Hey Michelle. I know several vendors who use the One Click Scorecard as part of their Real World Testing (RWT). ONC said that the ATL test tools like ETT generally should not be used for RWT efforts, but instead, they directed vendors to use more real-world tools, like the Scorecard. If the Scorecard is removed, it would be good if ONC could then speak as to how you validate real-world use of a C-CDA if the ETT tool is basically off limits.
Health IT developers should consider existing testing tools and approaches that may be used to assess real world interoperability. For example, we encourage health IT developers to consider metrics of use and exchange from existing networks, communities, and tools including, but not limited to, Surescripts, Carequality, CommonWell Health Alliance, the C-CDA One-Click Scorecard, and DirectTrust. We do not believe that testing through the ONC-approved test procedures is sufficient to demonstrate real world use as the test procedures developed for initial laboratory testing and certification are generally setting agnostic, focused on standards conformance, and do not always test the full scope of the certification criteria's intended functionality.