Da Vinci Payer Data Exchange (PDex) FHIR Implementation Guide.

The Da Vinci Payer Data Exchange (PDex) STU 2.0.0 Test Kit validates the conformance of systems to the PDex STU 2.0.0 FHIR IG. The test kit includes suites targeting the following actors from the specification:

• Payer Servers: Inferno will act as a client and make a series of requests to the server under test simulating a new payer's request to access member clinical data from an old payer using the payer to payer workflow.
• Payer Clients: Inferno will act as an old payer server that contains member information that the client under test would like to access using the payer to payer workflow. Inferno will wait for the client to make requests and respond appropriately to them.

In each case, content provided by the system under test will be checked individually for conformance and in aggregate to determine that the full set of features is supported.

This test kit is open source and freely available for use or adoption by the health IT community including EHR vendors, health app developers, and testing labs. It is built using the Inferno Framework. The Inferno Framework is designed for reuse and aims to make it easier to build test kits for any FHIR-based data exchange.

These tests are a DRAFT intended to allow PDex implementers to perform preliminary checks of their implementations against PDex IG requirements and provide feedback on the tests. Future versions of these tests may validate other requirements and may change how these are tested.

Neither the server nor client test suite included test the full scope of the PDex IG. This is because the PDex IG is under active development and the IG authors intend to change the approach to the workflows included within future versions of the IG. In particular

• The payer to payer workflow will move from a single-patient workflow to a multi-patient workflow.
• The payer to payer discovery and trust mechanisms will be updated.
• The payer to provider workflow will change to no longer use CDS Hooks.

Due to these expected changes, this test kit focuses on validating the high-level payer to payer workflow from both the client and server perspective under the expectation that the broad need of payers to exchange data will remain, but the details are expected to change.

Use either of the following methods to run the suites within this test kit. If you would like to try out the tests but don’t have a PDex implementation, the test home pages include instructions for trying out the tests, including

• For server testing: a public reference implementation (code on github)
• For client testing: a sample postman collection

Detailed instructions can be found in the suite descriptions when the tests are run or within this repository for the server and client.

You can run the PDex test kit via the ONC Inferno website by choosing the “Da Vinci Payer Data Exchange (PDex) Test Kit” test kit.

• Download the source code from this repository.
• Start or identify an Inferno Reference Server instance for Inferno to use for simulation (only needed if planning to run the Client test suite).
• Open a terminal in the directory containing the downloaded code.
• In the terminal, run setup.sh.
• In the terminal, run run.sh.
• Use a web browser to navigate to http://localhost.

The PDex client test suite needs to be able to return responses to FHIR read and search APIs. These responses can be complex and so the suite relies on a full FHIR server to provide responses for it to provide back to systems under test. The test kit was written to work with the Inferno Reference Server

• loaded with patient 999 and an associated group
• accepting bearer token SAMPLE_TOKEN for read access.

The test kit can be configured to point to either a local instance of the reference server or to a public instance. The location of the The following are valid configuration approaches:

1. Point to a public instance of the Inferno reference server at either https://inferno.healthit.gov/reference-server/r4/ or https://inferno-qa.healthit.gov/reference-server/r4/: update the FHIR_REFERENCE_SERVER environment variable in the appropriate environment file (.evn.production when running in docker as above, or env.development when running the test kit in Ruby).
2. Run a local instance of the Inferno Reference Server, either with docker or without docker (NOTE: this decision can be made independently from whether to run the test kit with docker or using Ruby).

If you are running the Server Bulk Export tests, you must use a local Inferno Reference Server with read-write mode enabled by adding READ_ONLY=false to the environment and with the timeout increased to 600 seconds.

1. Ensure you have a simulation server running as documented above
2. Open the Payer Server and Payer Client test suites in separate windows or tabs
3. Select "Run All Tests" to start the Payer Client suite
4. Use the SMART App Launch Test Kit to perform the authentication handshake. You can do this by running opening the SMART App Launch STU2.2 suite in another tab and running Test Group 1 Standalone Launch. Use the FHIR URL and SMART Client Id inputs from the Payer Client test's dialog box. Grab the bearer token from test 1.2.06 output standalone_access_token
5. On the Payer Client suite, follow the user action required to indicate you have completed client connection
6. Now on the Payer Server suite, select the "PDex Payer Server Preset for Client Tests" preset, start Test Group 1.1 $member-match, and enter the access token you grabbed from step 3. Submit the inputs to run 1.1
7. After the Client suite receives the $member-match request, which you can confirm on the Server suite's side, you can run any of the other Test Groups to simulate that portion of the PDex IG:

• 1.2 for a single clinical FHIR query on an Encounter resource
• 1.3 for the Patient $everything operation
• 1.4 for the $export operation from bulk data export
• 2.2 for the US Core and PDex GET API

8. Once you have executed any of the above tests, follow the User Action Required dialog box on the Client suite to indicate you have finished making requests

Troubleshooting: if you get the error Unable to find test run with identifier... it may be due to known race condition bug when running the two test suites against each other. Re-run the tests with the same inputs if you encounter the race condition. If the problem persists or its blocking your FHIR application testing, please raise an issue on GitHub.

We welcome feedback on the tests, including but not limited to the following areas:

• Validation logic, such as potential bugs, lax checks, and unexpected failures.
• Requirements coverage, such as requirements that have been missed and tests that necessitate features that the IG does not require.
• User experience, such as confusing or missing information in the test UI.

Please report any issues with this set of tests in the issues section of this repository.

To make updates and additions to this test kit, see the Inferno Framework Documentation, particularly the instructions on development with Ruby.

Licensed under the Apache License, Version 2.0 (the "License"); you may not use this file except in compliance with the License. You may obtain a copy of the License at

http://www.apache.org/licenses/LICENSE-2.0

Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an "AS IS" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License.

HL7, FHIR and the FHIR [FLAME DESIGN] are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.