Test Method Updates

Annual Value Set Update

The C-CDA Validator module of the Edge Testing Tool (ETT) validates clinical document conformance to vocabularies explicitly specified by the 2014 and 2015 Edition certification criteria. The versions of clinical vocabularies are dynamic and are updated regularly. As such, ONC will be updating the vocabularies that will be tested in the ETT on October 30, 2017 as follows:

No change to the vocabularies for the 2014 Edition.

2015 Edition C-CDA validator:

All new versions of vocabulary validations incorporated into the 2015 Edition Validator will be additive--previous versions of the vocabularies specified by rule will always be maintained.
As codes expire or get retired in a newer version of the vocabularies, WARNINGS will be flagged rather than errors because the minimum interoperable level will be tied to the version specified in the 2015 Edition final rule.

For Awareness: Change in the § 170.315(b)(1) Test Data

Reference the 2015 Edition rule transitions of care certification criterion § 170.315 (b)(1) aspect of (ii) Validate and display: "(2) Detect errors in corresponding “document-templates,” “section-templates,” and “entry-templates,” including invalid vocabulary standards and codes not specified in the standards adopted in § 170.205(a)(3) and § 170.205(a)(4)."

The ONC provided test data for this negative testing aspect (for visual inspection) has to-date, contained purposely invalid templates at the Section level and purposely invalid templates at the Entry level. The intent of these invalid templates is to allow the System Under Test (SUT) to ignore the invalid templates and correctly determine that the remaining data is appropriate for reconciliation and display.

Summary of the Test Data Change:

The 2015 Edition C-CDA Validator has always, and will continue to allow for the inclusion of unknown template ID’s (good or bad) in C-CDA documents as per the specification.

The ONC provided test data has been modified to remove the invalid template ID's testing documents for § 170.315(b)(1). This is to make it clear and simple that the receiver must detect documents not conformant to the C-CDA Implementation Guide and flag the appropriate errors.

This change in the test data set will not change the approach or outcome of testing, as the same errors must be identified today via required template ID's already missing from the current test data.

Change to Edge Testing Tool Direct Home Page

Since inception of the ETT, the Direct Home page has provided Direct addresses for C-CDA validation to the 2015 Edition. This approach was a hold-over from the 2014 Edition. Due to the lack of use, this capability will be removed effective October 19, 2017. The 2014 Edition Direct endpoints will be retained and moved to the "Message Validator" page.

If you have any questions about the updates to ETT or the C-CDA Validator, please send an email to: SITTeam@hhs.gov or ONC.Certification@hhs.gov.

Cypress 3.2.2 patch released

The Cypress 3.2.2 patch was released on 10/12/17. The changelog for the release is below:

Cypress Features

Bundle Management functionally enhanced to include bundle deprecation to better accommodate the release of bundle updates (including valueset addendums).
Optional "Record Shifting" allows for Cypress test records to be shifted into measurement periods that align with CMS performance periods.
Assurance that all § 170.315(c)(4) CQM - filter tests include at least 1 filtered patient in the Initial Patient Population.

Cypress Bugs Addressed

File import fails when uploaded patient gender is specified using nullFlavor="UNK. (CYPRESS-1165)
"Smoking Gun Errors" may be returned when QRDA files use names altered for patient de-duplication. (CYPRESS-1170)
File import fails when uploaded patient is born on 1970/1/1. (CYPRESS-1180)
Missing information in test records when ‘split’ by date. (CYPRESS-1185)
§ 170.315(c)(1) CQM – record and export Sample tests cannot verify a negated valueset for Device, Order. (CYPRESS-1195)

The Cypress 3.2.2 patch should be applied to an existing Cypress v3 installation. Instructions for installing or updating Cypress can be found here.

Now available: 2018 Electronic Clinical Quality Measure (eCQM) Logic Flows for Eligible Clinicians and Eligible Professionals

The Centers for Medicare & Medicaid Services (CMS) have published the 2018 performance period electronic Clinical Quality Measure (eCQM) Logic Flows for Eligible Clinicians and Eligible Professionals to the eCQI Resource Center. The eCQM Measure Logic Flows are designed to assist in interpretation of the eCQM logic and calculation methodology for performance rates.

Questions on the measure flows should be directed to the ONC CQM Issue Tracker. For more information about the Merit-based Incentive Payment System, please visit us online at https://qpp.cms.gov/.

CMS announces preview of draft eCQM specifications using Clinical Quality Language (CQL)

CMS invites eCQM implementers to preview draft measure specifications using the clinical quality language (CQL) standard for logic expression. CQL is a Health Level 7 International standard for trial use and aims to unify the expression of logic for eCQMs and Clinical Decision Support. CQL provides the ability to better express logic defining measure populations to improve the accuracy and clarity of eCQMs. The official timeline for the incorporation of CQL is dependent upon outcomes of further CQL testing. More information about CQL is available on the eCQI Resource Center website.

When and where will the draft eCQM specifications be available for review?

The draft specifications are available now through November 13, 2017, on the CQM Issue Tracker via the following tickets:

Eligible hospital and critical access hospital measures (CQM-2858)
Eligible professional and eligible clinician measures (CQM-2860)

What do I need to do?

Measure implementers may review these draft eCQM specifications to become familiar with the CQL standard for logic expression. Implementers may submit questions or comments regarding the draft specifications via the tickets above. Please note these draft specifications are for informational review only. These draft specifications are not intended for submission of 2017 or 2018 performance/reporting for CMS programs.

Updated eCQM information for 2017 or 2018 performance/reporting is available on the eCQI Resource Center website.

Where do I go for assistance?

To learn more about CQL, visit the eCQI Resource Center CQL Educational Resources page. CMS will announce additional education and outreach opportunities regarding CQL later this year.

Measure implementers can report questions regarding the draft specifications and CQL to the CQM Issue Tracker available at https://oncprojectracking.healthit.gov/support/projects/CQM/.