessments associated with immunization
                                                                                                                   administration.
         rash 1 hour after         immunization administration
         administration of         are indicated.
         vaccination.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                      Page 17 of 75
                                                                     2008 Certification of Inpatient EHRs                                                                      June 17, 2008
                                     Certification Commission
                                     for Healthcare
                                     Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.


            Procedure                      Expected Result           Actual Result      Pass/Fail                          Criteria and Reference                                     Comments
 1.045   The patient has had a       Allergy/adverse reaction to a                     Pass       Fail   FN 16.01   The system shall provide the ability to capture an           This may be
         reaction to the MMR.        specific immunization can be                                                   allergy/adverse reaction to a specific immunization.         recorded in the
         Note “redness and           captured.                                                                                                                                   general
         swelling at the injection                                                                                                                                               allergy/adverse
         site.”                                                                                                                                                                  reaction section of
                                                                                                                                                                                 the patient record.

                                                                                                                                                                                 At this time,
                                                                                                                                                                                 reaction information
                                                                                                                                                                                 may be stored as
                                                                                                                                                                                 free text.
 1.046   The nurse realizes that     Lot number is able to be                          Pass       Fail   IP 15.09   The system shall provide the ability to amend
         the lot number of the       modified.                                                                      immunization administration documentation and include
                                                                                                                    as part of the legal medical record.
         MMR vaccination has
         been incorrectly
         entered. Modify the
         previously entered lot
         number.
 1.047   Print immunization          Immunization administration                       Pass       Fail   IP 15.11   The system shall provide the ability for the                 Print preview or the
         administration record.      record is printed.                                                             immunization administration record to be printed.            ability to send the
                                                                                                                                                                                 document to a
                                                                                                                                                                                 printable file type is
                                                                                                                                                                                 acceptable.
 1.048   Logout as Nurse.            Logout successful.
 1.049   Login as Dr. Miller.        Login successful.
 1.050   Attempt to enter an         System warns user that                            Pass       Fail   IP 12.02   The system shall provide the ability to detect a daily
         order for                   ordered dose exceeds                                                           dose that falls outside the recommended range for
                                                                                                                    patient age and inform the user during ordering.
         Acetaminophen 40            recommended range.
         mg/kg PO every 4
         hours.                      User cancels order.
 1.051   Search for the Infant       The Infant Fever Order Set is                     Pass       Fail   FN 10.01   The system shall provide the ability to define a set of      See Appendix A for
         Fever Order Set (as         displayed on the screen.                                                       items to be ordered as a group.                              the Infant Fever
         entered during system                                                                           IP 09.21   The system shall provide the ability to allow users to       Order Set.
         set-up).                                                                                                   search for order sets by name.


2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                     Page 18 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                      June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                        Expected Result          Actual Result      Pass/Fail                          Criteria and Reference                                     Comments
 1.052   Select the Infant Fever   All different order types and                      Pass       Fail   FN 10.01   The system shall provide the ability to define a set of      See Appendix A for
         Order Set.                multiple choices of the same                                                    items to be ordered as a group.                              the Infant Fever
                                   order type (for example, there                                       IP 09.05   The system shall provide the ability to incorporate          Order Set.
                                   can be several orders for a                                                     multiple choices of medications or other types of orders
                                                                                                                   within an order set for clinician selection.
                                   medication but each has a
                                   different route) can be viewed
                                   in the Infant Fever Order Set.

                                   (See Appendix A for all
                                   orders included in the Infant
                                   Fever Order Set.)
 1.053   Review date last          The user can view the date of                      Pass       Fail   IP 09.03   The system shall provide the option to include date last     The user should be
         modified for this order   the last modification (today).                                                  modified in the display of order sets.                       able to view the
         set.                                                                                                                                                                   date of last
                                                                                                                                                                                modification from
                                                                                                                                                                                within the order set.
                                                                                                                                                                                This modification
                                                                                                                                                                                date may be stored
                                                                                                                                                                                as free text or
                                                                                                                                                                                within a discrete
                                                                                                                                                                                field.
 Instructions for the next several procedures utilize orders that are within the Infant Fever Order Set. See Appendix A for the Infant Fever Order Set.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                    Page 19 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                    June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                      Expected Result           Actual Result      Pass/Fail                        Criteria and Reference                                     Comments
 1.054   Select all the            All the NURSING orders are                         Pass       Fail   FN 10.03   The system shall provide the ability to include in an      The orders are
         NURSING orders from       selected in the Infant Fever                                                    order set order types including but not limited to         “signed” by Dr.
                                                                                                                   medications, laboratory tests, imaging studies,
         the Infant Fever Order    Order Set:                                                                      procedures and referrals.                                  Miller in a later
         Set:                                                                                                                                                                 step.
                                   •   Vital signs
         •   Vital signs           •   Weigh patient daily
         •   Weigh patient daily   •   Intake and Output
         •   Intake and Output     •   Peripheral IV access
         •   Peripheral IV         •   Assess hydration /
             access                    perfusion
         •   Assess hydration /    •   ECG monitoring
             perfusion             •   Sa02 oximetry
         •   ECG monitoring        •   Oxygen
         •   Sa02 oximetry
         •   Oxygen                Problem “fever” is entered as
                                   order component.
 1.055   Select the following      The following LABORATORY                           Pass       Fail   FN 10.03   The system shall provide the ability to include in an      The orders are
         LABORATORY orders         orders are selected in the                                                      order set order types including but not limited to         “signed” by Dr.
                                                                                                                   medications, laboratory tests, imaging studies,
         from the Infant Fever     Infant Fever Order Set:                                                         procedures and referrals.                                  Miller in a later
         Order Set:                                                                                                                                                           step.
                                                                                                        FN 11.01   The system shall provide the ability for individual
                                   •   CBC with differential                                                       orders in an order set to be selected or deselected by
         •   CBC with              •   Blood culture                                                               the user.
             differential
                                                                                                        IP 09.05   The system shall provide the ability to incorporate
         •   Blood culture                                                                                         multiple choices of medications or other types of
                                                                                                                   orders within an order set for clinician selection.
 1.056   Mark the Blood Culture    Blood Culture order is                             Pass       Fail   IP 08.24   The system shall provide the ability to enter
         order conditional; the    entered as conditional                                                          conditional orders that can be activated when certain
                                                                                                                   criteria and conditions are met.
         order will become         capturing the condition detail
         active when               temperature >39.0
         temperature > 39.0        centigrade.
         centigrade.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                  Page 20 of 75
                                                                      2008 Certification of Inpatient EHRs                                                                     June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                     Expected Result              Actual Result      Pass/Fail                        Criteria and Reference                                    Comments
 1.057   View the pre-selected     The pre-selected Urinalysis                          Pass       Fail   IP 09.04   The system shall provide the ability to configure order    No manual
         Urinalysis with culture   with culture order in the Infant                                                  sets with pre-selected orders.                             selection of the
         order in the Infant       Fever Order Set is already                                             IP 09.17   The system shall allow the display of individual orders    Urinalysis order is
         Fever Order Set.          selected.                                                                         in order sets with pre-selected order details for          necessary.
                                                                                                                     clinician review.

                                   •   Urinalysis, direct cath,                                                                                                                 See Appendix A for
                                       culture, STAT                                                                                                                            Urinalysis order
                                                                                                                                                                                details in the Infant
                                   The Urinalysis is displayed as                                                                                                               Fever Order Set.
                                   an individual order in the
                                   order set and has defaults for
                                   the Urinalysis (see defaults
                                   already selected – direct
                                   cath, culture, STAT).
 1.058   Select the following      The following RADIOLOGY                              Pass       Fail   IP 08.09   The system shall provide the ability to include urgency    The order is
         RADIOLOGY order           order is selected in the Infant                                                   status in orders.                                          “signed” by Dr.
         from the Infant Fever     Fever Order Set and the                                                                                                                      Miller in a later
         Order Set and modify      urgency is viewed as STAT:                                                                                                                   step.
         the urgency from
         routine to STAT:          •   Diagnostic Chest x-ray (2
                                       views), STAT
         •   Diagnostic Chest x-
             ray (2 views),
             routine (Change
             the frequency to
             STAT)

         Do not enter a reason
         for the CXR.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 21 of 75
                                                                      2008 Certification of Inpatient EHRs                                                                      June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                      Expected Result             Actual Result      Pass/Fail                        Criteria and Reference                                      Comments
 1.059   Select the following       Entry of patient weight is                          Pass       Fail   IP 08.02   The system shall provide the ability to display the         The order is
         MEDICATION order           required prior to entering                                                       patient’s weight or an indicator that the patient has a     “signed” by Dr.
                                                                                                                     weight recorded on medication ordering screens.
         from the Infant Fever      medication order.                                                                                                                            Miller in a later
         Order Set:                 The following MEDICATION                                              IP 10.03   The system shall provide the ability to allow the           step.
                                                                                                                     clinician to order medication doses in mg/kg and
                                    order is selected in the Infant                                                  mL/kg.
         •    Ibuprofen 10 mg/kg    Fever Order Set:
              PO every 6 hours                                                                            IP 10.07   The system shall provide the ability to select order
                                                                                                                     details including strength, route, frequency and
                                    •   Ibuprofen 10 mg/kg PO                                                        comments.
         System requires entry          every 6 hours
                                                                                                          IP 12.25   The system shall provide the ability for the hospital to
         of patient weight prior                                                                                     require documentation of information regarding
         to entering medication     Elizabeth’s weight is viewable                                                   patient weight, inclusive of using such terms as
         order; enter “13 pounds    during the medication                                                            Unknown, before entering medication orders.
         14 ounces (6.3 kg).”       ordering process.

         This notification may
         occur at any point prior
         to signing medication
         orders.
 1.060   Review in the              The medication instructions                         Pass       Fail   IP 09.16   The system shall provide the ability to incorporate text    Recommendations
         MEDICATION section         or recommendations are                                                           instructions or recommendations within order sets.          can be drug
         of the Infant Fever        viewable regarding the                                                                                                                       reference
         Order Set the              following medications in the                                                                                                                 information and / or
         medication instructions    Infant Fever Order Set:                                                                                                                      dosing information.
         or recommendations                                                                                                                                                      Applicant will need
         for the following:         1. Acetaminophen (all                                                                                                                        to show instructions
                                       various routes and order                                                                                                                  for each of the
         1.   Acetaminophen            frequency)                                                                                                                                listed medications.
         2.   Ibuprofen             2. Ibuprofen
         3.   Clindamycin           3. Clindamycin
         4.   Erythromycin          4. Erythromycin




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                   Page 22 of 75
                                                                      2008 Certification of Inpatient EHRs                                                                    June 17, 2008
                                       Certification Commission
                                       for Healthcare
                                       Information Technology                                  Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                        Expected Result           Actual Result      Pass/Fail                        Criteria and Reference                                   Comments
 1.061   Modify the                    The modified Acetaminophen                       Pass       Fail   IP 10.03   The system shall provide the ability to allow the
         Acetaminophen PO              dose of 10 mg/kg can be                                                       clinician to order medication doses in mg/kg and
                                                                                                                     mL/kg.
         PRN for fever order in        viewed.
         the Infant Fever Order                                                                           IP 10.14   The system shall provide the ability to modify
                                                                                                                     medication orders including dosing information
         Set by changing the                                                                                         without having to discontinue the order.
         dose:

         •   Change the order
             for Acetaminophen
             15 mg/kg PO every
             4 hours PRN for
             fever to
             Acetaminophen 10
             mg/kg PO every 4
             hours PRN for
             fever
 1.062   Enter special                 Order instructions are                           Pass       Fail   IP 08.18   The system shall provide the ability for the ordering     Comment can be
         instructions for the          entered and displayed in the                                                  provider to include free text comments or instructions    abbreviated.
                                                                                                                     in the order to be viewed by providers
         Acetaminophen PO              Acetaminophen order.                                                          departments/services fulfilling the order or service.
         PRN order:                                                                                                                                                            Some systems may
                                                                                                                                                                               need to sign-off in
         “Call Dr. Miller if T° is >                                                                                                                                           order to view the
         101.5 °F.”                                                                                                                                                            order instructions
                                                                                                                                                                               displayed in the
         This completes order                                                                                                                                                  Acetaminophen
         selection within the                                                                                                                                                  order.
         Infant Fever Order Set.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 23 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                  Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                       Expected Result         Actual Result      Pass/Fail                         Criteria and Reference                                      Comments
 1.063   Within the Infant Fever    Link is displayed with the                       Pass       Fail   IP 09.19   The system shall provide the ability to display active
         Order, display a link to   order set.                                                                    links within an order set to applicable clinical
                                                                                                                  standards and reference materials.
         applicable clinical
         standards or reference
         materials. For
         example,
         http://www.guideline.go
         v/summary/summary.a
         spx?doc_id=9690&nbr
         =005199&string=comm
         unity-
         acquired+AND+pneum
         onia
 1.064   Enter order from the       The order is entered for the                     Pass       Fail   IP 08.10   The system shall provide the ability for clinicians to        The order (FA
         general order catalog:     Fluorescent antibody (FA)                                                     write all patient care orders electronically, including,      Respiratory Virus
                                                                                                                  but not limited to nursing care, medications /
                                    Respiratory Virus Battery,                                                    immunizations, diagnostic testing, nutrition and food         Battery) may be
         •   Fluorescent            once, routine.                                                                service, consultation, and blood products.                    abbreviated.
             antibody (FA)                                                                             IO-IP 03.04 The system shall provide the ability to send Non-
             Respiratory Virus                                                                                     Medication Orders and Updates to receiving system
             Battery, once                                                                                         (e.g., LIS, RIS, Dietary)
             routine




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                    Page 24 of 75
                                                                            2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                           Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                      Expected Result                   Actual Result      Pass/Fail                         Criteria and Reference                                      Comments
 1.065   Dr. Miller signs the       A visual cue is viewable by                               Pass       Fail   IP 08.15    The system shall provide the ability to set or configure    Required fields are
         orders selected in the     Dr. Miller to enter in a reason                                                         the entry fields available for each order by order type.    dependent upon
         Infant Fever Order Set     for chest x-ray before this                                                 IP 08.16    The system shall provide the ability to set or configure    the order type – for
         and additional             order can be processed.                                                                 what fields are required for a complete order by order      this procedure in
                                                                                                                            type.
         individual orders.                                                                                                                                                             the script the
                                    Orders:                                                                     IO-IP 03.04 The system shall provide the ability to send Non-           required fields may
         A required field has       1. Vital signs per unit routine                                                         Medication Orders and Updates to receiving system           include procedure,
                                    2. Weigh patient daily                                                                  (e.g., LIS, RIS, Dietary)
         been previously set        3. Intake and Output q shift                                                                                                                        clinical history /
         (system set-up) for        4. Peripheral IV access routine                                             IO-IP 03.05 The system shall provide the ability to send                signs and
                                                                                                                            Medication Orders and Updates to Pharmacy IT
         Radiology orders to        5. Assess hydration / perfusion q                                                                                                                   symptoms, known
                                        4 hrs                                                                               system utilizing a coding system for medications
         request a mandatory                                                                                                                                                            diagnoses, and
                                    6. ECG monitoring
         field of reason for a      7. Sa02 oximetry per protocol
                                                                                                                                                                                        ordering physician’s
         CXR prior to the order     8. Oxygen – to keep SaO2 > 90%,                                                                                                                     name.
         being processed.               wean to room air, delivery
                                        method per RT/RN                                                                                                                                Applicant may
                                    9. CBC with differential once
         •   Infant Fever Order         routine
                                                                                                                                                                                        apply this clinical
             Set selections         10. Blood culture, aerobic, once                                                                                                                    decision support
         • Modified order of            routine                                                                                                                                         type (required
             Acetaminophen 10       11. Urinalysis, direct cath, culture,                                                                                                               fields) anytime
             mg/kg PO every             STAT                                                                                                                                            during the order
                                    12. Diagnostic Chest x-ray (2
             fours hours PRN            views), STAT
                                                                                                                                                                                        entry process
         • Individual order         13. Ibuprofen 10 mg/kg PO every 6                                                                                                                   based upon the
             includes:                  hours                                                                                                                                           design of the
             Fluorescent            14. Acetaminophen 10 mg/kg PO                                                                                                                       system.
                                        every 4 hours PRN for fever
             antibody (FA)          15. Fluorescent antibody (FA)
             Respiratory Virus          Respiratory Virus Battery, once
             Battery, once              routine
             routine
 1.066   Dr. Miller enters in the   The reason of “fever,                                     Pass       Fail   IP 08.15    The system shall provide the ability to set or configure
         Chest x-ray order the      unknown origin” is displayed                                                            the entry fields available for each order by order type.
         reason of “fever,          in the Chest x-ray order.                                                   IP 08.16    The system shall provide the ability to set or configure
         unknown origin.”                                                                                                   what fields are required fields for a complete order
                                                                                                                            type.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                         Page 25 of 75
                                                                     2008 Certification of Inpatient EHRs                                                                      June 17, 2008
                                     Certification Commission
                                     for Healthcare
                                     Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                        Expected Result          Actual Result      Pass/Fail                        Criteria and Reference                                     Comments
 1.067   Show the orders in the      The orders in “Infant Fever                       Pass       Fail   FN 11.04   The system shall provide the ability to display orders
         Infant Fever Order Set      Order Set” display                                                             placed through an order set either individually or as a
                                                                                                                    group.
         individually.               individually.
 1.068   Save the Infant Fever       This order set is saved as a                      Pass       Fail   IP 09.31   The system shall provide the ability for a clinician to
         Order Set to “favorites.”   “favorite.” for Dr. Miller                                                     save frequently used, approved hospital order sets
                                                                                                                    (“favorites”) to facilitate retrieval and ordering.

 1.069   Leave the patient           The system has the ability to                     Pass       Fail   IP 10.06   The system shall provide end-users with the ability to
         record for Elizabeth        search for drugs by                                                            browse or search for a drug by therapeutic class when
                                                                                                                    ordering a medication.
         Benson; enter another       therapeutic class. All
         patient record for a        catecholomines are displayed
         child in the Pediatric      including dopamine.
         Intensive Care Unit.

         In order entry, Search
         for drug by therapeutic
         class catecholamines.
 1.070   For this patient, enter     Order requires co-signature.                      Pass       Fail   IP 10.04   The system shall provide the ability to allow the            Co-signature
         an order for                                                                                               clinician to order medication doses in mg/kg/min,            requires a second
                                                                                                                    microgram/kg, and microgram/kg/min.
         • Dopamine, 5               Order is entered.                                                                                                                           signature by
             micrograms / kg /                                                                           IP 10.15   The system shall have the ability to allow the hospital      another licensed
                                                                                                                    to configure orders that require co-signature.
             minute and                                                                                                                                                          provider.
         • Glucose 7
             mg/kg/min

         If, at step 1.007, the
         applicant chose to add
         the requirement for a
         co-signature to a
         medication other than
         dopamine, please
         order that medication
         here, to demonstrate
         compliance with
         criterion IP 10.15.
 1.071   Logout as Dr. Miller.       Logout successful.
2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                     Page 26 of 75
                                                                       2008 Certification of Inpatient EHRs                                                            June 17, 2008
                                     Certification Commission
                                     for Healthcare
                                     Information Technology                                         Note: Items that are Provisional for 2008 are highlighted in yellow.


             Procedure                     Expected Result             Actual Result         Pass/Fail                        Criteria and Reference                          Comments
 For Procedures 1.072 – 1.075 Applicant may login as their choice of authorized user or users.
 1.072   Demonstrate how the      System shows identity of the                      Pass       Fail IP 08.13 For each order type, the system shall provide the
         system captures the      user, and date and time when                                                   ability to capture and display the identity of the user,
                                                                                                                 the date and the time when the order is signed, co-
         identity of the user and the order is signed. System                                                    signed, renewed, modified or discontinued.
         the date and time when displays the status
                                                                                                     IP 08.31    The system shall provide the ability to view status
         the order is signed, for information for the order.                                                     information for ordered services.
         the CXR order.
 The next two procedures demonstrate how the orders are received in departmental systems. Applicants can print a requisition (with prescribed fields as noted in the
 procedure for the scenario) in the receiving departments or interface to the departments for Step 1.073. The Pharmacy system cannot have a printed requisition to meet
 the requirements for Step 1.074.
 1.073 Demonstrate how the        Laboratory and Radiology                          Pass       Fail IP 08.15 The system shall provide the ability to set or configure Applicant may log-
         Laboratory and           systems receive complete                                                       the entry fields available for each order by order type. in at this time to
         Radiology systems        orders from the ordering                                           IP 08.16    The system shall provide the ability to set or configure their choice of user.
         capture order elements clinician.                                                                       what fields are required fields for a complete order
                                                                                                                 type.
         from the ordering                                                                                                                                                 Print preview of the
         clinician:               • CBC + Diff, once routine                                         IO-IP 03.04 The system shall provide the ability to send Non-        requisition or orders
                                                                                                                 Medication Orders and Updates to receiving system        is acceptable.
                                  • Blood culture, Aerobic,                                                      (e.g., LIS, RIS, Dietary)
         Example lab order            once routine
         elements include:                                                                                                                                                Not required to see
         frequency, test,         • Urinalysis, direct cath,                                                                                                              the requisition
         urgency, time and site.      culture, STAT                                                                                                                       information or
                                  • Diagnostic Chest 2 views,                                                                                                             orders in the
         • CBC + Diff, once           STAT with reason “fever                                                                                                             Departmental
              routine                 of unknown origin.”                                                                                                                 systems for Lab
         • Blood culture,                                                                                                                                                 and Radiology.
              Aerobic, once
              routine
         • Urinalysis, direct
              cath, culture, STAT

         •    Diagnostic Chest 2
              views, STAT with
              reason “fever of
              unknown origin.”
2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                             Page 27 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                         June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                     Expected Result           Actual Result      Pass/Fail                           Criteria and Reference                                       Comments
 1.074   Demonstrate how the       Pharmacy system                                   Pass       Fail    IP 08.13    For each order type, the system shall provide the             Applicant may log-
         Pharmacy system           electronically receives                                                          ability to capture and display the identity of the user,      in at this time to
                                                                                                                    the date and the time when the order is signed, co-
         receives medication       medication orders and                                                            signed, renewed, modified or discontinued.                    their choice of user
         orders:                   appropriate details display.                                                                                                                   to view date, time,
                                                                                                        IP 08.30    The system shall provide the ability to electronically
                                                                                                                    communicate the order to the receiving departmental
                                                                                                                                                                                  and ordering
         •   Acetaminophen 10      •   Acetaminophen 10 mg/kg                                                       system.                                                       clinician with each
             mg/kg PO every 4          PO every 4 hours PRN                                                                                                                       order.
                                                                                                        IO-IP 03.05 The system shall provide the ability to send
             hours PRN for             for fever                                                                    Medication Orders and Updates to Pharmacy IT                  Medication orders
             fever                                                                                                  system utilizing a coding system for medications              must be shown
                                   •   Ibuprofen 10 mg/kg PO                                                                                                                      within the pharmacy
         •   Ibuprofen 10 mg/kg        every 6 hours                                                                                                                              system to meet the
             PO every 6 hours                                                                                                                                                     requirement of
                                                                                                                                                                                  electronic
                                                                                                                                                                                  communication.
 1.075   Please complete pharmacy verification on the medications that have been received by the pharmacy for Elizabeth Benson.
 1.076   Logout.                Logout successful.
 Note that CCHIT recognizes that in real life there would be a time lapse between orders and receiving results; while the following does not reflect actual workflow, it will
 allow CCHIT to test criteria in a timely manner.
 1.077   Login as Nurse.           Login successful.
 1.078   View the immunization     Administration of MMR is                           Pass       Fail   IP 15.01    The system shall provide the ability to view all
         administration history.   viewed, including clinician,                                                     immunization administration history including clinician,
                                                                                                                    date, and time.
                                   date and time.
                                                                                                        IP 15.02    The system shall provide the ability to display the date
                                                                                                                    and time of the last immunization dose administered.

 1.079   Review orders for         Orders can be accessed by                          Pass       Fail   IP 08.27    The system shall provide the ability to access orders         For example active,
         Elizabeth Benson by       different views, e.g. active,                                                    for a patient by different views.                             discontinued, all,
         different views.          discontinued, all, date,                                                                                                                       date, ordering
                                   ordering clinician, type. .                                                                                                                    clinician and type.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                      Page 28 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                   June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.


            Procedure                     Expected Result           Actual Result      Pass/Fail                        Criteria and Reference                                  Comments
 1.080   View Elizabeth             Elizabeth Benson’s current                         Pass      Fail   FN 06.01   The system shall provide the ability to update and
         Benson’s medication        medication orders display:                                                     display a patient-specific medication list based on
                                                                                                                   current medication orders or prescriptions.
         list; review the details
         of each medication.        •   Poly-Vi-Sol Vitamin Drops                                       IP 06.02   The system shall provide the ability to view the name
                                                                                                                   of the ordering clinician, medication order (name,
                                        with Iron 1.0 mL once                                                      dose, route, and frequency), a start date and time,
                                        daily.                                                                     and an end date and time or duration for entries on
                                    •   Acetaminophen 10 mg/kg                                                     the medication list.
                                        PO every 4 hours PRN                                            IP 06.03   The system shall provide the ability to display on the
                                        for fever                                                                  medication list active medications that the patient
                                        a. name of the ordering                                                    brings from home to take while hospitalized, which the
                                             clinician                                                             Pharmacy may not dispense.
                                        b. medication order
                                             (name, dose, route,
                                             and frequency)
                                        c. start date and time
                                        d. stop date and time

                                    •   Ibuprofen 10 mg/kg PO
                                        every 6 hours
                                        a. name of the ordering
                                           clinician
                                        b. medication order
                                           (name, dose, route,
                                           and frequency)
                                        c. start date and time
                                        d. stop date and time




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                Page 29 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                    June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


            Procedure                     Expected Result          Actual Result      Pass/Fail                         Criteria and Reference                                    Comments
 1.081   Demonstrate how the       Applicant can demonstrate                          Pass      Fail    IP 06.01   When the display of the medication list exceeds the       For example, “Page
         system would indicate,    this functionality.                                                             current screen or printed page, the system shall          1 of 2,” “End of
                                                                                                                   indicate that the list continues.
         if the medication list                                                                                                                                              Report.”
         exceeded the current                                                                                                                                                Applicant may have
         screen, that the list                                                                                                                                               to log in to another
         continues via scrolling                                                                                                                                             patient record that
         or on following pages                                                                                                                                               has a longer list of
         or screens.                                                                                                                                                         medications to
                                                                                                                                                                             demonstrate this
                                                                                                                                                                             step.
 1.082   View the eMAR for         The eMAR can be viewed                             Pass       Fail   IP 14.01   The system shall provide the ability to present           Applicant may
         Elizabeth Benson and      over a selected date and time                                                   medications to be administered over a selectable          choose any date
                                                                                                                   date/time range.
         look up a specific date   range.                                                                                                                                    and time range;
         and time range on the                                                                          IP 14.03   The system shall provide the ability to display the       ranges may be pre-
                                                                                                                   ordered date, time, route of administration and dose
         eMAR. For example,        View the order date and time,                                                   of all scheduled medications.
                                                                                                                                                                             built.
         “12 noon to 12            route of administration and
         midnight on today’s       dose for the following on the
         date.”                    eMAR:

                                   •   Acetaminophen 10 mg/kg
                                       PO every 4 hours PRN
                                       for fever

                                   •   Ibuprofen 10 mg/kg PO
                                       every 6 hours




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 30 of 75
                                                                      2008 Certification of Inpatient EHRs                                                                    June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                       Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                    Expected Result               Actual Result      Pass/Fail                        Criteria and Reference                                   Comments
 1.083   Administer and           View the following                                     Pass      Fail   IP 08.18   The system shall provide the ability for the ordering
         document on Elizabeth    administration details on the                                                      provider to include free text comments or instructions
                                                                                                                     in the order to be viewed by providers’
         Benson’s eMAR:           eMAR:                                                                              departments/services fulfilling the order or service.
                                                                                                          IP 14.13   The system shall provide the ability to capture
         •   Acetaminophen 10     •    Acetaminophen:
                                                                                                                     medication administration details as discrete data,
             mg/kg PO every 4         1) medication name,                                                            including:
             hours PRN for               strength and dose;                                                          (1) the medication name, strength and dose;
             fever                    2) date and time of                                                            (2) date and time of administration;
                                         administration;                                                             (3) route and site;
                                      3) route and site;                                                             (4) username and credentials.
         •   Ibuprofen 10 mg/kg       4) user name and
             PO every 6 hours                                                                             IP 14.17   The system shall allow the user to enter patient
                                         credentials.                                                                specific instructions or other free text on the eMAR.

         Enter a text note to     •    Ibuprofen:
         eMAR: “crushed pills         1) medication name,
         in pudding”.                    strength and dose;
                                      2) date and time of
                                         administration;
                                      3) route and site;
                                      4) user name and
                                         credentials.

                                  The instructions for the
                                  Acetaminophen should also
                                  be viewed:
                                  “Call Dr. Miller if T° is > 101.5
                                  °F.”

                                  Text note is included on the
                                  eMAR (crushed pills in
                                  pudding).




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                    Page 31 of 75
                                                                     2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                      Expected Result            Actual Result      Pass/Fail                         Criteria and Reference                                      Comments
 1.084   View medication           View the medication                                  Pass      Fail    IP 14.02   The system shall provide the ability to view the
         administration history.   administration history                                                            medication administration history including
                                                                                                                     administering clinician, date, and time.
         Show clinician, dates     including clinician, date, and
         and times associated      time.                                                                  IP 14.32   The system shall maintain and display as part of the
                                                                                                                     medication administration profile the dates and times
         with each medication      View dates associated with                                                        associated with the medication orders such as start,
         administration. View      medication orders such as                                                         modify, and stop dates.
         medication order          start, modify and stop dates.
                                                                                                          IP 14.04   The system shall provide the ability to display the date
         details such as start,                                                                                      and time of the last dose administered.
         modify and stop dates.
 1.085   Logout as Nurse.          Logout successful.
 1.086   Login as Dr. Miller.      Login successful.
 1.087   Dr. Miller enters the     The allergy to Amoxicillin is                        Pass       Fail   IP 12.18   The system shall provide the ability to check for            Clinical decision
         following medication      displayed for Dr. Miller to see                                                   potential interactions between medications to be             support may occur
                                                                                                                     prescribed/ordered and medication allergies and
         order for Elizabeth       during the ordering process                                                       intolerances listed in the record and alert the user at      at different times in
         Benson:                   and before the order is                                                           the time of medication selection during                      the ordering
                                   signed.                                                                           prescribing/ordering if potential interactions exist.        process.
         •   Ceftriaxone 1000      Any method of alert is
             mg IV piggyback       acceptable.
             STAT
 1.088   View the rationale for    The rationale for the drug                           Pass       Fail   FN 12.05   The system shall provide the ability to view the
         the drug interaction      interaction alert can be                                                          rationale for a drug interaction alert.
         alert.                    viewed (penicillin G
                                   cephalosporin allergy cross
                                   reaction).
 1.089   Access the reference      Reference information is                             Pass       Fail   FN 07.05   The system shall provide the ability to access               The reference
         information for           accessed.                                                                         reference information for prescribing/ordering.              information may
         prescribing/ordering                                                                                                                                                     reside within the
         Ceftriaxone.                                                                                                                                                             system or be
                                                                                                                                                                                  provided through
                                                                                                                                                                                  links to external
                                                                                                                                                                                  sources.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                      Page 32 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                      June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                       Expected Result         Actual Result      Pass/Fail                         Criteria and Reference                                    Comments
 1.090   Override the allergy       The alert is overridden and                       Pass      Fail    FN 12.06   The system shall provide the ability to capture and
         alert and document a       reason “allergy reaction is                                                    maintain at least one reason for overriding any drug-
                                                                                                                   drug or drug-allergy interaction warning triggered at
         reason for the override;   mild” is documented.                                                           the time of medication prescribing / ordering.
         “allergy reaction is
                                                                                                        FN 12.08   The system shall provide the ability to prescribe/order
         mild”.                                                                                                    a medication despite alerts for interactions and/or
                                                                                                                   allergies being present.
                                                                                                        IP 13.07   The system shall provide the ability to record the
                                                                                                                   reason for variation from rule-based clinical messages
                                                                                                                   as discrete data. (for example alerts and reminders)

 1.091   Demonstrate how the        The alert or high dose                            Pass       Fail   IP 12.01   The system shall provide the ability to detect a drug      Clinical decision
         system alerts or           information is displayed for                                                   dose that falls outside the min-max range for a single     support may occur
                                                                                                                   dose for the medication and to inform the clinician
         informs the user of a      the 1000 mg IV dose of                                                         during ordering.                                           at different times in
         dose that exceeds the      Ceftriaxone.                                                                                                                              the ordering
         min-max range for a        Any method of alert is                                                                                                                    process.
         single dose for:           acceptable.

         •  Ceftriaxone 1000
            mg IV piggyback
            STAT
 1.092   Modify the Ceftriaxone     View the modified dose of                         Pass       Fail   IP 08.11   The system shall provide the ability to renew, modify,
         dose to:                   Ceftriaxone.                                                                   and discontinue orders.


         •   Ceftriaxone 400 mg
             IV piggyback STAT




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                               Page 33 of 75
                                                                      2008 Certification of Inpatient EHRs                                                                     June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


            Procedure                     Expected Result             Actual Result      Pass/Fail                          Criteria and Reference                                  Comments
 1.093   View Elizabeth             Elizabeth Benson’s current                           Pass      Fail   IP 06.02    The system shall provide the ability to view the name
         Benson’s medication        medication orders display,                                                        of the ordering clinician, medication order (name,
                                                                                                                      dose, route, and frequency), a start date and time,
         list.                      and include ordering clinician,                                                   and an end date and time or duration for entries on
                                    name, dose, route and                                                             the medication list.
                                    frequency, a start date and                                           IP 06.04    The system shall provide the ability to update the
                                    time, a stop date and time,                                                       medication list with new medication orders, start date
                                    and pharmacy verification                                                         and time, end date and time or duration, and
                                    status for each medication.                                                       pharmacy verification status.
                                    Pharmacist, date and time is                                          IP 06.05    The system shall provide the ability to update the
                                    available when reviewing                                                          medication list with changes from pharmacist
                                    pharmacy verification.                                                            verification including pharmacist, date, and time.
                                                                                                          IO-IP 03.06 The system shall provide the ability to receive Status
                                    •   Poly-Vi-Sol Vitamin Drops                                                     Updates from Pharmacy
                                        with Iron 1.0 mL once                                             FN 06.01    The system shall provide the ability to update and
                                        daily.                                                                        display a patient-specific medication list based on
                                    • Acetaminophen 10 mg/kg                                                          current medication orders or prescriptions.
                                        PO every 4 hours PRN
                                        for fever – verified
                                        previously
                                    • Ibuprofen 10 mg/kg PO
                                        every 6 hours – verified
                                        previously
                                    • Ceftriaxone 400 mg IV
                                        piggyback STAT as
                                        unverified
 1.094   Logout as Dr. Miller.      Logout successful.
 1.095   Login as Nurse.            Login successful.
 1.096   From Elizabeth             System provides the ability to                      Pass       Fail   IP 16.07    The system shall provide the ability to view the
         Benson’s eMAR, view        view the medication                                                               medication screening alert history during
                                                                                                                      administration.
         the medication             screening alert history during
         screening alert history.   administration.
 1.097   From the eMAR, view        Medication order for                                Pass       Fail   IP 14.14    The system shall provide the ability to view the
         the medication order       Ceftriaxone is viewed from                                                        medication order as written during administration.
         for Ceftriaxone as         the eMAR.
         written.
2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                   Page 34 of 75
                                                                     2008 Certification of Inpatient EHRs                                                                     June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


            Procedure                     Expected Result            Actual Result      Pass/Fail                        Criteria and Reference                                      Comments
 1.098   From the eMAR,             Physical location of                               Pass       Fail   IP 14.16   The system shall provide the ability to display from the    For example,
         determine where the        medication can be displayed                                                     eMAR where the clinician can locate the medication          refrigerator,
                                                                                                                    on the unit.
         clinician can locate the   from the eMAR.                                                                                                                              dispensing
         Ceftriaxone on the unit.                                                                                                                                               machine, or cart.
 1.099   Administer the             View the following                                 Pass       Fail   IP 14.13   The system shall provide the ability to capture
         Ceftriaxone and            administration details on the                                                   medication administration details as discrete data,
                                                                                                                    including:
         document the               eMAR:                                                                           (1) the medication name, strength and dose;
         administration:                                                                                            (2) date and time of administration;
         • Ceftriaxone 400 mg       •   Ceftriaxone                                                                 (3) route and site;
              IV piggyback STAT         administration                                                              (4) user name and credentials.
                                        1) medication name,                                              IP 14.26   The system shall provide the hospital with the ability
                                           strength and dose;                                                       to allow documentation of medication administration
                                        2) date and time of                                                         prior to pharmacy review.
                                           administration;                                               IP 16.05   The system shall provide the ability for medication
                                        3) route and site;                                                          interaction alerts to be displayed from the MAR,
                                        4) user name and                                                            based upon hospital policy
                                           credentials.

                                    Ceftriaxone is unverified by
                                    the pharmacy.

                                    Nurse is able to display the
                                    drug allergy alert information
                                    for the Ceftriaxone from
                                    within the eMAR.
 1.100   System alerts to drug-     System alerts to drug-allergy                      Pass       Fail   IP 16.01   The system shall provide the hospital the option to set     For example, an
         allergy interaction at     interaction at the time of                                                      for re-alerting via the eMAR for drug-allergy               icon may appear
                                                                                                                    interactions at the time of administration.
         the time of                administration.                                                                                                                             next to all
         administration.                                                                                 IP 16.06   The system shall provide the ability to indicate            medications that
                                                                                                                    medication orders with medication screening alerts
                                                                                                                    during medication administration.
                                                                                                                                                                                have interaction
                                                                                                                                                                                alerts or a pop up
                                                                                                                                                                                message may
                                                                                                                                                                                occur.
 1.101   Logout as Nurse.           Logout successful.
 1.102   Login as Pharmacist.       Login successful.

2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                    Page 35 of 75
                                                                 2008 Certification of Inpatient EHRs                                                                     June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                  Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                     Expected Result         Actual Result      Pass/Fail                         Criteria and Reference                                   Comments
 1.103   Demonstrate that the     Pharmacy system                                  Pass       Fail   IP 08.30    The system shall provide the ability to electronically
         Pharmacy system          electronically receives                                                        communicate the order to the receiving departmental
                                                                                                                 system.
         received the new         medication orders and
         medication orders for    appropriate details display                                        IO-IP 03.05 The system shall provide the ability to send
                                                                                                                 Medication Orders and Updates to Pharmacy IT
         Elizabeth Benson.        (medication name, dose,                                                        system utilizing a coding system for medications
                                  route, frequency, comments,
         •   Ceftriaxone 400 mg   ordering provider, date/time
             piggyback IV STAT    etc.).
 1.104   Verify all new           All new medications for                          Pass       Fail   IP 08.30    The system shall provide the ability to electronically
         medications for          Elizabeth Benson now                                                           communicate the order to the receiving departmental
                                                                                                                 system.
         Elizabeth Benson.        display as verified:
                                                                                                     IO-IP 03.05 The system shall provide the ability to send
                                                                                                                 Medication Orders and Updates to Pharmacy IT
                                  •  Ceftriaxone 400 mg IV                                                       system utilizing a coding system for medications
                                     piggyback STAT is
                                     verified.
 1.105   Logout as Pharmacist.    Logout successful.
 1.106   Login as Nurse.          Login successful.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                             Page 36 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                     June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                       Expected Result           Actual Result      Pass/Fail                         Criteria and Reference                                   Comments
 1.107   The Nurse views the       The eMAR for Elizabeth                              Pass      Fail    IP 06.04   The system shall provide the ability to update the
         eMAR for Elizabeth        Benson includes the                                                              medication list with new medication orders, start date
                                                                                                                    and time, end date and time or duration, and
         Benson:                   administration details for the                                                   pharmacy verification status.
                                   following:
                                                                                                         IP 14.07   The system shall provide the ability to display PRN
         •   View Pharmacy’s                                                                                        medications in a manner that distinguishes them from
             verification of the   •   Ceftriaxone 400 mg IV                                                        other medications
             Ceftriaxone 400 mg        STAT – Verified
                                                                                                         IP 14.13   The system shall provide the ability to capture
             IV.                                                                                                    medication administration details as discrete data,
                                   Previously administered:                                                         including:
         Also view administered                                                                                     (1) the medication name, strength and dose;
         medications:              •   Acetaminophen 10 mg/kg                                                       (2) date and time of administration;
                                                                                                                    (3) route and site;
                                       PO every 4 hours PRN                                                         (4) user name and credentials.
         •   Acetaminophen 10          for fever - Active PRN
             mg/kg PO every 4          order
             hours PRN for
             fever                 •   Ibuprofen 10 mg/kg PO
                                       every 6 hours – Active
         •   Ibuprofen 10 mg/kg        order
             PO every 6 hours
                                   The PRN medication
                                   (Acetaminophen) is
                                   distinguished from the
                                   regularly scheduled
                                   medications.
 1.108   View the eMAR for the     Medication administration                           Pass       Fail   IP 14.30   The system shall provide the ability to amend
         administration of the     documentation for                                                                medication administration documentation and include
                                                                                                                    as part of the legal medical record.
         Ceftriaxone, and          Ceftriaxone is viewed and
         modify the route.         can be amended.
 1.109   Logout as Nurse.          Logout successful.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 37 of 75
                                                                     2008 Certification of Inpatient EHRs                                                                          June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                       Note: Items that are Provisional for 2008 are highlighted in yellow.


Test Script Scenario 2 – Pediatric Inpatient
Scenario 2 continues to involve Elizabeth Benson, a 6-month old female.
 Test Script Scenario #2
 Key Features of this scenario are:
 • Ordering process - Telephone / verbal orders, Order sets, and favorite lists (frequently used order sets)
 • Electronic medication administration record
 • Pharmacy functional integration
 • Nurse verification
 • Print outs of all medication and orders, and current medications at time of discharge.

           Procedure                     Expected Result             Actual Result         Pass/Fail                             Criteria and Reference                                 Comments
 2.01     Login as Nurse.          Login successful.
 2.02     Receive and              The telephone order is                                 Pass         Fail   IP 08.06 The system shall provide the ability to document a            The Applicant may
          document a telephone     documented, including:                                                              telephone order, including the clinician taking the           execute the
                                                                                                                       telephone order and the ordering physician in the patient
          order from Dr. Miller                                                                                        record.                                                       procedure as a
          for the patient          •   the clinician who took the                                                                                                                    revision to the
          Elizabeth Benson as          telephone order (Nurse)                                                                                                                       existing
          follows:                 •   the ordering physician                                                                                                                        medication order.
                                       who gave the telephone
          •   Discontinue the          order (Dr. Miller)
              Acetaminophen 10     •   Discontinue the
              mg/kg PO every 4         Acetaminophen 10 mg/kg
              hours PRN for            PO every 4 hours PRN for
              fever                    fever
                                   •   Add a medication order
          •   Add a medication         for Acetaminophen
              order for                15mg/kg oral every 8
              Acetaminophen            hours times one day
              15mg/kg oral
              every 8 hours
              times one day




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                      Page 38 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                    Expected Result             Actual Result       Pass/Fail                          Criteria and Reference                                   Comments
 2.03    Associate the order for The medication order can be                          Pass       Fail   IP 08.19   The system shall provide the ability to associate an
         acetaminophen with      associated with the diagnosis.                                                    order of any type (including medication order) with a
                                                                                                                   related clinical problem(s) and/or diagnosis code(s)
         diagnosis of                                                                                              and description.
         pneumonia.
                                                                                                        FN 09.01   The system shall provide the ability to require problem
                                                                                                                   / diagnosis as an order component.

 2.04    Document the              The verification read-back is                      Pass       Fail   IP 08.07   The system shall provide the ability to document a           This may be
         verification read-back.   documented                                                                      verification “read-back” of the complete order by the        accomplished
                                                                                                                   person receiving the telephone or verbal order.
                                                                                                                                                                                during step 2.02
 2.05    Show history of        History of changes to                                 Pass       Fail   IP 04.02   The system shall provide the ability to display the
         changes made to the    diagnosis is displayed and                                                         history of changes made to a specific problem /
                                                                                                                   diagnosis, including clinician, date, and time.
         diagnosis              includes clinician, date and
         “pneumonia.”           time. Display should indicate
                                when the diagnosis was
                                entered (diagnosis should
                                have been entered as part of
                                the setup to this test script.)
 2.06    Review Elizabeth       Allergies display:                                    Pass       Fail   FN 05.05   The system shall provide the ability to capture and          Attributes include
         Benson’s allergies and • Amoxicillin with reaction                                                        maintain, as discrete data, the identity of the user who     the name of the
                                                                                                                   added, modified, inactivated or removed items from
         document that the          of “hives” and severity of                                                     the allergy and adverse reaction list, including             allergen and the
         allergy list was           “mild”                                                                         attributes of changed items. The user ID and                 action (reviewed,
         reviewed.              • Peanut Oil with reaction of                                                      date/time stamp shall be recorded.                           added, modified,
                                    “hives and cough” and                                               FN 05.06   The system shall provide the ability for a user to           inactivated or
                                    severity of “severe”                                                           explicitly document that the allergy list was reviewed.      removed).
                                System provides the ability to                                                     The user ID and date/time stamp shall be recorded
                                document that allergies were                                                       when the allergies reviewed option is selected.
                                reviewed. User ID and
                                date/time stamp are
                                recorded.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                  Page 39 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                        June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                     Expected Result            Actual Result       Pass/Fail                          Criteria and Reference                                     Comments
 2.07    Administer the first     Elizabeth’s Benson’s                                Pass       Fail   IP 14.11   The system shall provide the ability to indicate any          In a subsequent
         dose of the new          temperature is documented                                                        clinical interventions or assessments associated with         procedure the
                                                                                                                   medication administration.
         telephone order:         along with documentation of                                                                                                                    Nurse is then
                                  administration of the                                                 IP 14.15   The system shall provide the ability to document              asked to
                                                                                                                   clinical assessment pertinent to medication
         •   Acetaminophen        Acetaminophen.                                                                   administration.
                                                                                                                                                                                 document a
             15mg/kg oral                                                                                                                                                        response to this
             every 8 hours                                                                                                                                                       Acetaminophen
             times one day                                                                                                                                                       administration.

         Document on
         Elizabeth Benson’s
         eMAR her
         temperature of 104 °F
         Tympanic.
 2.08    Activate the             Conditional order can be                            Pass       Fail   IP 08.24   The system shall provide the ability to enter conditional
         conditional order for    activated, as the prerequisite                                                   orders that can be activated when certain criteria and
                                                                                                                   conditions are met.
         Blood Culture, as        criteria have been met.
         temperature is >39
         degrees C.
 2.09    Logout as Nurse.         Logout successful.
 2.10    Login as Dr. Miller.     Login successful; notification                      Pass       Fail   IP 17.08   The system shall provide the ability to notify the
         Receive notification     received.                                                                        ordering clinician concerning orders requiring signature
                                                                                                                   (verbal and telephone orders, co signature).
         that there is an order
         requiring signature
         (telephone order for
         Acetaminophen).
 2.11    Sign the telephone       The telephone order for the                         Pass       Fail   IP 08.13   For each order type, the system shall provide the
         order for the            Acetaminophen is signed by                                                       ability to capture and display the identity of the user,
                                                                                                                   the date and the time when the order is signed, co-
         Acetaminophen.           Dr. Miller. Order date and                                                       signed, renewed, modified or discontinued.
                                  time are captured.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                     Page 40 of 75
                                                                      2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                       Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                       Expected Result             Actual Result       Pass/Fail                          Criteria and Reference                                   Comments
 2.12    Order a CBC +             System alerts to the previous                         Pass       Fail   IP 13.08   The system shall provide the ability to set elapsed time
         Differential.             order for CBC + Differential                                                       parameters for purposes of duplicate order checking.
                                   within the elapsed time
                                   parameters set. Order is not
                                   completed.
 2.13    View the order history    Order history for Ceftriaxone                         Pass       Fail   IP 08.14   The system shall provide the ability to permit display of
         for the medication        display and includes clinician                                                     order history for any order including ordering clinician
                                                                                                                      order, date, and time.
         order of Ceftriaxone.     (Dr. Miller), date (today) and
                                   time.
 2.14    Open the Infant           Pre-selected order for                                Pass       Fail   IP 09.30   The system shall apply the same decision support to          Order may need to
         Pneumonia Order Set.      Amoxycillin triggers allergy                                                       orders placed through an order set as to orders written      be placed to
                                                                                                                      individually
                                   alert.                                                                                                                                          demonstrate
                                                                                                                                                                                   allergy alert.
 2.15    De-select the order for   The orders are selected from                          Pass       Fail   FN 10.03   The system shall provide the ability to include in an        See Appendix A
         Amoxycillin and select    the Infant Pneumonia Order                                                         order set order types including but not limited to           for the Infant
                                                                                                                      medications, laboratory tests, imaging studies,
         the following orders      Set:                                                                               procedures and referrals.                                    Pneumonia Order
         from the Infant                                                                                                                                                           Set.
                                                                                                           FN 11.01   The system shall provide the ability for individual
         Pneumonia Order Set:      •   D5 ¼ NS + Potassium                                                            orders in an order set to be selected or deselected by
                                       Chloride 20 mEq/L 1000                                                         the user.                                                    The Applicant may
         •   IV INFUSIONS –            mL                                                                                                                                          choose to delete
                                                                                                           IP 09.05   The system shall provide the ability to incorporate
             select D5 ¼ NS +    •     Electrolytes, routine, daily                                                   multiple choices of medications or other types of            duplicate orders
             Potassium                                                                                                orders within an order set for clinician selection.          with any
             Chloride 20 mEq/L                                                                                                                                                     methodology.
             1000 mL
         • LABORATORY –
             select only
             Electrolytes,
             routine, daily
 2.16    For the IV Infusion “D5 A comma can be used. .                                  Pass       Fail   IP 10.02   The system shall provide the ability in dosage fields in
         ¼ NS + Potassium                                                                                             medication orders: to spell out the word "UNITS", use
                                                                                                                      the words "Thousands" and "Millions" as part of
         Chloride 20 mEq/L                                                                                            expressing large doses and allow the use of commas
         1000 mL” insert a                                                                                            in doses expressed in thousands.
         comma in the dose
         (1,000).


2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                     Page 41 of 75
                                                                  2008 Certification of Inpatient EHRs                                                                      June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                      Expected Result          Actual Result       Pass/Fail                           Criteria and Reference                                    Comments
 2.17    View Elizabeth            Test results can be viewed                        Pass       Fail   IP 07.01    The system shall provide the ability to view test results   See Appendix A
         Benson’s test results     during the ordering process.                                                    during the ordering process.                                for laboratory
         during the ordering       Note that display of results                                        IO-IP 03.07 The system shall provide the ability to provide access      results.
         process.                  may vary:                                                                       and view capabilities for relevant lab results for
                                                                                                                   medication ordering or administration
                                   For example, could be
                                   WBC = 19,600
                                   Diff = 12,200 PMN
                                   Bands = 2,120
                                   Lymphocytes = 4,880
                                   Eosinophils = 400
                                   Potassium = 3.8 mEq/L

                                   Or could be
                                   WBC = 19.6 K/mm3
                                   Differential:
                                   PMN = 62 %
                                   Bands = 11 %
                                   Lymphocytes = 25 %
                                   Eosinophils = 2 %
                                   Potassium = 3.8 mEq/L
 2.18    Add the following         View order entered with                           Pass       Fail   IP 08.18    The system shall provide the ability for the ordering       Comment can be
         individual order:         comments / instructions                                                         provider to include free text comments or instructions      abbreviated.
                                                                                                                   in the order to be viewed by providers
                                   regarding the order.                                                            departments/services fulfilling the order or service
         •   Administer D10W
             IV 20 mL once
             with special
             instruction to give
             if not taking feeds
             well in next 2
             hours.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                Page 42 of 75
                                                                      2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                       Expected Result            Actual Result       Pass/Fail                          Criteria and Reference                                   Comments
 2.19    Demonstrate how the       The clinician can save                                Pass       Fail   IP 08.26   The system shall provide the ability for a clinician to
         physician can create      “favorites” or “preferences” to                                                    save frequently used and institutionally approved
                                                                                                                      orderables or order sets as “favorites” or "preferences"
         and save a “favorites”    facilitate retrieval and                                                           to facilitate retrieval and ordering.
         list; save the D10        ordering. The order for D10
         order to the favorites.   is saved as a favorite.
 2.20    Sign the orders           The clinician (Dr. Miller) order                     Pass        Fail   IP 08.13   The system shall provide the ability to capture the          Proctor to update
         selected in the Infant    date (today) and time (now)                                                        clinician, order date and time when an order is signed,      Audit Trail
                                                                                                                      co-signed, renewed, modified, or discontinued.
         Pneumonia Order Set       are captured as these orders                                                                                                                    Worksheet
         and any additional        are signed:                                                             IP 08.16   The system shall provide the ability to set or configure     (Appendix E).
                                                                                                                      what fields are required for a complete order by order
         individual orders.                                                                                           type.
                                   •   D5 ¼ NS + Potassium
                                       Chloride 20 mEq/L 1,000
                                       mL
                                   •   Electrolytes, routine, daily
                                   •   D10W IV 20 mL once with
                                       special instruction to give
                                       if not taking feeds well in
                                       next 2 hours




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                   Page 43 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                      Expected Result          Actual Result      Pass/Fail                           Criteria and Reference                                    Comments
 2.21    On Elizabeth              Amoxicillin is inactivated on                     Pass       Fail    FN 05.01   The system shall provide the ability to modify or            This could include
         Benson’s allergy list,    Elizabeth Benson’s allergy                                                      inactivate an item on the allergy and adverse reaction       removal, marking
                                                                                                                   list.
         inactivate “amoxicillin.” list. System records that Dr.                                                                                                                as erroneous, or
                                   Miller is the user who                                               FN 05.05   The system shall provide the ability to capture and          marking as
                                                                                                                   maintain, as discrete data, the identity of the user who
                                   inactivated the item along                                                      added, modified, inactivated or removed items from
                                                                                                                                                                                inactive.
                                   with date/time stamp.                                                           the allergy and adverse reaction list, including             "Remove" in this
                                                                                                                   attributes of changed items. The user ID and                 context implies
                                                                                                                   date/time stamp shall be recorded.                           specifying that an
                                                                                                                                                                                allergy or allergen
                                                                                                                                                                                specification is no
                                                                                                                                                                                longer valid or
                                                                                                                                                                                active as opposed
                                                                                                                                                                                to deleting the
                                                                                                                                                                                information from
                                                                                                                                                                                the database
                                                                                                                                                                                entirely. Applicant
                                                                                                                                                                                may show user,
                                                                                                                                                                                date and time of
                                                                                                                                                                                the change in
                                                                                                                                                                                another part of the
                                                                                                                                                                                system.
 2.22    Logout as Dr. Miller.    Logout successful.
 2.23    Login as user            Login successful.
         authorized to execute
         the next step.
 2.24    Show where               Applicant shows where in the                        Pass       Fail   FN 07.03   The system shall provide the ability to maintain a           There is no
         medication codes are     system codes are attached to                                                     coded list of medications including a unique identifier      requirement that
                                                                                                                   for each medication.
         maintained in the        medication list.                                                                                                                              the codes show in
         system (e.g. in the                                                                                                                                                    the GUI. The
         user interface,                                                                                                                                                        Applicant can
         database table, etc.)                                                                                                                                                  simply show their
                                                                                                                                                                                tables where a
                                                                                                                                                                                unique code is
                                                                                                                                                                                associated with
                                                                                                                                                                                each medication.

2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                Page 44 of 75
                                                                2008 Certification of Inpatient EHRs                                                                           June 17, 2008
                                 Certification Commission
                                 for Healthcare
                                 Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                   Expected Result           Actual Result       Pass/Fail                             Criteria and Reference                                     Comments
 2.25    Logout as the           Logout successful.
         authorized user.
 2.26    Login as Nurse.         Login successful.
 2.27    Acknowledge             Medication orders can be                          Pass         Fail   IP 14.25    The system shall provide the ability for the clinician to
         medication orders for   acknowledged, including date                                                      acknowledge medication orders prior to administration
                                                                                                                   including date and time.
         Elizabeth Benson.       and time.


 2.28    View Elizabeth          View on the eMAR the D5 ¼                         Pass         Fail   IP 14.06    The system shall provide the ability to display               Method not
         Benson’s eMAR for       NS + Potassium Chloride 20                                                        continuous infusions in a distinguishable manner from         specified, but for
                                                                                                                   other medications that is complete and visible in one
         the IV fluid.           mEq/L 1,000 mL the                                                                place on the eMAR.                                            example,
                                 continuous infusion is                                                                                                                          highlighting or
                                 distinguishable from other                                                                                                                      section breaks.
                                 medications

                                 The Nurse would also see the
                                 D10W IV order on the eMAR.
 2.29    View the eMAR to        Elizabeth’s latest Potassium                      Pass         Fail   IP 07.02    The system shall provide the ability to view test results     The Applicant
         review Elizabeth        result can be viewed:                                                             during medication administration.                             should have the
         Benson’s last                                                                                 IO-IP 03.07 The system shall provide the ability to provide access        Potassium value
         Potassium result.       Potassium = 3.8 mEq/L                                                             and view capabilities for relevant lab results for            “resulted” in the
                                                                                                                   medication ordering or administration
                                                                                                                                                                                 system from set
                                                                                                                                                                                 up data.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 45 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                    June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                     Expected Result            Actual Result       Pass/Fail                         Criteria and Reference                                 Comments
 2.30    Document Elizabeth       Response to the medication                          Pass       Fail   IP 14.31   The system shall provide ability to document a reaction
         Benson’s response to     administration is captured:                                                      / response to medication administration.
         the last dose given of   “patient’s temperature 2
         • Acetaminophen          hours post administration is
             15mg/kg every 8      99 °F Tympanic.”
             hours times one
             day.
         Response is
         • Elizabeth’s
             temperature 2
             hours post
             administration is
             99 °F Tympanic.
 2.31    Open the D10W IV         The medication not given is                         Pass       Fail   IP 14.29   The system shall provide the ability to document the
         order on the eMAR.       documented in the eMAR                                                           reason a medication was not given.
                                  with the reason “patient
         This medication was      taking oral feedings well” for
         not given; document      D10W IV.
         the reason “patient
         taking oral feedings
         well.”
 2.32    Modify the Ibuprofen     The Ibuprofen administration                        Pass       Fail   IP 14.23   The system shall provide the ability to modify            This Procedure is
         administration           schedule is modified to a new                                                    medication administration schedules on the electronic     not changing the
                                                                                                                   medication administration record.
         schedule to 8:00 a.m.,   schedule on the eMAR.                                                                                                                      frequency of the
         2:00 p.m., 8:00 p.m.                                                                                                                                                order – just the
         and 2:00 a.m.                                                                                                                                                       scheduled
                                                                                                                                                                             administration
                                                                                                                                                                             time. This
                                                                                                                                                                             procedure may be
                                                                                                                                                                             performed as the
                                                                                                                                                                             Pharmacist if the
                                                                                                                                                                             Nurse user does
                                                                                                                                                                             not have these
                                                                                                                                                                             rights.


2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 46 of 75
                                                                     2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                    Expected Result              Actual Result       Pass/Fail                          Criteria and Reference                                   Comments
 2.33    Notify the Pharmacy       Pharmacy is notified of                              Pass       Fail   IP 14.24   The system shall provide the ability to notify the
         that the administration   changes in schedule on the                                                        Pharmacy of changes in schedules on the electronic
                                                                                                                     medication administration record.
         schedule for Ibuprofen    eMAR.
         is modified.
 2.34    Print the eMAR.           The eMAR can be printed.                             Pass       Fail   IP 14.34   The system shall provide the ability for the electronic      Proctor to update
         (Show a print preview                                                                                       medication administration record to be printed.              Audit Trail
         of the medication list                                                                                                                                                   Worksheet
         for verification                                                                                                                                                         (Appendix E).
         purposes, then print a
         copy for purposes of
         the Audit Trail
         Worksheet).
 2.35    Logout as Nurse.          Logout successful.
 2.36    Login as Nurse            Login successful.
         Manager and select
         Elizabeth Benson’s
         record.
 2.37    View Elizabeth            The current medication list is                       Pass       Fail   FN 06.02   The system shall provide the ability to display a view
         Benson’s current          displayed.                                                                        that includes only current medications.
         medications.
 2.38    Print the current         The current medication list for                      Pass       Fail   FN 06.04   The system shall provide the ability to print a current      Applicant may
         medication list for       Elizabeth Benson is printed.                                                      medication list.                                             demonstrate with
         Elizabeth Benson.                                                                                                                                                        a “print preview”
                                                                                                                                                                                  function.

                                                                                                                                                                                  If the Applicant
                                                                                                                                                                                  cannot
                                                                                                                                                                                  demonstrate via a
                                                                                                                                                                                  “print preview,”
                                                                                                                                                                                  then a copy should
                                                                                                                                                                                  be faxed to CCHIT
                                                                                                                                                                                  at 312-277-3112.



2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                      Page 47 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                     Expected Result             Actual Result       Pass/Fail                         Criteria and Reference                                     Comments
 2.39    Open a report to view    Report includes all orders that                      Pass       Fail   IP 19.02   The system shall provide the ability to include patient      Applicant may
         all the orders that      have been entered on                                                              identifying information as well as time and date report      provide patient
                                                                                                                    printed, on each page of individual patient-specific
         have been entered on     Elizabeth Benson.                                                                 reports generated.                                           identifier of their
         Elizabeth Benson.                                                                                                                                                       choosing.
                                                                                                         IP 19.03   The system shall provide the ability to create paper
         Create a printed         Report includes patient                                                           copies of order- and medication-administration-related
         version of this report   identifying information and                                                       medical record elements.
         (may use “print          time and date report was
                                                                                                         IP 19.04   The system shall provide the ability to view the
         preview” or may print    printed on each printed page.                                                     complete order and medication administration history.
         and fax to CCHIT Test
         Proctor at 312-277-
         3112).
 2.40    Identify all providers   Providers associated with this                       Pass       Fail   FN 03.01   The system shall provide the ability to capture and          A provider is
         associated with this     patient encounter are                                                             maintain, as discrete data elements, the identity of all     defined as anyone
                                                                                                                    providers associated with a specific patient encounter.
         patient encounter.       identified. It is not specified                                                                                                                delivering clinical
                                  where in the system this                                                                                                                       care such as
                                  information must appear.                                                                                                                       physicians, PAs,
                                                                                                                                                                                 CNPs, and
                                                                                                                                                                                 Nurses.
 2.41    Identify the principal   Dr. Miller is identified as the                      Pass       Fail   FN 03.02   The system shall provide the ability to capture and          “Principal provider”
         provider responsible     principal provider responsible                                                    maintain, as discrete data elements, the principal           is not required
                                                                                                                    provider responsible for the care of an individual
         for the care of          for the care of Elizabeth                                                         patient.                                                     text; and words
         Elizabeth Benson.        Benson.                                                                                                                                        that indicate
                                                                                                                                                                                 similar relationship
                                                                                                                                                                                 will be acceptable.
 2.42    Logout as Nurse          Logout successful.
         Manager.
 2.43    Login as Dr. Miller.     Login successful.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 48 of 75
                                                                  2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                     Expected Result          Actual Result       Pass/Fail                          Criteria and Reference                                    Comments
 2.44    Elizabeth Benson is       Medication reconciliation is                      Pass       Fail   IP 11.08   At admission and discharge from the hospital, the
         going to be               completed and provider                                                         system shall provide the ability to permit the clinician to
                                                                                                                  designate which home medications are being
         discharged. Complete      signature is captured.                                                         continued / discontinued.
         medication
                                                                                                       IP 11.10   At each change in level of care (to ICU, to surgery,
         reconciliation for        •   Poly-Vi-Sol home                                                           discharge), the system shall display prior, active
         Elizabeth; select at          medication is                                                              medication orders for provider review during writing of
         least one of the              documented as being                                                        admission/transfer orders.
         Inpatient medications         resumed                                                         IP 11.11   At discharge and each change in level of care, the
         to be continued after     •   At least one Inpatient                                                     system shall provide the ability to designate which
         discharge and                 medication is                                                              current medications are being continued /
         document that the rest        documented as being                                                        discontinued.
         of the Inpatient              continued after                                                 IP 11.12   At each change in level of care, the system shall
         medications will be           discharge.                                                                 provide the ability to display corresponding inpatient
                                                                                                                  orders for medications the provider designates as
         discontinued at           •   At least one Inpatient                                                     being continued.
         discharge. In addition,       medication is
         document that the             documented as being                                             IP 11.13   At admission, discharge, and each change in level of
         original home                                                                                            care during the hospital stay, the system shall capture
                                       discontinued at                                                            provider signature that medication reconciliation has
         medication of Poly-Vi-        discharge.                                                                 been completed.
         Sol will be resumed
         upon discharge.
 2.45    Discharge                 Discharge medications,                            Pass       Fail   IP 11.15   At discharge, the system shall provide the ability to         If a “print preview”
         medications, allergies    allergies and current weight                                                   communicate discharge medications and allergies to            is not available the
                                                                                                                  the next provider of care.
         and current weight are    can be communicated to the                                                                                                                   applicant may fax
         to be communicated        next provider of care.                                              IP 11.16   At discharge, the system shall provide the ability to         the document to
                                                                                                                  communicate current weight (including date and time
         to the next provider of                                                                                  of measurement) to the next provider of care.
                                                                                                                                                                                CCHIT at 312-
         care. Create a file       For verification purposes, a                                                                                                                 277-3112.
         that includes             print preview of the file is                                        IP 11.17   The system shall provide the ability to communicate
                                                                                                                  the active medication list to appropriate providers (to
         medications, allergies    acceptable.                                                                    the next provider of care).
         and current weight.
 2.46    Review history of         The history of medication                         Pass       Fail   IP 11.14   At admission, discharge, and each change in level of
         medication                reconciliation for Elizabeth                                                   care, the system shall provide the ability to retain the
                                                                                                                  history of medication reconciliation (including prior
         reconciliation for        Benson is retained.                                                            medications reviewed, medications
         Elizabeth Benson.                                                                                        continued/discontinued, new medication orders,
                                                                                                                  signature of each provider completing review) for
                                                                                                                  subsequent review.

2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                   Page 49 of 75
                                                                 2008 Certification of Inpatient EHRs                                                                     June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                  Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                      Expected Result         Actual Result       Pass/Fail                           Criteria and Reference                                Comments
 2.47    Exit patient record for   Patient record selected.
         Elizabeth Benson, and
         select patient Mary
         Beth Benson.
 2.48    Mary Beth has             Drug dose is computed,                           Pass         Fail   IP 10.26   The system shall compute drug doses, based on
         rheumatoid arthritis.     based on the patient’s body                                                     appropriate dosage ranges, using the patient’s body
                                                                                                                   surface area and ideal body weight.
         Place an order for:       surface area.
         • Prednisone 4.5
             mg/m2 daily PO.
 2.49    Logout as Dr. Miller.     Logout successful.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                Page 50 of 75
                                                                  2008 Certification of Inpatient EHRs                                                                        June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


Test Script Scenario 3 – Adult Inpatient
Scenario 3 involves a male, John McSorley, who was admitted through the Emergency Department post an automobile accident in which he sustained an unstable
distal radius fracture which he is being admitted for an open reduction internal fixation (ORIF) surgical procedure. John McSorley has a normal past medical
history without any chronic diseases and has had abdominal surgery at this hospital last year.
 Test Script Scenario #3
 Key Features of this scenario are:
 • All order types and order sets
 • Verbal orders
 • Order renewal
 • Clinical decision support during ordering and administration
 • Non-formulary medication ordering
 • eMAR and administration signatures
 • Laboratory, Radiology and Medication orders entered and received by ancillary
    departments

          Procedure                     Expected Result          Actual Result        Pass/Fail                           Criteria and Reference                                   Comments
 3.01    Login as Nurse.         Login successful.
 3.02    Receive notification    Clinician is notified                               Pass         Fail   IP 17.05   The system shall provide the ability to notify the          CBC expiration is
         that CBC order for      concerning orders due to                                                           ordering clinician concerning orders due to expire.         based on pre-
         John McSorley is        expire.                                                                                                                                        entered set up
         expiring.                                                                                                                                                              data.
                                  Any form of notification is
                                  acceptable.
 3.03    Receive a verbal order View the documentation of                            Pass         Fail   IP 08.05   The system shall provide the ability to document a
         from the surgeon, Dr.    the verbal order:                                                                 verbal order, including the clinician taking the verbal
                                                                                                                    order and the ordering physician in the patient record.
         Bradley, for the patient
         John McSorley for the • the clinician who took the
         following medication:        verbal order (Nurse)
                                  • the ordering physician
         • Morphine 4 mg IV           (Dr. Bradley)
              now                 • Morphine 4 mg IV now

         Document the verbal
         order.
2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 51 of 75
                                                                    2008 Certification of Inpatient EHRs                                                          June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                       Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                     Expected Result            Actual Result          Pass/Fail                         Criteria and Reference                             Comments
 3.04    Documentation of        “No known drug allergies” or                            Pass       Fail IP 12.20 The system shall provide the ability for the hospital to
         allergy information is  similar description is                                                              require the documentation of allergy information
                                                                                                                     inclusive of using such terms as Unknown, before
         required before         documented; medication                                                              entering medication orders.
         entering medication     order can now be completed.
                                                                                                          FN 05.08 The system shall provide the ability to explicitly
         orders. Enter “no                                                                                           indicate that a patient has no known drug allergies or
         known drug allergies”                                                                                       adverse reactions.
         or similar description
         for John McSorley.
         Note: The Applicant should set assessment of pain level overdue times (clinical decision support) to less than or equal to 30 minutes (will depend upon the amount of time it
         takes to perform Procedure 3.05 thru Procedure 3.50).
 3.05    Administer and          The administration of the                               Pass       Fail IP 14.18 The system shall provide ability for a second provider
         document the IV         Morphine is documented and                                                          to witness and co-document administration.
         Morphine prior to       includes the user name, date                                             IP 14.26   The system shall provide the hospital with the ability to
         Pharmacy verification; and time. It also requires a                                                         allow documentation of medication administration prior
                                                                                                                     to pharmacy review.
         a witness to the        second user to access the
         administration is       system, authenticate
         required.               themselves (for example
                                 through password or PIN)
                                 and record that they
                                 witnessed the administration.
                                 The “witness” action should
                                 contain the witness name,
                                 date and time and may be
                                 viewed within the eMAR itself
                                 or in the system audit log.
                                 eMAR now has two
                                 signatures for the Morphine
                                 administration:

                                  •   Performed by (or similar
                                      term)
                                  •   Witnessed by (or similar
                                      term)



2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                        Page 52 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                        June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                    Expected Result              Actual Result       Pass/Fail                          Criteria and Reference                                    Comments
 3.06    View the orders and      Orders and eMAR data from                            Pass       Fail   IP 19.01   The system shall provide the ability to view patient
         eMAR from John           John McSorley’s last                                                              data from previous admissions.
         McSorley’s last          admission are viewable.
         admission (which was
         for abdominal
         surgery).
 3.07    Review the eMAR for      Due and overdue medications                          Pass       Fail   IP 14.05   The system shall allow the clinician to identify and          Any method of
         John McSorley;           display; Narcan is overdue,                                                       display due and overdue medications.                          identification for
         overdue medication       as per the setup data for this                                         IP 17.01   The system shall provide the ability to establish time        due and overdue
         displays:                scenario.                                                                         periods for designating medication administration tasks       medications will be
                                                                                                                    overdue.
                                                                                                                                                                                  acceptable.
         •  Narcan 2mg IV                                                                                IP 17.02   The system shall provide the ability to establish time
            every 30 minutes                                                                                        periods and recipients for notification of overdue
                                                                                                                    medication administration.
            for two doses
 3.08    Logout as Nurse.         Logout successful.
 3.09    Login as Dr. Bradley.    Login successful.
 3.10    Sign the verbal order    The verbal order for Morphine                        Pass       Fail   IP 08.13   For each order type, the system shall provide the
         for Morphine.            is signed by Dr. Bradley.                                                         ability to capture and display the identity of the user,
                                                                                                                    the date and the time when the order is signed, co-
                                  Order date and time are                                                           signed, renewed, modified or discontinued.
                                  captured.
 3.11    Display the identities   Identities of the two providers                      Pass       Fail   IP 08.29   The system shall provide the ability for cosigned
         of the providers who     are displayed (Nurse and Dr.                                                      orders to retain and display the identities of both the
                                                                                                                    ordering and cosigning providers.
         ordered and cosigned     Bradley).
         the morphine order.
 3.12    Search for the Infant    Order Set is not found, as                           Pass       Fail   IP 09.18   The system shall allow restricting the access to
         Fever Order Set.         access is limited to Pediatric                                                    individual order sets by user role or department
                                  Department.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                      Page 53 of 75
                                                                   2008 Certification of Inpatient EHRs                                                                      June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                      Expected Result           Actual Result       Pass/Fail                          Criteria and Reference                                    Comments
 3.13    Place the Post Op        The following orders are all                        Pass       Fail   IP 08.17   The system shall provide the ability to configure orders    For example,
         Order Set and do not     defaulted to the typical order                                                   within order sets with default order details.               setting the default
         change the order set     details in the Post-op ORIF                                           IP 17.04   The system shall provide the ability to establish time      priority to STAT or
         defaults (pre-           Order Set:                                                                       periods for order expiration for types of orders.           the frequency to
         selected).                                                                                                                                                            daily.
         NURSING                  NURSING                                                                                                                                      See Appendix C
         • Neurovascular          • Neurovascular check                                                                                                                        for the Post Op
             check every hour       every hour times 8 hours                                                                                                                   Order Set.
             times 8 hours and      and then every 4 hours
             then every 4 hours     (set to expire after 2 days)
             (set this order to
             expire after 2       LABORATORY
             days)                • CBC with differential
         LABORATORY                  times two days, routine
         • CBC with               • PT / INR, routine, daily
             differential times
             two days, routine    CONSULTS
         • PT / INR, routine,     • Case Coordinator / Social
             daily                  Services consult re:
         CONSULTS                   discharge planning
         • Case Coordinator /
             Social Services
             consult re:
             discharge planning
 3.14    Change Case              Consult order is changed.                           Pass       Fail   IP 08.20   The system shall provide the ability to allow the entry
         Coordinator / Social                                                                                      of orders to be activated at a future date and time
                                                                                                                   including admission orders, discharge orders, and
         Services consult re:                                                                                      post-op orders.
         discharge planning to
         2 days from now.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                   Page 54 of 75
                                                                     2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                       Expected Result           Actual Result       Pass/Fail                          Criteria and Reference                                     Comments
 3.15    Select the following       The medication orders are                           Pass       Fail   IP 08.17   The system shall provide the ability to configure orders     See Appendix C
         from the Post-Op           selected and the order details                                                   within order sets with default order details.                for the Post Op
         Order Set:                 are already completed.                                                IP 10.11   The system shall provide the ability to enter all order      Order Set.
                                                                                                                     details for medication orders that include dosing
                                                                                                                     adjustments and limits.
         MEDICATIONS                •   Vancomycin 1.5 gm IV
         • Vancomycin 1.5               every 12 hours                                                    IP 12.26   The system shall provide the ability to inform the
                                                                                                                     clinician about potential drug-food interactions
           gm IV every 12           •   Demerol (Meperidine)
           hours                        75mg IM every 4 hours as                                          IP 13.04   The system shall provide the ability to display for
         • Demerol                      needed                                                                       selection a secondary, or corollary, order that is
                                                                                                                     recommended in conjunction with the primary order.
           (Meperidine) 75mg        •   Warfarin (Coumadin) 5
           IM every 4 hours             mg PO daily
           as needed
         • Warfarin                 Order for Warfarin includes
           (Coumadin) 5 mg          information about potential
           PO daily                 interactions with food high in
         • Morphine 1mg/ml,         vitamin K (phylloquinone). A
           PCA, demand: 1.0         link to this information is
           mg, lockout: 15          acceptable.
           minutes, 4-hour
           limit: 10 mg             Order for Warfarin includes a
                                    recommendation for a
                                    secondary order, which is
                                    displayed for selection. For
                                    example, a selectable
                                    recommendation for an order
                                    for Prothrombin Time (INR)
                                    lab.
 3.16    Show how the system        There is an indicator on the                        Pass       Fail   IP 08.04   The system shall provide the ability to have viewable
         provides a viewable        order screen: No known drug                                                      an indicator that the patient has allergies (allergies
                                                                                                                     exist) or no known allergies on all order screens.
         indicator of the           allergies or no known
         patient’s allergy status   allergies.
         on the order screen.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                      Page 55 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                    June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                      Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                     Expected Result             Actual Result       Pass/Fail                          Criteria and Reference                                    Comments
 3.17    Create an individual     The system displays the                              Pass       Fail   IP 09.22   The system shall provide the ability to display orders in   Not testing for
         order for:               orders in the same manner,                                                        an order set in the same manner as when the order is        duplicate warnings
                                                                                                                    placed individually.
                                  whether ordered individually                                                                                                                  in this step.
         •   Vancomycin 1.5       or as part of an order set.
             gm IV every 12
             hours

         Show how the system
         displays this order in
         the same manner as
         the order for
         Vancomycin placed
         through the order set.

         Do not order the
         second Vancomycin.
 3.18    Search the list of       Users have the ability to                            Pass       Fail   FN 07.04   The system shall provide end-users the ability to
         orderable medications    search for medications by                                                         search for medications by generic name or brand
                                                                                                                    name.
         for Bupropion.           generic name from a
                                  medication list that uses “Tall                                        IP 12.12   The system shall provide the ability to search from
                                                                                                                    medication lists which use “Tall Man” letters.
                                  Man” letters.
 3.19    Search the list of       Users have the ability to                            Pass       Fail   FN 07.04   The system shall provide end-users the ability to
         orderable medications    search for medications by                                                         search for medications by generic name or brand
                                                                                                                    name.
         for Wellbutrin.          brand name from a
                                  medication list that uses “Tall                                        IP 12.12   The system shall provide the ability to search from
                                                                                                                    medication lists which use “Tall Man” letters.
                                  Man” letters.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 56 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                 Certification Commission
                                 for Healthcare
                                 Information Technology                                       Note: Items that are Provisional for 2008 are highlighted in yellow.


           Procedure                   Expected Result              Actual Result       Pass/Fail                          Criteria and Reference                                   Comments
 3.20    Place the following     Tall Man lettering viewed                             Pass       Fail   IP 10.07   The system shall provide the ability to select order
         individual medication   (BuPROPion) and formulary                                                          details including strength, route, frequency and
                                                                                                                    comments.
         order:                  search completed by generic
         • Wellbutrin            and brand name.                                                         IP 06.06   The system shall provide the ability to indicate the
                                                                                                                    reason/ indication for the medication during order
             (Bupropion) 150                                                                                        entry.
             mg PO once a day    The reason for the medication
                                 is indicated during order entry
         Add reason for the      as “smoking cessation.”
         medication “smoking
         cessation.”
 3.21    Place the following     The Zantac order is entered.                          Pass       Fail   IP 10.07   The system shall provide the ability to select order
         medication order:                                                                                          details including strength, route, frequency and
                                                                                                                    comments.
         • Zantac
            (Ranitidine) 150
            mg PO twice daily.
 3.22    Create the following    System alerts user to the                             Pass       Fail   FN 12.01   The system shall provide the ability to check for            The applicant may
         medication order:       interaction between                                                                potential interactions between medications to be             modify the test
                                                                                                                    prescribed/ordered and current medications and alert
                                 medication to be ordered                                                           the user at the time of medication ordering if potential     step to enter a
         •   Dilantin            (Dilantin) and current                                                             interactions exist.                                          different drug
             (Phenytoin) 300     medication (Zantac).                                                                                                                            combination that
             mg PO twice daily                                                                                                                                                   will trigger a drug-
                                 The Dilantin order is not                                                                                                                       drug interaction
         Interaction between     entered.                                                                                                                                        alert as per their
         Zantac and Dilantin                                                                                                                                                     own evidenced
         displays.               Note that if other previously                                                                                                                   based practice
                                 entered medications trigger                                                                                                                     system if the
         De-select and do not    alerts, override those alerts in                                                                                                                Dilantin/Zantac
         enter the Dilantin      this procedure.                                                                                                                                 combination does
         order.                                                                                                                                                                  not trigger the
                                                                                                                                                                                 warning. (For
                                                                                                                                                                                 example, they
                                                                                                                                                                                 could enter
                                                                                                                                                                                 Warfarin/Dilantin).



2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                  Page 57 of 75
                                                                        2008 Certification of Inpatient EHRs                                                                         June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                          Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                      Expected Result                Actual Result       Pass/Fail                           Criteria and Reference                                    Comments
 3.23    Create the following     System alerts to multiple                                Pass       Fail   IP 12.14    The system shall provide the ability to identify when
         medication order:        medications of the same                                                                multiple medications of the same therapeutic or
                                                                                                                         pharmacologic class are ordered and inform the user
                                  therapeutic class: Zyban and                                                           when medications are selected during prescribing /
         •   Zyban 150 mg PO      Bupropion.                                                                             ordering.
             twice daily          Zyban is not ordered.
 3.24    Place the following      The nonformulary medication                              Pass       Fail   FN 07.01    The system shall provide the ability to alert the user at
         medication order for     order for “Wonder Drug” is                                                             the time a new medication is prescribed/ordered that
                                                                                                                         drug interaction, allergy, and formulary checking will
         John McSorley that is    ordered.                                                                               not be performed against the uncoded medication or
         not on the formulary:    System alerts that no                                                                  free text medication.
                                  interaction checking will be                                               FN 07.02    The system shall provide the ability to prescribe/order
         •   “Wonder Drug”        performed against the                                                                  uncoded or nonformulary medications.
             800 mg PO three      uncoded medication.
             times daily
 3.25    Review eMAR for          eMAR can be viewed without                               Pass       Fail   IP 10.12    The system shall provide the ability to view the
         dose of previous         interrupting the ordering                                                              electronic medication administration record without
                                                                                                                         interrupting the ordering process.
         administration of        process.
         insulin.
 3.26    Enter an order for       A sliding scale insulin range                            Pass       Fail   IP 10.10    The system shall provide the ability to document              See Appendix B
         Insulin (Human           is viewable and configurable                                                           complex medication orders that include dosing based           for Insulin (Human
                                                                                                                         on either physical status or laboratory values.
         Regular) Sliding Scale   during order entry by the                                                                                                                            Regular) Sliding
         for John McSorley.       ordering clinician.                                                        IP 10.16    The system shall provide the ability to enter medication      Scale.
                                                                                                                         orders utilizing a sliding scale.
         When ordering insulin     From   To    Dose       Condition                                         IP 13.01    The system shall provide the ability to display relevant,
                                   150    199   2 units    Call < 70                                                     patient-specific laboratory test results when entering
         sliding scale, view       200    249   4 units                                                                  an order.
         blood glucose results.    250    299   6 units
                                   300    349   8 units                                                      IO-IP 03.05 The system shall provide the ability to send Medication
                                   350    399   10 units   Call > 400                                                    Orders and Updates to Pharmacy IT system utilizing a
         “UNITS” must be
                                                                                                                         coding system for medications
         spelled out in the
         order.                   Blood glucose results as
                                  entered from appendix are
                                  available.

                                  “UNITS” is spelled out in the
                                  order.


2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                       Page 58 of 75
                                                                           2008 Certification of Inpatient EHRs                                                                        June 17, 2008
                                     Certification Commission
                                     for Healthcare
                                     Information Technology                                          Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                       Expected Result                  Actual Result       Pass/Fail                          Criteria and Reference                                    Comments
 3.27    Create a medication        System alerts to a cumulative                             Pass       Fail   IP 12.03   The system shall provide the ability to detect a
         order:                     dose that exceeds the                                                                  cumulative dose that falls outside the recommended
                                                                                                                           daily dose and inform the clinician during ordering.
         • Acetaminophen            recommended daily dose.
            650 mg PO every
            three hours for
            John McSorley.

         Do not complete the
         order.
 3.28    Sign all orders that Dr.   All orders from the Post Op Order                         Pass       Fail   IP 08.13   For each order type, the system shall provide the             The word, "sign,"
         Bradley has placed on      Set or that have been individually                                                     ability to capture and display the identity of the user,      is intended here to
                                    placed can be viewed as active,                                                        the date and the time when the order is signed, co-
         John McSorley.             unverified, and in progress.                                                           signed, renewed, modified or discontinued.                    convey actions,
                                    1. CBC with differential times two                                                                                                                   rather than
                                         days, routine am draw                                                                                                                           referring to digital
                                    2. PT / INR, routine, daily                                                                                                                          signature
                                    3. Vancomycin 1.5 gm IV every 12
                                         hours
                                                                                                                                                                                         standards.
                                    4. Demerol (Meperidine) 75mg IM
                                         every 4 hours as needed                                                                                                                         Dr. Bradley signed
                                    5. Warfarin (Coumadin) 5 mg PO                                                                                                                       the morphine
                                         daily                                                                                                                                           order in step 3.10.
                                    6. Morphine 1mg/ml, PCA,
                                         demand: 1.0 mg, lockout: 15
                                         minutes, 4-hour limit: 10 mg
                                    7. Neurovascular check every
                                         hour times 8 hours and then
                                         every 4 hours
                                    8. Case Coordinator / Social
                                         Services consult re: discharge
                                         planning

                                    1.   Wellbutrin (Bupropion) 150 mg
                                         PO three times a day
                                    2.   Zantac (Ranitidine) 150 mg PO
                                         twice daily
                                    3.   Wonder Drug 800 mg PO three
                                         times daily
                                    4.   Insulin (Human Regular) Sliding
                                         Scale


2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                             Page 59 of 75
                                                                     2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                      Expected Result             Actual Result       Pass/Fail                            Criteria and Reference                                 Comments
 3.29    Logout as Dr. Bradley.   Logout successful.
 3.30    Login as Pharmacist.     Login successful.
 3.31    Demonstrate that the     Pharmacy system                                      Pass          Fail   IP 08.30   The system shall provide the ability to electronically     Proctor to update
         Pharmacy system          electronically receives                                                              communicate the order to the receiving departmental        Audit Trail
                                                                                                                       system.
         receives new             medication orders and                                                                                                                           Worksheet
         medication orders for    appropriate details display                                               IO-IP 03.05         The system shall provide the ability to send      (Appendix E)
                                                                                                                       Medication Orders and Updates to Pharmacy IT system
         John McSorley; verify    (medication name, dose,                                                              utilizing a coding system for medications
         all orders. Dispense     route, frequency, comments,                                                                                                                     Please override
         Wellbutrin.              ordering provider, date/time                                                                                                                    any Pharmacy
                                  etc.).                                                                                                                                          specific alerts.

                                  Note that the details are
                                  verified in detail in an earlier
                                  step and we do not require
                                  detailed review here.

                                  All new medications for John
                                  McSorley now display as
                                  verified.

                                  Pharmacy dispenses
                                  Wellbutrin.
 3.32    Logout as Pharmacist.    Logout successful.
 3.33    Login as Nurse.          Login successful.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                   Page 60 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                      Expected Result            Actual Result       Pass/Fail                          Criteria and Reference                                    Comments
 3.34    Print all orders for      Orders for John McSorley are                        Pass       Fail   IP 08.22   The system shall provide the ability to print orders for     Applicant may
         John McSorley.            printed (verified with a print                                                   all order types.                                             demonstrate with
                                   preview).                                                                                                                                     a “print preview”
         (Show a print preview                                                                                                                                                   function.
         of the medication list
         for verification                                                                                                                                                        If the Applicant
         purposes).                                                                                                                                                              cannot
                                                                                                                                                                                 demonstrate via a
                                                                                                                                                                                 “print preview,”
                                                                                                                                                                                 then a copy should
                                                                                                                                                                                 be faxed to CCHIT
                                                                                                                                                                                 at 312-277-3112.
 3.35    Access and review         Medication information can                          Pass       Fail   FN 17.01   The system shall provide the ability to access and
         medication information    be accessed and reviewed.                                                        review medication information (such as patient
                                                                                                                    education material or drug monograph) which may
         for Wellbutrin                                                                                             reside within the system or be provided through links
         (Bupropion).                                                                                               to external sources.
         The information may                                                                             IP 14.28   The system shall provide the ability for the hospital to
         reside within the                                                                                          provide links to reference information / knowledge
         system or be provided                                                                                      resources for any medication on the eMAR.
         through links to
         external sources.
 3.36    Access and review         eMAR displays Wellbutrin                            Pass       Fail   IP 14.10   The system shall have the ability to view on the eMAR
         dose and quantity of      dispensed as either (2) 75 mg                                                    medications as dispensed (including dose and quantity
                                                                                                                    of dispensed units of medication).
         dispensed units from      tablets or (1) 150 mg tablet.
         the pharmacy for
         Wellbutrin in the
         eMAR.
 3.37    Add comment to            Comment is added to                                 Pass       Fail   IP 14.12   The system shall provide the ability to attach a
         Vancomycin dose           individual scheduled dose.                                                       comment to an individual scheduled dose and include
                                                                                                                    as part of the legal medical record.
         (second dose from
         now): “Draw
         peak/trough blood
         levels with this dose.”



2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                  Page 61 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                      June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                      Expected Result            Actual Result       Pass/Fail                         Criteria and Reference                                   Comments
 3.38    Document John             View the documentation on                           Pass       Fail   IP 14.11   The system shall provide the ability to indicate any
         McSorley’s blood          the eMAR:                                                                        clinical interventions or assessments associated with
                                                                                                                    medication administration.
         glucose finger stick of
         234 on the eMAR.          •   Blood glucose finger stick                                        IP 14.15   The system shall provide the ability to document
                                                                                                                    clinical assessment pertinent to medication
                                       of 234                                                                       administration

 3.39    Based on the blood        View documentation on the                           Pass       Fail   IP 14.13   The system shall provide the ability to capture
         glucose value of 234,     eMAR:                                                                            medication administration details as discrete data,
                                                                                                                    including:
         administer and            • 4 units of Regular Insulin,                                                    (1) the medication name, strength and dose;
         document the                  including:                                                                   (2) date and time of administration;
         administration of 4          o Medication name,                                                            (3) route and site;
         units of Regular                 strength and dose;                                                        (4) user name and credentials.
         Insulin.                     o Date and time of
                                          administration;
                                      o Route and site;
                                      o User name and
                                          credentials.
 3.40    Administer Demerol;       Effectiveness of the “as                            Pass       Fail   IP 14.08   The system shall provide the ability to record the          The effectiveness
         enter comment that        needed” dose is recorded.                                                        effectiveness of PRN or "as needed" doses after they        of the “as needed”
                                                                                                                    have been administered on the eMAR.
         pain scale level                                                                                                                                                       dose should be
         dropped from 8 to 4                                                                                                                                                    viewable from the
         following                                                                                                                                                              eMAR.
         administration.
 3.41    Logout as Nurse.          Logout successful.
 3.42    Login as Dr. Bradley.     Login successful.
 3.43    Renew the Demerol         The Demerol order is                                Pass       Fail   IP 10.08   The system shall provide the ability to renew an
         order for John            renewed without entering                                                         existing medication order without requiring re-entry of
                                                                                                                    order information.
         McSorley without re-      order information (uses
         entry of the order        information from the previous
         information.              Demerol order).




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 62 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                       June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                       Expected Result           Actual Result       Pass/Fail                          Criteria and Reference                                   Comments
 3.44    Discontinue the Insulin   Insulin is excluded from the                        Pass       Fail   FN 06.03   The system shall provide the ability to exclude a
         order; reason is          current medication list, with                                                    medication from the current medication list (e.g.,
                                                                                                                    marked inactive, erroneous, completed, discontinued)
         documented “switch to     reason noted as “switching to                                                    and document reason for such action.
         NPH insulin.”             NPH insulin.”

         Review the current
         medication list.
 3.45    Patient complains of      When Nexium is ordered, a                           Pass       Fail   IP 12.31   The system shall provide the ability to display
         upset stomach. Order      message is displayed                                                             recommended medication for substitution (based on
                                                                                                                    cost or clinical policy).
         Nexium.                   indicating that Prevacid or
                                   Protonix are medically
                                   equivalent and less
                                   expensive.
 3.46    Select patient record     System displays that patient                        Pass       Fail   FN 06.05   The system shall provide the ability to display that the
         for Suzanne Smith,        takes no medications.                                                            patient takes no medications.
         and review
         medications.
 3.47    Review preventive         Demographic criteria are                            Pass       Fail   IP 13.05   The system shall allow demographic criteria to be used
         service alerts. Note      used as an element in clinical                                                   as a data element in clinical decision support rules.
         that due to her age,      decision support rules.
         Suzanne Smith is due      Influenza vaccine shows as
         for an influenza          due for this patient.
         vaccine.
 3.48    Logout as Dr. Bradley.    Logout successful.
 3.49    Login as Nurse.           Login successful.
 3.50    Receive notification of   System has the ability to                           Pass       Fail   IP 17.03   The system shall provide the ability to notify the           Any method of
         overdue medication        notify the user that the                                                         clinician of overdue medication administration.              notification is
         administration task:      medication administration                                                                                                                     acceptable.
         document pain             task “document pain
         response for              response” is overdue.
         administration of
         morphine (step 3.05).
 3.51    Logout as Nurse.          Logout successful.


2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                 Page 63 of 75
                                                                  2008 Certification of Inpatient EHRs                                                                        June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                     Expected Result           Actual Result       Pass/Fail                           Criteria and Reference                                   Comments
 3.52    Login as                 Login successful.
         Administrator.
 3.53    Review use of all        Order sets used today are                          Pass         Fail   IP 09.32   The system shall provide the ability to report on the       Order sets used
         order sets used today.   displayed, including ordering                                                     use of order sets, including data such as ordering          today include
                                                                                                                    provider, date/time ordered and basic patient data (for
                                  provider, date/time ordered                                                       example age, diagnoses, etc).                               Infant Fever Order
                                  and patient data.                                                                                                                             Set, Infant
                                                                                                                                                                                Pneumonia Order
                                                                                                                                                                                Set and
                                                                                                                                                                                Orthopedic Post-
                                                                                                                                                                                Op Order Set.
 3.54    Generate a report for    Report is generated, and                           Pass         Fail   IP 12.34   The system shall provide the ability for report
         review of override       includes override data.                                                           generation capabilities to review override data.
         data.                    • Scenario 1; override drug
                                      allergy alert
                                  • Scenario 3; may include
                                      overrides relating to
                                      Warfarin order.
 3.55    Logout as                Logout successful.
         Administrator.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                                Page 64 of 75
                                                                  2008 Certification of Inpatient EHRs                                                       June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                     Note: Items that are Provisional for 2008 are highlighted in yellow.


Test Script Scenario 4 – Interoperability Testing – Clinical Documentation
         Procedure                   Expected Result             Actual Result         Pass/Fail                        Criteria and Reference                  Comments
       The following actions are conducted by the CCHIT Test Proctor:
          1. CCHIT Test Proctor logs into LAIKA
                  • Proctor uses LAIKA to generate a HITSP C32 document for import by the Applicant’s EHR. This will be selected from a set of pre-built test cases; test case
                      matches on the existing patient charts that are created by the Applicant for use in this Test Script
                  • Instructions are generated for Applicant to retrieve the C32 document by either file transfer via email, FTP or HTTP.
                  • Instructions are generated for Applicant to create C32 document and transport using either file transfer by email, FTP or HTTP.
          2. CCHIT Test Proctor generates inspection checklist for Juror
                  • Checklist will describe C32 document content to look for in Applicant’s EHR, based on the content of the C32 document generated.
4.01   Login as required.       Login successful.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                  Page 65 of 75
                                                                    2008 Certification of Inpatient EHRs                                                              June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


          Procedure                   Expected Result            Actual Result      Pass/Fail                      Criteria and Reference                                Comments
4.02   Receive HITSP C32          HITSP C32 file generated                         Pass     Fail   IO-IP 01.03   The system shall provide the ability to display   The data is
       file by agreed upon        by LAIKA is received.                                                          CCD documents, using a subset of the HITSP        structured,
                                                                                                                 C32 specification for Registration Summary
       method.                                                                                                   information and file them as intact documents in  exchanged using a
       Match HITSP C32 file       Juror will observe that the                                                    the EHR                                           standard format, filed
       to existing chart; store   document is filed with the                                       IO-IP 01.07   The system shall provide the ability to display
                                                                                                                                                                   (not thrown away),
       HITSP C32 file as a        appropriate chart by                                                           CCD documents, using a subset of the HITSP        and displayed, but
       text document in the       matching the patient                                                           C32 specification for Medication and              discrete data import
       chart.                     registration information                                                       Immunization History information and file them as is not required.
                                  contained in the document                                                      intact documents in the EHR
       Display content of         to the appropriate test                                          IO-IP 02.03   The system shall provide the ability to display    It is acceptable to
       HITSP C32 document.        patient chart in the system.                                                   CCD documents, using a subset of the HITSP         display calculated
                                                                                                                 C32 specification for Allergy and Conditions
                                                                                                                                                                    age of patient rather
                                                                                                                 content information and file them as intact
                                  Juror will use the                                                             documents in the EHR                               than date of birth.
                                  inspection checklist to
                                  verify that the system                                                                                                            For further guidance,
                                  displays the correct                                                                                                              see the 2008 CCHIT
                                  narrative (human readable)                                                                                                        Interoperability
                                  information contained in                                                                                                          Testing Instructions
                                  the HITSP C32 document.                                                                                                           and Applicant
                                                                                                                                                                    Form.
                                  The required display
                                  elements are:
                                  • Patient Name, Birth
                                     date, and Gender from
                                     the HITSP C32
                                     document header; and
                                  • Section labels (title)
                                     and associated
                                     narrative text for the
                                     Medication and
                                     Immunization History
                                     and Conditions and
                                     Allergy HITSP C32
                                     modules.


2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                            Page 66 of 75
                                                               2008 Certification of Inpatient EHRs                                                                 June 17, 2008
                                 Certification Commission
                                 for Healthcare
                                 Information Technology                                 Note: Items that are Provisional for 2008 are highlighted in yellow.


         Procedure                  Expected Result         Actual Result      Pass/Fail                      Criteria and Reference                                    Comments
4.03   Generate a HITSP C32    HITSP C32 document is                          Pass     Fail   IO-IP 01.05   The system shall provide the ability to generate      For the HITSP C32
       document using          generated by EHR and                                                         and format CCD documents with narrative               document generated,
                                                                                                            sections and structured entries (discrete fields)
       instructions provided   sent back to LAIKA.                                                          as specified by the HITSP ISO3/C32                    the proctor will ask
       by the proctor, and                                                                                  specification of the Registration Information         the vendor to update
       transport to LAIKA                                                                                   module subset. For 2008, the values within the        specific demographic
       using the agreed upon                                                                                structured entries do not have to use industry        information,
                                                                                                            standard vocabularies/terminologies (such as
       method.                                                                                              RxNORM or SNOMED-CT).
                                                                                                                                                                  problems,
                                                                                                                                                                  medications, and/or
       •   Generate a HITSP                                                                   IO-IP 01.09   The system shall provide the ability to generate      allergies.
                                                                                                            and format CCD documents with narrative
           C32 document for                                                                                 sections and structure entries (discrete fields) as
           patient to be                                                                                    specified by the HITSP ISO3/C32 specification of
           named by Proctor.                                                                                the Medication and Immunization History module
                                                                                                            subset. For 2008, the values within the structured
                                                                                                            entries do not have to use industry standard
                                                                                                            vocabularies/terminologies (such as RxNORM or
                                                                                                            SNOMED-CT).
                                                                                              IO-IP 02.05   The system shall provide the ability to generate
                                                                                                            and format CCD documents with narrative
                                                                                                            sections and structure entries (discrete fields) as
                                                                                                            specified by the HITSP ISO3/C32 specification of
                                                                                                            the Allergy and Conditions module subset. For
                                                                                                            2008, the values within the structure entries do
                                                                                                            not have to use industry standard
                                                                                                            vocabularies/terminologies (such as RxNORM or
                                                                                                            SNOMED-CT.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                          Page 67 of 75
                                                               2008 Certification of Inpatient EHRs                                                                June 17, 2008
                                 Certification Commission
                                 for Healthcare
                                 Information Technology                                 Note: Items that are Provisional for 2008 are highlighted in yellow.


        Procedure                   Expected Result         Actual Result      Pass/Fail                      Criteria and Reference                                 Comments
4.04   LAIKA validates HITSP   The file must conform to                       Pass     Fail   IO-IP 01.05   The system shall provide the ability to generate
       C32 document.           the following XML                                                            and format CCD documents with narrative
                                                                                                            sections and structured entries (discrete fields)
                               schematron rulesets:                                                         as specified by the HITSP ISO3/C32
                               • CDA R2                                                                     specification of the Registration Information
                               • CCD                                                                        module subset. For 2008, the values within the
                               • HITSP C32                                                                  structured entries do not have to use industry
                                                                                                            standard vocabularies/terminologies (such as
                                                                                                            RxNORM or SNOMED-CT).
                                                                                              IO-IP 01.09   The system shall provide the ability to generate
                                                                                                            and format CCD documents with narrative
                                                                                                            sections and structure entries (discrete fields) as
                                                                                                            specified by the HITSP ISO3/C32 specification of
                                                                                                            the Medication and Immunization History module
                                                                                                            subset. For 2008, the values within the structured
                                                                                                            entries do not have to use industry standard
                                                                                                            vocabularies/terminologies (such as RxNORM or
                                                                                                            SNOMED-CT).
                                                                                              IO-IP 02.05   The system shall provide the ability to generate
                                                                                                            and format CCD documents with narrative
                                                                                                            sections and structure entries (discrete fields) as
                                                                                                            specified by the HITSP ISO3/C32 specification of
                                                                                                            the Allergy and Conditions module subset. For
                                                                                                            2008, the values within the structure entries do
                                                                                                            not have to use industry standard
                                                                                                            vocabularies/terminologies (such as RxNORM or
                                                                                                            SNOMED-CT.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                         Page 68 of 75
                                                                    2008 Certification of Inpatient EHRs                                                                June 17, 2008
                                   Certification Commission
                                   for Healthcare
                                   Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


         Procedure                     Expected Result           Actual Result      Pass/Fail                      Criteria and Reference                                 Comments
4.05   Proctor will use LAIKA     Results for C32 file display                     Pass     Fail   IO-IP 01.05   The system shall provide the ability to generate
       to view the generated      are provided to Juror.                                                         and format CCD documents with narrative
                                                                                                                 sections and structured entries (discrete fields)
       C32 document through                                                                                      as specified by the HITSP ISO3/C32
       the HL7 standard CCD       The required display                                                           specification of the Registration Information
       stylesheet.                elements are:                                                                  module subset. For 2008, the values within the
       Proctor saves this         • Patient Name, Birth                                                          structured entries do not have to use industry
                                                                                                                 standard vocabularies/terminologies (such as
       HTML view and shares          date, and Gender from                                                       RxNORM or SNOMED-CT).
       with the Juror to verify      the HITSP C32
       the correctness of            document header; and                                          IO-IP 01.09   The system shall provide the ability to generate
                                                                                                                 and format CCD documents with narrative
       information.               • Section labels (title)                                                       sections and structure entries (discrete fields) as
                                     and associated                                                              specified by the HITSP ISO3/C32 specification of
                                     narrative text for the                                                      the Medication and Immunization History module
                                     Medication and                                                              subset. For 2008, the values within the structured
                                                                                                                 entries do not have to use industry standard
                                     Immunization History                                                        vocabularies/terminologies (such as RxNORM or
                                     and Allergy and                                                             SNOMED-CT).
                                     Conditions HITSP C32
                                                                                                   IO-IP 02.05   The system shall provide the ability to generate
                                     modules.                                                                    and format CCD documents with narrative
                                                                                                                 sections and structure entries (discrete fields) as
                                                                                                                 specified by the HITSP ISO3/C32 specification of
                                                                                                                 the Allergy and Conditions module subset. For
                                                                                                                 2008, the values within the structure entries do
                                                                                                                 not have to use industry standard
                                                                                                                 vocabularies/terminologies (such as RxNORM or
                                                                                                                 SNOMED-CT.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                              Page 69 of 75
                                                                    2008 Certification of Inpatient EHRs                                                               June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                   Note: Items that are Provisional for 2008 are highlighted in yellow.


         Procedure                      Expected Result          Actual Result      Pass/Fail                      Criteria and Reference                                 Comments
4.06   Provisional                 The C32 file will be                            Pass     Fail   IO-IP 01.06   The system shall provide the ability to generate    For the document
                                   successfully validated by                                                     and format CCD documents with narrative             generated, the
                                                                                                                 sections and structured entries (discrete fields)
       Create a valid HITSP        the LAIKA tool for C32                                                        as specified by the HITSP IS03/C32 specification    CCHIT Proctor will
       C32 document                compliance and                                                                of the Registration Information module subset.      select a pre-existing
       containing subsets for      correctness of information.                                                   Structured entries value sets must adopt            patient from the
       the Registration                                                                                          industry-standard vocabularies/terminologies        system.
                                                                                                                 (such as RxNORM or SNOMED-CT).
       Information module,
       Medications and                                                                             IO-IP 01.10   The system shall provide the ability to generate
       Immunization History                                                                                      and format CCD documents with narrative
                                                                                                                 sections and structured entries (discrete fields)
       module, and Allergy                                                                                       as specified by the HITSP IS03/C32 specification
       and Conditions module                                                                                     of the Medication and Immunization History
       with C32 declared                                                                                         module subset. Structured entries value sets
       templates and full                                                                                        must adopt industry-standard
                                                                                                                 vocabularies/terminologies (such as RxNORM or
       content with narrative                                                                                    SNOMED-CT).
       sections and structured
       entries (discrete fields)                                                                   IO-IP 02.06   The system shall provide the ability to generate
                                                                                                                 and format CCD documents with narrative
       per the HITSP                                                                                             sections and structured entries (discrete fields)
       IS03/C32 specification.                                                                                   as specified by the HITSP IS03/C32 specification
       Structured entries                                                                                        of the Allergy and Conditions module subset.
       value sets must adopt                                                                                     Structured entries value sets must adopt
                                                                                                                 industry-standard vocabularies/terminologies
       industry-standard
                                                                                                                 (such as RxNORM or SNOMED-CT).
       vocabularies/terminolo
       gies (such as RxNORM
       or SNOMED-CT).
4.07   Logout as required          Logout successful.




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                             Page 70 of 75
                                                                     2008 Certification of Inpatient EHRs                                                  June 17, 2008
                                    Certification Commission
                                    for Healthcare
                                    Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.



Appendix A – Additional Information and Order Sets for Scenario 1 and Scenario 2 – Pediatric Inpatient
Involves an inpatient admission for Elizabeth Benson, a 6-month old who is 26 inches. She was admitted to the inpatient pediatric unit with a diagnosis of
pneumonia and possible sepsis.

The following medication history and allergies is to be a scanned document, to be attached to Elizabeth Benson’s record per step 1.024. It may be scanned in
advance of the test.
 Medication History and Allergies
 Medication
 • Poly-Vi-Sol Vitamin Drops with Iron 1.0 mL once daily.

 Allergies
 •   Amoxicillin
 •   Peanut Oil



 Hospital Stay Laboratory & Radiology Test Results          Results

 White Blood Count                                          19,600

 Differential                                               12,200 PMN

 Bands                                                      2,120

 Lymphocytes                                                4,880

 Eosinophils                                                400

 Potassium                                                  3.8 mEq/L

 Radiology CXR Result                                       Right lower lobe infiltrate




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                Page 71 of 75
                                                                  2008 Certification of Inpatient EHRs                                                     June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                    Note: Items that are Provisional for 2008 are highlighted in yellow.


Inpatient Infant Fever Order Set for Scenario 1
Use this order set for Scenario 1 for system set-up. The order set below contains suggested orders and does not represent clinical validity and should only be
used for testing. Bolded items represent orders that will be selected during the ordering process in Scenario 1. A check box represents an order that has been
pre-selected or a default in the order set for the clinician’s review. A required field should be set up for the Radiology order to request a mandatory field of reason
for a CXR prior to the order being processed.
NURSING                                                                                               LABORATORY
   Vital signs per unit routine                                                                          CBC
   Weigh patient daily                                                                                   Blood Culture, Aerobic, once routine
   Intake and Output every shift                                                                         Urinalysis, direct cath, culture, STAT
   Peripheral IV access routine                                                                          Urinalysis, clean catch, culture, STAT
   Assess hydration / perfusion every 4 hours                                                            CSF studies Order Set
   ECG monitoring                                                                                     RADIOLOGY
   Monitor: Sa02 Oximetry per protocol                                                                   DX Chest 2V, routine
   Oxygen: Adjust to keep Sa02 > (%) 90, Wean to room air, Delivery method per RT/RN
NUTRITION
   Standard Formula (Formula Infant, Floor stock)
   Standard Diet:: Regular Infant 6 – 12 months (baby food)
   Standard Diet:: Clear Liquid
   Standard Diet:: Regular
IV INFUSIONS
   D5 ¼ NS + Potassium Chloride 20 mEq/L 1000 mL to run at 1mL/hr
   D5 ½ NS 1000 mL to run at 10mL/hr
   NS Bolus 20 mL /kg IV ONE TIME, Unscheduled, STAT
MEDICATIONS
   Acetaminophen 15 mg/kg PO one time, STAT
   Acetaminophen 15 mg/kg supp rectally one time, STAT
   Acetaminophen 15 mg/kg PO every 4 hours PRN for Fever
   Acetaminophen 15 mg/kg supp rectally every 4 hours PRN for Fever
   Ibuprofen 10 mg/kg PO every 6 hours
   Clindamycin 10 mg/kg IV every 8 hours
   Erythromycin 10 mg/kg PO every 6 hours


2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                Page 72 of 75
                                                                2008 Certification of Inpatient EHRs                                                  June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                 Note: Items that are Provisional for 2008 are highlighted in yellow.


Inpatient Infant Pneumonia Order Set for Scenario 2
Use this order set for Scenario 2 for system set-up. The order set below contains suggested orders and does not represent clinical validity and should only be
used for testing. Bolded items represent orders that will be selected during the ordering process in Scenario 2.

NURSING                                                                                           LABORATORY
   Vital signs per unit routine                                                                        CBC
   Weigh patient daily                                                                                 Blood Culture, Aerobic, once routine
   Intake and Output every shift                                                                       Electrolytes, routine, daily
   Peripheral IV access routine                                                                        Sputum Culture, once routine
   Assess hydration / perfusion every 4 hours
   Monitor: Sa02 Oximetry per protocol                                                            RADIOLOGY
   Oxygen: Adjust to keep Sa02 > (%) 90, Wean to room air, Delivery method per RT/RN                   DX Chest 2V, routine
NUTRITION                                                                                              DX Chest 3V, routine
   Standard Formula (Formula Infant, Floor stock)
   Standard Diet:: Regular Infant 6 – 12 months (baby food)
   Standard Diet:: Clear Liquid
   Standard Diet:: Regular
CONTINUOUS INFUSIONS
   D5 ¼ NS + Potassium Chloride 20 mEq/L 1000 mL
   D5 ½ NS 1000 mL to run at 10 mL/hr
   NS Bolus 20 mL /kg IV ONE TIME, Unscheduled, STAT
MEDICATIONS
   Cefuroxime 40 mg/kg IV every 8 hours
   Erythromycin 7.5 mg/kg IV every 6 hours
   Erythromycin 10 mg/kg PO every 6 hours
   Azithromycin 500 mg tab PO ONE TIME
   Acetaminophen 15 mg/kg PO every 4 hours PRN for Fever
   Acetaminophen 15 mg/kg supp rectally every 4 hours PRN for Fever
   Amoxycillin 10 mg/kg PO every 12 hours




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                           Page 73 of 75
                                                                       2008 Certification of Inpatient EHRs                                                         June 17, 2008
                                        Certification Commission
                                        for Healthcare
                                        Information Technology                                         Note: Items that are Provisional for 2008 are highlighted in yellow.



Appendix B: Additional Information for Scenario 3 – Adult Inpatient
There should be a daily CBC order entered for John McSorley that is set to expire on the day of certification testing.
Scenario 3 involves a 54 year old male, John McSorley, who was admitted through the Emergency Department post an automobile accident in which he sustained
an unstable distal radius fracture which he is being admitted for an open reduction internal fixation (ORIF) surgical procedure. John McSorley has a normal past
medical history without any chronic diseases and has had abdominal surgery at this hospital last year. John’s home medications include Wellbutrin (Bupropion)
and vitamins.

Laboratory Test Results: Prothrombin Time (PT), International Normalized Ratio (INR)

Description           Usual abbreviation                                                     Results (Normal range)               Units

Prothrombin Time                                 PT/INR                                                (0.81 - 1.20)              INR
Day 1 results                                    PT/INR                                                    2.00                   INR
Day 2 results                                    PT/INR                                                    2.50                   INR

Laboratory Test Results: Hemoglobin A1c (Hgb A1c) and blood glucose

Description                                               Result                                            Units

Day of admission Hgb A1c result                            6.7                                                %
Day of admission blood glucose                             120                                              mg/dL
Insulin (Human Regular) Sliding Scale
From                  To                                      Dose              Condition

150                               199                        2 units            Call if less than 70
200                               249                        4 units
250                               299                        6 units
300                               349                        8 units
350                               399                       10 units            Call if greater than 400



2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                                         Page 74 of 75
                                                               2008 Certification of Inpatient EHRs                                                  June 17, 2008
                                  Certification Commission
                                  for Healthcare
                                  Information Technology                                Note: Items that are Provisional for 2008 are highlighted in yellow.



Appendix C: Test Script Scenario 3 – Orthopedic Post-Op Order Set
Use this order set for Scenario 3 for system set-up. The order set below contains suggested orders and does not represent clinical validity and should only be
used for testing. Bolded items represent orders that will be selected during the ordering process in Scenario 3. A check box represents an order that has been
pre-selected or a default for the clinician’s review.

NURSING                                                                                LABORATORY
   Vital signs every 4 hours x 48 then every shift                                         CBC with differential times two days, routine
   Neurovascular check every hour times eight hours and then every 4 hours                 PT / INR, routine, daily
   Incentive spirometer and cough and deep breath every 2 hours while awake                Electrolytes, routine, daily
   Wound / skin care: Empty hemovac every shift and record
   Activity: As tolerated
NUTRITION                                                                              CONSULTS
   NPO                                                                                     OT Consult for ADLs
   Standard Diet:: Clear Liquid                                                            Case Coordinator / Social Services consult re: discharge planning
   Standard Diet:: Regular Diet as Tolerated
MEDICATIONS
   Vancomycin (Vancocin, Vancoled) 1.5 gm IV every 12 hours
   Cefazolin (Ancef) 1 gm IV every 8 hours
   Clindamycin (Cleocin) 600 mg PO every 8 hours
   Ciprofloxacon (Cipro) 400 mg PO every 12 hours
   Meperidine (Demerol) 75 mg IM every 4 hours PRN for pain
   Warfarin (Coumadin) 5 mg PO daily
   Morphine 1mg/ml, PCA, demand: 1.0 mg, lockout: 15 minutes, 4-hour limit: 10 mg




2008 Test Script - INP - v5.0 - FINAL.doc                                                                                                          Page 75 of 75

								
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