26 File validation performed to determine compliance with the required specifications. This step performed outside of the demonstration. Files are generated with the appropriate syndromic surveillance information and are conformant to the HL7 v2.5.1 standard and, when applicable, the PHIN Messaging Guide for Syndromic Surveillance. This step scored on the Conformance Worksheet. TE2.03-2.04 [AMB] IN2.01 [AMB] TE3.03-3.04 [INP] IN3.01 [INP] 170.314(f)(6) Transmission to Cancer Registries [Ambulatory Only--Optional] Setup Create patient records for and input all data for each of the provided test data sets ONC Test Data and Procedure and available in test tool Guidance and Test Tool or Step # Action to Perform Expected Outcome Reference Notes / Deviations 1 [AMB] Open the patient record for the data set selected by the Proctor for Category 1 and display the cancer test data previously entered. Test Data located at: Open Test Tool Click the link to the appropriate test case and category To view another category, click the Back button on the browser, or click Meaningful Use (Cancer Registry) from the top of the page Cancer case test data marked as SHALL are entered correctly and without omission. Proctor documents the Case number used. TE1.01-1.02 2 [AMB] Generate a cancer case message for the patient based on the following standards: HL7 CDA, Release 2.0, Normative Edition Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, HL7 CDA IHTSDO SNOMED-CT International Release July 2012 and US Extension to SNOMED-CT March 2012 Release LOINC v2.40 Cancer case message is generated correctly and without omission. TE1.03
170.314(f)(4) Transmission of Reportable Lab Tests and Values/Results [Inpatient Only] Setup Create patient records for and input all data for each of the provided test data sets ONC Test Data and Procedure Test Data available through the Context-Based Validation section of the Test Tool Guidance and Test Tool or Step # Action to Perform Expected Outcome Reference Notes / Deviations 1 [INP] Open the patient record for the data set selected by the Proctor for the Maximally Populated Final Quantitative Results test case and display the lab tests and values/results data previously entered. Test Data located at: Open Test Tool Select Context-Based Validation tab Expand the Test Case fields to view the available test data Lab tests and values/results data is entered. Proctor documents the test data set (e.g. 1.1, 1.2, or 1.3). TE1.01-1.02 2 [INP] Proctor identifies one or more test data elements to change (e.g. patient name or other Changeable Data). Test data is modified per the Proctor’s instructions. Proctor documents the data that was changed. IN1.02 3 [INP] Generate an HL7 v.2.5.1: ORU^R01 message based on the Receiver Profile, SNOMED-CT, and LOINC. The message is generated correctly and without omission. TE1.03 4 [INP] Open the patient record for the data set selected by the Proctor for the Final Quantitative Result test case and display the lab tests and values/results data previously entered. Lab tests and values/results data is entered. Proctor documents the test data set. TE1.01-1.02 5 [INP] Proctor identifies one or more test data elements to change (e.g. specimen received date/time or other Changeable Data). Test data is modified per the Proctor’s instructions. Proctor documents the data that was changed. IN1.02 6 [INP] Generate a message based on the standards specified in Step 2. The message is generated correctly and without omission. TE1.03
2 [AMB] Electronically generate a clinical summary according to the CCDA standard and named vocabulary standards for the and the following data elements: Provider’s name and office contact info Date and location of visit Reason for visit Immunizations and/or medications administered during the visit Diagnostic tests pending Clinical instructions Future appointments Referrals to other providers Future scheduled tests Recommended patient decision aids CCDA clinical summary is generated. TE1.02 3 [AMB] Electronically generate a clinical summary in format, including the requirements specified at Step 2. Proctor verifies that a human-readable clinical summary is generated, is complete and accurate and contains all required data elements. TE1.02 TE1.04 IN1.03 4 [AMB] In the same patient’s record, begin the process to generate another clinical summary. Proctor identifies the data to be excluded from the clinical summary using one of the data elements from Step 2. Data is selected for inclusion and exclusion in the clinical summary. Proctor documents the data that was excluded. TE2.01 5 [AMB] Electronically generate a clinical summary in CCDA format, including the requirements specified at Step 2. CCDA clinical summary is generated. TE2.02 6 [AMB] Electronically generate a clinical summary in format, including the requirements specified at Step 2. Proctor verifies that a human-readable clinical summary is generated, is complete and accurate and does not contain the data identified for exclusion at Step 4. TE2.02-2.03 IN2.02 readable readable
7 [AMB] Access both CCDAs and the e2 .txt file and zip them together per the instructions at . Upload the zip file to ICSA Labs using the URL provided by the Proctor. Uploaded zip files must include the organization name and criterion number in the filename (e.g. e2_ABCompany). Resubmissions during the same test session MUST modify the .zip filename to include the word ‘Retest’, as in e2_ABCompany_Retest1, e2_ABCompany_Retest2, etc. Zip file containing the CCDAs is uploaded using the correct filename. 8 [AMB] File validation performed to determine compliance with the required specifications. This step performed outside of the demonstration. Files contain the required data elements and are in conformance with the required specifications and the named vocabulary standards. Clinical summaries generated at Steps 2 and 5 are accurate and complete and summary generated at Step 5 excludes the data identified at Step 4. This step scored on the Conformance Worksheet. TE1.03 TE1.05 IN1.01-1.02 TE2.04-2.05 IN2.01 IN2.03
170.314(b)(6) Transmission of Electronic Lab Tests and Values/Results to Ambulatory Providers [Inpatient Only] Setup Create patient records for and input all data for each of the provided test data sets ONC Test Data and Procedure Test Data available through the LIS Context-Based Validation Tool Guidance and Test Tool or Step # Action to Perform Expected Outcome Reference Notes / Deviations 1 [INP] Notify Proctor which LRI profile will be used for testing. Available options include: GU/RU GU/RN NG/RU NG/RN Proctor documents the LRI profile being used. Proctor documents the test tool version. LRI Profile: Test Tool v 2 [INP] Open the patient’s record to be used for transmitting the Final Sed Rate message and show the Proctor that the test data has been entered correctly. Proctor confirms that the test data is entered. Test data found at: Select GU or NG Select LRI_1_Sed_Rate Select LRI_1.0_Sed_Rate Select LRI_1.0-GU_Final (or NG) Test Data Specification tab TE1.01-1.02 3 [INP] Proctor identifies one or more test data elements to change (e.g. relevant clinical information or other Changeable Data). Test data is modified per the Proctor’s instructions. Proctor documents the data that was changed. IN1.02
4 [INP] Generate the indicated LRI HL7 v2.5.1 ORU^R01 Final Sed Rate message and send it directly to the tool using the tool’s “receive” feature or by downloading the file and uploading it to the LIS Context-Based Validation Tool. Auto-Send Instructions: Select GU or NG Select LRI_1_Sed_Rate Select LRI_1.0_Sed_Rate Select LRI_1.0-GU_Final (or NG) Click ‘Select’ Click ‘Receive’ Click ‘Start’ NOTE: You will have 60 seconds to send the message to the test tool after clicking ‘Start’. Download/Direct Send Instructions: Download message from EHR Open LIS Context-Based Validation Tool Select GU or NG Select LRI_1_Sed_Rate Select LRI_1.0_Sed_Rate Select LRI_1.0-GU_Final (or NG) Click ‘Select’ to load the test case Click ‘Browse’ and upload the file LRI HL7 v2.5.1 ORU^R01 message is generated and is received by the LRI Test Tool. TE1.03 5 [INP] Download the generated Message Validation Result as a PDF. Message Validation Result is saved in PDF format with filename FinalSedRate. 6 [INP] Open the patient’s record to be used for transmitting the Corrected Sed Rate message and show the Proctor that the test data has been entered correctly. Proctor confirms that the test data is entered. TE1.01-1.02
170.314(f)(7) Transmission to Public Health Agencies – Syndromic Surveillance [Ambulatory Only – Optional] Setup Create a patient record and enter syndromic surveillance data ONC Test Data and Procedure Guidance and Test Tool Step # Action to Perform Expected Outcome Reference Notes / Deviations 1 [AMB] Open the patient’s record that contains syndromic surveillance data that was entered prior to the test. The presence of syndromic surveillance data is confirmed. Proctor documents the syndromic event. TE1.01 2 [AMB] Generate the syndromic message for this patient, then open the message, and display the syndromic event. Syndromic surveillance message was generated for the appropriate patient. TE1.02-1.03 IN1.01 Steps 3-4 only performed by systems demonstrating the optional ability to electronically create syndromic surveillance data elements 3 [AMB] [optional] Zip the file and then submit it to ICSA Labs. Include organization name and criterion number in .zip filename (e.g. f7_ABCompany). Syndromic surveillance message is submitted using correct filename. 4 [AMB] [optional] File validation performed to determine whether the file contains the required data elements. This step performed outside of the demonstration. The message contains the following required data elements: Patient demographics Provider specialty Provider address Problem list Vital signs Laboratory test values/results Procedure Medication list Insurance This step scored on the Conformance Worksheet. TE2.01 IN2.01
3 Access and display the changed demographic data. Changed demographics are stored correctly, without omission, and in conformance with the appropriate standards. TE3.01-3.03 IN2.02 IN3.01-3.02 4 Select the second patient and enter the following demographic data: Preferred language: Spanish (ISO 639-2 alpha 3 code: spa) Sex: Male Race: Black or African American and White Ethnicity: Hispanic or Latino Date of birth: 08/31/1938 Preliminary cause of death [INP only]: Head Trauma After entering the data, exit the screen. Demographic data is entered correctly, without omission, and in conformance with the standards for race, ethnicity, and preferred language. When the alpha-3 codes for Preferred Language (e.g. spa, eng, fra) are not displayed in the user interface, the mapping of the code to the description are confirmed elsewhere (e.g. database table). At least 2 races can be recorded for the patient and are in accordance with OMB standards. “Multiracial” may not be used to indicate more than one race. TE1.01-1.03 IN1.01-1.02 5 Access and display the demographics entered at Step 4. Then change the demographic data to the following: Preferred language: Japanese (ISO 639-2 alpha 3 code: jpn) Sex: Female Race: Asian Ethnicity: Not Hispanic or Latino Date of birth: 02/24/1974 Preliminary cause of death [INP only]: Cardiac Arrest After changing the data, exit the screen. Demographics are accessed and displayed correctly, without omission, and in conformance with the appropriate standards. Demographics are changed correctly, without omission, and in conformance with the standards for race, ethnicity, and preferred language. TE2.01-2.03 IN2.01 IN2.03 IN3.01-3.02 6 Access and display the changed demographic data. Changed demographics are stored correctly, without omission, and in conformance with the appropriate standards. TE3.01-3.03 IN2.02 IN3.01-3.02
170.314(f)(1) Immunization Information Setup Create a patient record ONC Test Data and Procedure Guidance Step # Action to Perform Expected Outcome Reference Notes / Deviations 1 Select a patient record and enter the 3 immunizations from the test data set selected by the Proctor. Exit the immunization screen. Immunization test data is entered correctly and without omission. Proctor documents the test data set. TE1.01-1.03 IN1.01 2 Access and display the immunization data entered at Step 1. Immunization data is displayed correctly and without omission. TE3.01-3.02 IN1.02 IN3.01 3 Change the previously entered immunization data using the provided test data. Exit the immunization screen. Immunization data is changed correctly and without omission. TE2.01-2.03 IN2.01 4 Access and display the immunization data changed at Step 3. Revised immunization data is displayed correctly and without omission. TE3.01-3.02 IN2.02 IN3.01
9 Access and display the smoking status entered at Step 8. Change it to ‘Heavy tobacco smoker’, which has an associated SNOMED-CT code of 428071000124103. Exit the smoking status screen. Previously recorded smoking status and associated SNOMED-CT code are displayed correctly prior to modification. Smoking status and associated SNOMED-CT code are changed correctly and without omission. TE3.02-3.03 IN3.01-3.02 TE1.01 IN1.01 10 Access the current smoking status of the patient. Smoking status and associated SNOMED-CT code are displayed correctly and without omission. TE4.01-4.02 IN4.01 170.314(a)(13) Family Health History Setup Create a patient record ONC Test Data and Procedure Customer must create their own test data Guidance Step # Action to Perform Expected Outcome Reference Notes / Deviations 1 Notify the Proctor whether SNOMED-CT or HL7 Pedigree will be used. Proctor documents whether SNOMED-CT or HL7 Pedigree is used. 2 Select a patient and enter the patient’s family health history data for first-degree family members: Parents; Offspring; and Siblings The data must be structured and include the relationship to the patient. After entering the data, exit the screen. Family health history data is entered correctly as structured data, without omission, and in conformance with the named standard for: Parents; Offspring; and Siblings NOTE: Family health history data includes both the condition and the familial relationship and as such both must be entered as structured data. TE1.01-1.03 IN1.01 3 Access and display the family health history data entered at Step 2. Family health history data is displayed correctly, without omission, and in conformance with the standard. IN1.02
2 Select a patient and enter active medication data from the provided test data set for the relevant care setting (AMB or INP). Exit the medication screen. Active medication data is entered correctly and without omission. TE1.01-1.03 [AMB] IN1.01 [AMB] TE4.01-4.03 [INP] IN4.01 [INP] 3 Access and display the medications entered at Step 2. Previously entered medications are stored correctly in the patient’s record. IN1.02 [AMB] IN4.02 [INP] 4 Change the previously entered medication list using the provided test data. Exit the medication screen. Medications are changed correctly and without omission. TE2.01-2.03 [AMB] IN2.01 [AMB] TE5.01-5.03 [INP] IN5.01 [INP] 5 Access and display the medications changed at Step 4. Changed medications are stored correctly and without omission. IN2.02 [AMB] IN5.02 [INP] 6 Access and display the active medication list. Active medication list displays correctly and without omission. TE3.01 [AMB] TE3.03 [AMB] IN3.01 [AMB] TE6.01 [INP] TE6.03 [INP] IN6.01 [INP] 7 Access and display the medication history. Medication history displays correctly, without omission and includes active and discontinued medications. TE3.02-3.03 [AMB] IN3.02 [AMB] TE6.02-6.03 [INP] IN6.02 [INP]
4 [INP] Demonstrate how the materials needed by the assistive technology for identification of the patients and the medications are generated. Materials needed by the assistive technology are generated. 5 [INP] Sign on as a user with eMAR authorization and access and display the eMAR for the first test patient. The eMAR is accessed and displayed. TE1.02 6 [INP] For the first patient, administer the medications and demonstrate how the EHR assistive technology is used to determine that the right patient is identified and to verify the following for each medication order: Medication is the right medication based on the medication order; Dose matches the dose information in the medication order; Route matches the route information in the medication order; and Current time matches the time indicated for the medication being administered in the medication order. EHR assistive technology correctly and accurately verifies the right patient and the right medication, dose, route, and time for each medication administered. Using the system clock, the Proctor documents the User ID, date and time that the medication administration information was verified and/or submitted to the patient’s record for each medication administered. TE1.03-1.05 IN1.01 TE2.01 7 [INP] Display the date, time, and user ID for each medication administered at Step 6 that was electronically, automatically, and simultaneously recorded. The system-generated dates, times and user IDs match those recorded by the Proctor in Step 6. TE2.02 8 [INP] Select the second test patient and using EHR assistive technology, generate a “wrong patient” automated message during the eMAR verification process. Example: Patient ID barcode does not match the patient for whom the eMAR is being displayed. Using EHR assistive technology, an automated “wrong patient” message appears during the eMAR verification process. TE1.06 IN1.02
9 Select a patient and demonstrate that the CDS interventions are identified and triggered based on data from each one of the following categories and at least one combination of data from two or more of the categories: Problem list Medication list Medication allergy list Demographics Laboratory tests and values/results Vital signs CDS interventions are electronically identified and triggered automatically and electronically based on each of the required categories separately and one combination from two or more categories. TE2.02-2.03 IN2.01 IN2.04 TE4.03 IN4.02 TE5.02 10 Access an evidence-based CDS intervention using one of the required data categories from Step 9 and review the following attributes: Bibliographic citation (clinical research/guideline); Developer (translation from clinical research/guideline); Funding source of the technical implementation; Release; and Revision date, if applicable At least 1 evidence-based CDS intervention is accessed based on the required data categories and the attributes are displayed correctly and without omission. TE5.02-5.04 IN5.01 11 Access 1 diagnostic and therapeutic reference resource using one of the required data categories from Step 9 and review the following attributes: Developer, and Bibliographic citation (clinical research/guideline), where clinically indicated At least 1 linked referential CDS is accessed based on the required data categories and the attributes are displayed correctly and without omission. TE5.06-5.08 IN5.02 12 Electronically incorporate a CCDA into the patient’s record that contains: Medications Medication allergies Problems One or more CDS interventions are triggered automatically and electronically based on data found within the newly incorporated: Medications, Medication allergies, and Problems TE2.04-2.05 IN2.02 IN2.04 Step 13 only performed by Ambulatory systems
21 In Step 5 of the Discover DCDT's Certificates section, choose the test case "D12 - No certificates found in DNS CERT records and no available LDAP servers." Attempt to send a message from the EHR to the Direct (To) address provided by the DCDT for that test case. Sending of message was attempted (results email to be examined at Step 26). TE1.02 TE1.04 22 In Step 5 of the Discover DCDT's Certificates section, choose the test case "D13 - No certificates discovered in DNS CERT records or LDAP servers." Attempt to send a message from the EHR to the Direct (To) address provided by the DCDT for that test case. Sending of message was attempted (results email to be examined at Step 26). TE1.02 TE1.04 23 In Step 5 of the Discover DCDT's Certificates section, choose the test case "D14 - Discovery of certificate larger than 512 bytes in DNS." Attempt to send a message from the EHR to the Direct (To) address provided by the DCDT for that test case. Sending of message was attempted (results email to be examined at Step 26). TE1.02 TE1.04 24 In Step 5 of the Discover DCDT's Certificates section, choose the test case "D15 - Certificate discovery in LDAP based on SRV priority value." Attempt to send a message from the EHR to the Direct (To) address provided by the DCDT for that test case. Sending of message was attempted (results email to be examined at Step 26). TE1.02 TE1.04 25 In Step 5 of the Discover DCDT's Certificates section, choose the test case "D16 - Certificate discovery in LDAP based on SRV weight value." Attempt to send a message from the EHR to the Direct (To) address provided by the DCDT for that test case. Sending of message was attempted (results email to be examined at Step 26). TE1.02 TE1.04
170.314(d)(9) Accounting of Disclosures [Optional] Setup Create a patient record ONC Test Data and Procedure Customer must create their own test data Guidance Step # Action to Perform Expected Outcome Reference Notes / Deviations 1 Record a disclosure related to treatment, including a description of the disclosure. Description of disclosure is recorded correctly and the system automatically records: Date Time Patient identification User identification TE1.01-1.02 IN1.01-1.02 2 Record a disclosure related to payment, including a description of the disclosure. Description of disclosure is recorded correctly and the system automatically records: Date Time Patient identification User identification TE1.01-1.02 IN1.01-1.02 3 Record a disclosure related to healthcare operations, including a description of the disclosure. Exit the disclosure screen. Description of disclosure is recorded correctly and the system automatically records: Date Time Patient identification User identification TE1.01-1.02 IN1.01-1.02 4 Enter the disclosure screen and display the disclosures entered at Steps 1 - 3. The three disclosures are displayed correctly and without omission and include the required data elements. Date Time Patient identification User identification Description of the disclosure TE1.03 IN1.01-1.02
Steps 14-19 are required to be performed by all systems except for steps previously exempted via attestation prior to the day of the test 14 [conditional] If the EHR permits electronic health information to be added, select a patient and add electronic health information to the patient record. Otherwise, skip to the next step. After test data is entered, exit the record. Electronic health information is entered into the patient record. Proctor documents the date, time, user identification, patient identification, and identifies the patient data accessed. TE3.01 Time: User ID: Patient ID: Data Accessed: 15 [conditional] If the EHR permits electronic health information to be changed, select the patient used at Step 14 and change electronic health information from the patient record. Otherwise, skip to the next step. After test data is changed, exit the record. Electronic health information is changed in the patient record. Proctor documents the date, time, user identification, patient identification, and identifies the patient data accessed. TE3.03 Time: User ID: Patient ID: Data Accessed: 16 [conditional] If the EHR permits electronic health information to be queried, select the patient used at Step 14 and query electronic health information from the patient record. Otherwise, skip to the next step. After test data is queried, exit the record. Electronic health information is queried from the patient record. Proctor documents the date, time, user identification, patient identification, and identifies the patient data accessed. TE3.04 Time: User ID: Patient ID: Data Accessed: 17 [conditional] If the EHR permits electronic health information to be printed, select the patient used at Step 14 and print electronic health information from the patient record. Otherwise, skip to the next step. Electronic health information is printed from the patient record. Proctor documents the date, time, user identification, patient identification, and identifies the patient data accessed. TE3.05 Time: User ID: Patient ID: Data Accessed: 18 [conditional] If the EHR permits electronic health information to be copied, select the patient used at Step 14 and copy electronic health information from the patient record. Otherwise, skip to the next step. Electronic health information is copied from the patient record. Proctor documents the date, time, user identification, patient identification, and identifies the patient data accessed. TE3.06 Time: User ID: Patient ID: Data Accessed:
7 Using the test data submitted electronically to the receiving system, the Proctor will generate a new hash value. This step performed outside of the demonstration. The electronically exchanged hash value and the hash value generated on the receiving system are the same. TE3.03-3.04 IN3.01 170.314(d)(7) End-User Device Encryption Setup Attestation identifying the encryption algorithm and corresponding key length must be submitted prior to scheduling test date. ONC Test Data and Procedure Customer must create their own test data Guidance Step # Action to Perform Expected Outcome Reference Notes / Deviations Steps 1-9 performed only if the system stores electronic health information on an end-user device 1 [conditional] Notify the Proctor of the encryption algorithm and corresponding key length to be used to encrypt electronic health information on end-user devices. Proctor documents the encryption algorithm and corresponding key length and verifies they are compliant with FIPS 140-2 Annex A and matches the algorithm provided via attestation. TE1.01-1.02 IN1.01-1.02 2 [conditional] From an end-user device, initiate an EHR session that is designed to store electronic health information on the end-user device. A session is initiated to store electronic health information on the end-user device. TE3.01 3 [conditional] Stop the EHR session using the end-user device identified in Step 2. The session is stopped using the end-user device. TE3.02 4 [conditional] Demonstrate that the electronic health information stored locally on the end-user device after the session stops is encrypted. The electronic health information stored locally on the end-user device after the session stops is encrypted and unreadable. TE3.03 IN3.01 Steps 5-9 performed only if the system allows the encryption of electronic health information stored on an end-user device to be disabled 5 [conditional] Determine the EHR's default setting to encrypt electronic health information stored on end-user devices (enabled or disabled). The default setting to encrypt electronic health information stored on end-user devices is enabled. TE2.01-2.02 IN2.01
169 [INP] [eMAR] Enter test data for 1 patient selected by the Proctor from 3: Add New Patient or Modify Existing Patient. Test data is entered correctly and without omission. TE25.02 170 [INP] [eMAR] Enter test data for 1 patient selected by the Proctor from 4: Add New Patient or Modify Existing Patient. Test data is entered correctly and without omission. TE25.03 171 [INP] [eMAR] Enter the test data for 1 patient selected by the Proctor from 5: Add New or Modify Existing Patient. Test data is entered correctly and without omission. TE25.04 172 [INP] [eMAR] Generate the delta report. Report includes sufficient detail to match the patients/actions to the denominator limitations and the numerator increments as expected. TE25.05-25.06 IN25.01-25.03
5 [AMB] Increase the numerator of patients entered for one of the providers. Numerator is increased for one of the providers. TE2.02 6 [AMB] Generate and display the same report(s) again. Report is created and includes the numerator, denominator, and resulting percentage correctly and without omission. The numerator increments correctly for the appropriate provider. TE2.03-2.04 IN2.01 Steps 7-9 required for Inpatient systems testing measures related to: Problems, Meds, Med Allergies, Demographics, Vital Signs, Smoking Status, Patient Education, Family Health History, Electronic Notes, or Advance Directives 7 [INP] Demonstrate that the Setup patient data (Scenario 1) was entered according to the provided test data and includes all patients and encounter information: (A) Direct admission to INP department (POS 21) (B) Admitted to ED and then admitted to the INP department (POS 21) (C) Admitted to ED and discharged from ED (POS 23) (D) Admitted to ED and received observation services and then admitted to the INP department (POS 21) (E) Admitted to INP department upon receiving observation services in the outpatient department (POS 22) Patients and encounter information from the Setup test data (Scenario 1) are included. TE3.01 IN3.01
137 [Summary of Care] Create an additional encounter with a referral/transition of care for the patient selected at Step 133. Additional encounter with referral/transition of care is created. TE18.08 IN18.02 138 [Summary of Care] Generate another set of Stage 1, Stage 2 Measure A and Stage 2 Measure B delta reports. Reports include numerator and denominator value increments as expected and percentage calculations are accurate (denominator and numerator increment for every transition of care/referral that is created). TE18.09-18.10 IN18.05 Steps 139-144 required for Ambulatory systems testing criterion e3 which maps to the Secure Messaging measure [Stage 2] 139 [AMB] [Messaging] For Secure Messaging, create a baseline report that includes the numerator and denominator values and resulting percentage using the data that was previously entered from 1: Test Data Set-Up for New Patient. Report is created correctly and without omission and includes the required information. TE19.01 TE19.07 IN19.01 IN19.03 140 [AMB] [Messaging] Enter test data for 1 patient selected by the Proctor from 2: Modify Test Data Set-Up for New Patient. Test data is entered correctly and without omission. TE19.02 IN19.02 141 [AMB] [Messaging] Enter test data for 1 patient selected by the Proctor from 3: Add New Patient or Modify Existing Patient. Test data is entered correctly and without omission. TE19.03 IN19.02 142 [AMB] [Messaging] Enter test data for 1 patient selected by the Proctor from 4: Add New Patient or Modify Existing Patient. Test data is entered correctly and without omission. TE19.04 IN19.02 143 [AMB] [Messaging] Enter the test data for 1 patient selected by the Proctor from 5: Add New or Modify Existing Patient. Test data is entered correctly and without omission. TE19.05 IN19.02 144 [AMB] [Messaging] Generate the delta report. Report includes numerator and denominator value increments as expected and percentage calculation is accurate. TE19.06-19.07 IN19.03-19.04