ONC Testing Program Updates

The below information is directly related to the Testing Process - for updates and information pertaining to Certification to include Real World Testing, please visit the ACB's Certification Program Updates page.

Native Applications Fact Sheet Aug 3, 2021 

The ONC Clarifications in the Interim Final Rule to Support Native Applications fact sheet is now available. The fact sheet summarizes updates to the ONC Health IT Certification Program from the November 2020 Interim Final Rule and Certification Companion Guide clarifications regarding support for native applications. The fact sheet identifies updates and clarifications regarding support for native applications including interactions with authorization servers, issuance of refresh tokens, and updates to the regulation text and Conditions of Certification for clarity and consistency.

USCDI v2 is Now Available July 12, 2021 

The United States Core Data for Interoperability v2 (USCDI v2) is now available. USCDI v2 has new data classes and elements that will support the sharing of gender identity, sexual orientation, social determinants of health, and other data in health IT. The USCDI helps to standardize data elements, providing a roadmap for health IT developers to build products and solutions that can help improve health outcomes at both the individual and population level.

Updated eCQM Specfications and eCQM Materials for 2022 Reporting May 06, 2021 

The Centers for Medicare & Medicaid Services (CMS) has posted the electronic clinical quality measure (eCQM) specifications for the 2022 reporting period for Eligible Hospitals and Critical Access Hospitals (CAHs), and the 2022 performance period for Eligible Professionals and Eligible Clinicians. CMS updates the specifications annually to align with current clinical guidelines and code systems so they remain relevant and actionable within the clinical care setting. These updated eCQMs are to be used to electronically report 2022 clinical quality measure data for CMS quality reporting programs. Measures will not be eligible for 2022 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program.

Where to Find the Updated eCQM Specifications and Materials

The updated eCQM specifications are available on the Electronic Clinical Quality Improvement (eCQI) Resource Center for Eligible Hospitals and CAHs and Eligible Professionals and Eligible Clinicians pages under the 2022 Reporting/Performance Year. Other eCQM resources, including the Guide for Reading eCQMs, eCQM Logic and Implementation Guidance, tables of eCQMs, and technical release notes, are also available at the same locations. CMS updated the Guide to Reading eCQMs and eCQM Logic and Implementation Guidance based on end user feedback and continues to update these guides to assist stakeholders in understanding and implementing eCQMs. 

Where to Find the 2022 eCQM Value Sets, Direct Reference Codes, and Terminology

The 2022 reporting/performance period eCQM value sets are available through the National Library of Medicine’s Value Set Authority Center (VSAC). The value sets are available as a complete set, as well as value sets per eCQM. The direct reference codes specified within the eCQM HQMF files are also available in a separate file for download on the VSAC Downloadable Resources page.

Hospital Hybrid Measures Information

The eCQI Resource Center includes information about CMS hybrid measures for Eligible Hospitals and CAHs. A hybrid measure is a quality measure that uses both claims data and clinical data from electronic health records (EHRs) for calculating the measure. Please visit the Hybrid Measures page on the eCQI Resource Center to learn more. The hybrid measure value sets for use in the hybrid measures are available through the VSAC.

Where to Find the Guidance on Allowance of Telehealth Encounters

The guidance is available on the eCQI Resource Center under the 2022 Performance Period in the Telehealth Guidance for eCQMs for Eligible Professional/Eligible Clinician 2022 Quality Reporting document and with the Eligible Professionals and Eligible Clinicians table of eCQMs on the Eligible Professionals and Eligible Clinician page for the 2022 Performance Period.

For More Information or Questions

To find out more about eCQMs, visit the eCQI Resource Center. Visit the eCQM Data Element Repository which is a searchable module that provides all the data elements associated with eCQMs in CMS quality reporting programs, as well as the definitions for each data element. This information is intended to improve clarity for those implementing eCQMs. 

For Questions Regarding eCQMs

To report questions or comments on the eCQM specifications, visit the eCQM Issue Tracker. Note that an ONC Project Tracking System (Jira) account is required to ask a question or comment.

Sunsetting the Interoperability Roadmap May 04, 2021 

Over six years ago, ONC embarked on an ambitious initiative to create a shared, nationwide Interoperability Roadmap (the Roadmap).  In typical fashion, the ONC produced a draft, many of you shared your comments, and then they released the final Roadmap in October 2015.

The Roadmap looked 10 years into the future and projected health care interoperability milestones for the nation to achieve within three overall time bands “2015 to 2017,” “2018-2020,” and “2021-2024.” As with all long-term plans, roadmaps, and strategies there comes a time when the future becomes the present.  Collectively, we have all made solid progress on many of the early milestones identified by the Roadmap.  It is important to recognize those successes while at the same time acknowledging that the Roadmap itself no longer drives our work.  Though the Roadmap has been sunset slightly ahead of the third time band’s final date, it will continue to be accessible on HealthIT.gov for referential purposes.

As a community, we are well positioned to continue to advance health IT interoperability with the 21st Century Cures Act and its implementing rules now in place, the 2020-2025 Federal Health IT Strategic Plan released, and continued insights from the Health IT Advisory Committee (HITAC) informing our work (e.g., priority uses of health IT and related standards).  Indeed, from ONC’s perspective, we will continue to lean into our coordination role across government and industry; align investments in standards development, pilots, and programs; promote the implementation and use of what has been built over these many years; and drive to outcomes not yet fully realized.


New eCQM Standards Webpage Apr 28, 2021 

The Centers for Medicare & Medicaid Services (CMS) has expanded the Electronic Clinical Quality Improvement (eCQI) Resource Center to include a new summary webpage for Electronic Clinical Quality Measure (eCQM) Standards. The eCQM Standards webpage provides an overview of key standards for developing and reporting eCQMs.  Additionally, the new page includes information on:

  • transmission standards for the electronic exchange of healthcare data
  • connections between standards and tools used to develop and test eCQMs
  • the eCQM standards update cycle

CMS invites you to explore the eCQI-centered community of the eCQI Resource Center and send us your suggestions about the website at ecqi-resource-center@hhs.gov.

Fact Sheets for FHIR API Apr 20, 2021 

Four new fact sheets are available to help clarify the FHIR® API.  These fact sheets, created by ONC and Health Level Seven International (HL7)®, explain the key technical concepts that make up the foundation of the Fast Healthcare Interoperability Resources (FHIR®) standard – how it is developed in an open and public process, and why it has become the focus of the Health IT standards.  The fact sheets are available as PDF files on the ONC FHIR® webpage.

(b)(3) Testing Requirement Updates Feb 11, 2021

The 21st Century Cures Act Final Rule provided several revisions to the ONC’s 2015 Edition Health IT Certification Program.  One significant update was made to the e-Prescribing protocol certification requirements, as prescribed in the 170.315(b)(3) Cures Update criterion.

The 2015 Edition Cures Update Final Rule required electronic healthcare records (EHRs) to adopt the NCPDP Script 10.6 to interface with electronic prescription systems.  The new requirement is to use NCPDP Script 2017071 for e-Prescribing messaging to meet the 2020 CMS Medicare Part D requirements. 

CMS has required the HIT technology to adopt NCPDP SCRIPT 2017071 messaging since Jan. 1, 2020.  To comply with the CMS mandate, ONC announced in 2019 that a developer certified to the 170.315(b)(3) criterion would be allowed to update their e-Rx implementations to support SCRIPT 2017071.  ONC’s announcement served to inform developers certified to  170.315(b)(3) – 2015 Edition the need to report to their ONC-Authorized Certification Body (ONC-ACB) before Dec. 31, 2019, only if the Complete EHR or Health IT Module adopted and deployed modifications to demonstrate compliance with the CMS SCRIPT 2017071 requirement by that time.

NOTE - ONC’s position on the attestation notification as described above: while it does assert that a Certified EHR Technology (CEHRT) developer who had modified and reported the updated to support SCRIPT 2017071 is sufficient for purposes of 2020 CMS Medicare Part D requirements, this does not constitute a certification to ONC’s 170.315(b)(3) Cures Update criterion. 

As of July 1, 2020, there are several ways a developer may test and certify to this revised 170.315(b)(3) e-Prescribing criterion:

  • For Complete EHRs or Health IT Modules already certified to 170.315(b)(3) – 2015 Edition, the ONC permits a developer to self-test using the NCPDP ERX Test Tool, capture the test tool reports for each test scenario, and submit a signed attestation statement to the ONC-ACB as proof of compliance.  Self-testing results would need to cover all required tests and any optional tests.
  • For Complete EHRs or Health IT Modules that have never been certified to 170.315(b)(3), you will need to complete a Live Test session.  The Proctor lead Test session will follow our Test Script and utilized the ONC’s NCPDP test tool. 

To date, SureScripts has yet to be authorized by ONC to provide an alternative test method for the revised 170.315(b)(3) criterion.  There is no estimated timeline for this approval, and until authorization by ONC, ONC-ACBs cannot accept SureScripts certifications as proof of compliance to the revised (b)(3) criterion.  Currently, the only way to achieve (b)(3) Cures Update certification is one of the applicable two methods discussed above.

The (b)(3) Cures Update criterion is similar to the original 2015 Edition (b)(3) criterion, however, with some new testing and certification requirements.  In addition to the update from SCRIPT v10.6 to SCRIPT 2017071 messages, certified Complete EHR or Health IT Module must now support “Verify and Error” messages.  Verify messages are part of the NCPDP Test Tool’s Cancel scenarios, and Error messages must be visually inspected.

Lastly, new optional tests are available:

  • Prior Authorization
  • Risk Evaluation
  • Management Strategy
  • Transferring between Pharmacies
  • Long-term post-acute care
  • New Rx request
  • Rx Fill Indicator

Compliance with optional test scenarios can be certified by the developer and listed on the ONC CHPL listing.

ONC Releases Draft USCDI v2 Jan 19, 2021

ONC recently released the Draft United States Core Data for Interoperability Version (Draft USCDI v2). The Draft USCDI v2 results from wide-ranging public input into the elements that should be included to enhance the interoperability of health data for patients, providers, and other users. ONC encourages the public to review this draft standard, including the list of data elements that did not make it into the standard, and provide comments through the USCDI home page by April 15th, 2021.

ONC also released the Standards-Version Advancement Process (SVAP) Approved Standards for 2020. Under the SVAP, health IT developers can incorporate newer versions of health IT standards and implementation specifications in certified health IT and update systems for their customers without undergoing certification testing again.

Additional information about the Draft USCDI v2 and SVAP Approved Standards for 2020 is in the Standards Bulletin 2021-1:

  • Learn more about the USCDI and comment
  • Learn more about the SVAP

(g)(9) and (g)(10)Testing Requirement Updates Jan 13, 2021

The 21st Century Cures Act Final Rule provided several revisions to the ONC's 2015 Edition Health IT Certification Program.  One of the changes is related to the retirement of §170.315(g)(9) Application access - all data request and transitioning to §170.315(g)(10) Standardized API for patient and population services.  

Inferno Program Edition is a streamlined testing tool for services seeking to meet the Standardized API requirements for Patient and Population Services criterion §170.315(g)(10) - 2015 Edition Cures Update.  The Inferno Test Tool is used to test compliance of §170.315(g)(10).  Inferno is a rich and rigorous ONC testing suite for HL7® Fast Healthcare Interoperability Resources (FHIR) to help developers implement the FHIR standard consistently.  Inferno is open source and freely available to install and use by the health IT community, including EHR vendors.

The ONC is consistently improving the testing tools used for the certification process.  The ONC sends announcements for Inferno tech talks in their google group, which you can sign up for here: https://groups.google.com/g/inferno-testing.   The Inferno Tech talks are held on the second Wednesday of each month from at 1:00 pm (Eastern Time).

2014 Edition Retirement May 11, 2020

The ONC Cures Act Final Rule is now published to the Federal Register with an effective June 30th, 2020. As of this effective date, the 2014 Edition Certification Program will officially retire from the ONC Health IT Certification program and all 2014 Edition program requirements. As a result, we are no longer accepting quarterly reporting for 2014 Edition certifications or processing any 2014 Edition Complete EHR or Health IT Module updates. Surveillance related to the 2014 Edition certification program will conclude by June 30th

Please see that all references to your 2014 Edition certifications, or their related certification logos/marks, are removed from your website disclosures and marketing materials by the effective date. It is recommended that you inform any remaining customers that may be using a 2014 Edition certified Complete EHR or Health IT Module the certification will no longer be active.