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Da Vinci DTR Test Kit Overview

The Da Vinci Documentation Templates and Rules (DTR) Test Kit is a testing tool designed to validate the conformance of DTR client and server systems to versions of the Da Vinci Documentation Templates and Rules (DTR) FHIR Implementation Guide (IG), including

This document provides a high-level overview of the Test Kit, including its purpose, general testing approach, scope, limitations, and guidance on how to interpret results.

Purpose

This test kit helps implementers ensure that their systems can correctly participate in Qustionnaire retrieval and completion workflows as defined by the DTR IG. It does so by simulating an exchange partner for the system under test (when testing a DTR client Inferno will simulate a DTR server and vice-versa) and verifying that each exchange is conformant and that all exchanges in aggregate demonstrate the required capabilities.

This test kit is open source and freely available for use or adoption by the health IT community including EHR vendors, payer systems, 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.

Test Kit Actors and Approach

The DTR specification defines two sides of the basic exchange: a payer side which provides Questionnaires and a provider side which completes them. The specification further provides for the provider side to be fulfilled either by

  • a single DTR Full EHR actor that retrieves Questionnaires, renders them for users to complete, and supplies the data, or
  • a combination of a DTR SMART Client responsible for retrieving Questionnaires and rendering them for users to complete, plus a DTR Light EHR responsible for providing the data.

For the v2.0.1 version of the DTR specification, this test kit contains suites for all 4 actors. Starting with the v2.2.0 version of the DTR specification, only two suites are provided for DTR clients and DTR Payer Services. DTR SMART Apps and Light EHRs that wish to test their capabilities can team up with each other to complete the client suite.

Inferno's testing approach varies based on the target actor

  • When testing DTR clients, Inferno will simulate a DTR payer service and provide Questionnaires for the tester to complete using the tested client system. Some of these Questionnaires will be specified by Inferno to ensure certain scenarios are tested, while others can be specified by the tester. Over the course of completing these Questionnaires, the client system will demonstrate all of the required capabilities of DTR form fillers. Some details of these requirements will be checked by Inferno while others will be attested to by the tester. See the Client Details page for more information.
  • When testing DTR payer services, Inferno will simulate a DTR client by making requests to the server's $questionnaire-package and $next-question operations. These requests will be provided by the tester so that Inferno's requests will contain the right details to trigger responses with Questionnaires. Inferno will ask for requests to make that demonstrate the full scope of DTR payer services capabilities. See the Server Details page for more information.

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 required by the IG for the actor is supported.

Test Scope and Limitations

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

While these tests cover core aspects of the DTR IG, there are known limitations:

  • DTR workflow are highly visual with significant numbers of requirements around the rendering and population of and interaction with Questionnaires by users, or the design of such Questionnaires to integrate into workflows where users will fill them out. Inferno is not able to rigorously verify these visual and design-level requirements related to Questionnaires.
  • Logic within Quesitonnaires can be driven by Clinical Quality Language (CQL) expressions, which can contain complex logic. Inferno does not include a CQL execution engine and so has limited ability to evaluate CQL expressions or the answers to them provided by client systems for correctness.

For a details on specific specific limitations, detailed requirements, and known issues, please consult the following resources:

Conformance Criteria & Interpreting Results

A test run is considered successful if all mandatory tests pass:

  • Passing Tests: Indicate expected behavior for specific scenarios
  • Failing Tests: Indicate deviations from DTR IG requirements
  • Warnings: Highlight potential concerns that require manual review
  • Skipped Tests: Occur when necessary prerequisites are not met
  • Omitted Tests: Occur when optional prerequisites are not met

Given the known limitations, passing all automated tests does not solely constitute full DTR IG conformance. Systems should also meet requirements verified through attestation or other means.

For specific testing prerequisites and detailed test descriptions, refer to:

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