§170.315(h)(2) Direct Project, Edge Protocol, and XDR/XDM

Real World Testing: Products certified to this criterion must complete requirements outlined for the Real World Testing Conditions and Maintenance of Certification.

Design and Performance: The following design and performance certification criteria (adopted in § 170.315(g)) must also be certified in order for the product to be certified.

• Quality management system (§ 170.315(g)(4)): When a single quality management system (QMS) is used, the QMS only needs to be identified once. Otherwise, the QMS’ need to be identified for every capability to which it was applied.
• Accessibility-centered design (§ 170.315(g)(5)): When a single accessibility-centered design standard is used, the standard only needs to be identified once. Otherwise, the accessibility-centered design standards need to be identified for every capability to which they were applied; or, alternatively, the developer must state that no accessibility-centered design was used.

Privacy and Security: This certification criterion was adopted at § 170.315(h)(2). As a result, an ONC Authorized Certification Body (ONC-ACB) must ensure that a product presented for certification to a § 170.315(h) criterion includes the privacy and security criteria (adopted in § 170.315(d)) within the overall scope of the certificate issued to the product.

• The privacy and security criteria (adopted in § 170.315(d)) do not need to be explicitly tested with this specific paragraph (h) criterion unless it is the only criterion for which certification is requested.
• As a general rule, a product presented for certification only needs to be tested once to each applicable privacy and security criterion (adopted in § 170.315(d)) so long as the health IT developer attests that such privacy and security capabilities apply to the full scope of capabilities included in the requested certification. However, exceptions exist for § 170.315(e)(1) “View, download, and transmit to 3rd party (VDT)” and (e)(2) “Secure messaging,” which are explicitly stated.
• § 170.315(d)(2)(i)(C) is not required if the scope of the Health IT Module does not have end-user device encryption features.

For more information on the approaches to meet these Privacy and Security requirements, please review the Privacy and Security CCG.

• If choosing Approach 1:
  • Authentication, access control, and authorization (§ 170.315(d)(1))
  • Auditable events and tamper-resistance (§ 170.315(d)(2))
  • Audit reports (§ 170.315(d)(3))
  • Encrypt authentication credentials (§ 170.315(d)(12))
  • Multi-factor authentication (MFA) (§ 170.315(d)(13))
  • For each applicable privacy and security certification criterion not certified using Approach 1, the health IT developer may certify using system documentation which is sufficiently detailed to enable integration such that the Health IT Module has implemented service interfaces to access external services necessary to meet the requirements of the privacy and security certification criterion. Please see the ONC Cures Act Final Rule at 85 FR 25710 for additional clarification.
  Revision History Regulation Text

  § 170.315 (h)(2) Direct Project, Edge Protocol, and XDR/XDM—

  1. Able to send and receive health information in accordance with:
     1. The standard specified in § 170.202(a)(2), including formatted only as a “wrapped” message;
     2. The standard specified in § 170.202(b), including support for both limited and full XDS metadata profiles; and
     3. Both edge protocol methods specified by the standard in § 170.202(d).

     Paragraph (h)(2)(i)(A)

     Paragraph (h)(2)(i)(B)

     Paragraph (h)(2)(i)(C)

     Paragraph (h)(2)(ii)

     Standard Version Advancement Process (SVAP) Version(s) Approved

     Conditions and Maintenance of Certification

     Real World Testing: Products certified to this criterion must complete requirements outlined for the Real World Testing Conditions and Maintenance of Certification.

     Design and Performance: The following design and performance certification criteria (adopted in § 170.315(g)) must also be certified in order for the product to be certified.

     • Quality management system (§ 170.315(g)(4)): When a single quality management system (QMS) is used, the QMS only needs to be identified once. Otherwise, the QMS’ need to be identified for every capability to which it was applied.
     • Accessibility-centered design (§ 170.315(g)(5)): When a single accessibility-centered design standard is used, the standard only needs to be identified once. Otherwise, the accessibility-centered design standards need to be identified for every capability to which they were applied; or, alternatively, the developer must state that no accessibility-centered design was used.

     Privacy and Security: This certification criterion was adopted at § 170.315(h)(2). As a result, an ONC Authorized Certification Body (ONC-ACB) must ensure that a product presented for certification to a § 170.315(h) criterion includes the privacy and security criteria (adopted in § 170.315(d)) within the overall scope of the certificate issued to the product.

     • The privacy and security criteria (adopted in § 170.315(d)) do not need to be explicitly tested with this specific paragraph (h) criterion unless it is the only criterion for which certification is requested.
     • As a general rule, a product presented for certification only needs to be tested once to each applicable privacy and security criterion (adopted in § 170.315(d)) so long as the health IT developer attests that such privacy and security capabilities apply to the full scope of capabilities included in the requested certification. However, exceptions exist for § 170.315(e)(1) “View, download, and transmit to 3rd party (VDT)” and (e)(2) “Secure messaging,” which are explicitly stated.
     • § 170.315(d)(2)(i)(C) is not required if the scope of the Health IT Module does not have end-user device encryption features.

     For more information on the approaches to meet these Privacy and Security requirements, please review the Privacy and Security CCG.

     • If choosing Approach 1:
       • Authentication, access control, and authorization (§ 170.315(d)(1))
       • Auditable events and tamper-resistance (§ 170.315(d)(2))
       • Audit reports (§ 170.315(d)(3))
       • Encrypt authentication credentials (§ 170.315(d)(12))
       • Multi-factor authentication (MFA) (§ 170.315(d)(13))
       • For each applicable privacy and security certification criterion not certified using Approach 1, the health IT developer may certify using system documentation which is sufficiently detailed to enable integration such that the Health IT Module has implemented service interfaces to access external services necessary to meet the requirements of the privacy and security certification criterion. Please see the ONC Cures Act Final Rule at 85 FR 25710 for additional clarification.
       Testing Tool

       2015 Direct Certificate Discovery Tool (DCDT)

       Approved SVAP Version(s)

       Testing must be conducted for one of the Sending Alternatives outlined on the Test Procedure tab to satisfy the requirements for this criterion.
       Testing must also be conducted for one of the alternative connection requirements within each of the Sending Alternatives on the Test Procedure tab.
       Note: The “Secure Network” alternative only needs to be verified once for the Testing Procedure. (Where applicable the TLS required should be unchecked in the ETT Profile).

       Testing must be conducted for one of the Receiving Alternatives outlined on the Test Procedure tab to satisfy the requirements for this criterion: IHE XDR, SMTP, IMAP, or POP3.

       Test Tool Documentation

       This Test Procedure illustrates the test steps required to certify a Health IT Module to this criterion. Please consult the most recent ONC Final Rule on the Certification Regulations page for a detailed description of the certification criterion with which these testing steps are associated. ONC also encourages developers to consult the Certification Companion Guide in tandem with the test procedure as it provides clarifications that may be useful for product development and testing.

       Note: The test step order does not necessarily prescribe the order in which the tests should take place.

       Testing components

       

       Paragraph (h)(2)(i)(A) – Send

       System Under Test

       Discover Certificates

       1. The user performs setup tasks to discover Direct Certificate Discovery Tool (DCDT) certificates (by downloading the DCDT Trust Anchor from the Edge Testing Tool (ETT): Direct, “Cert Discovery DCDT,” uploading it into the Health IT Module’s Direct instance, and mapping the Direct address to a non-Direct email address for receiving results) so that the user can discover and use address-bound and domain-bound certificates hosted in both DNS and LDAP in DCDT using identified health IT function(s).

       Register Direct Address

       1. The user selects “Register Direct” within the ETT: Direct Testing and registers a Direct address within the ETT and corresponding Contact Email address for receipt of the ETT validation report.

       Send Health Information Using Direct

       1. The user identifies the payload for sending to the ETT via Direct. ONC-supplied payloads are available for download from the ETT-Documents page.
       2. The user sends encrypted and signed health information to a third party (ETT) using Direct in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2, August 2015 using identified health IT function(s).
       3. Based upon the types of Direct messages the Health IT Module supports for sending of information (“wrapped” RFC-5751 messages required), the user sends health information to a third party using Direct in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2, August 2015.

       Approved SVAP Version(s)

       • Complete step 1 using DCDT in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete steps 2-5 using ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       Test Lab Verification

       Discover Certificates

       1. The tester verifies the Health IT Module can discover and use address-bound and domain-bound certificates hosted in both DNS and LDAP in order to create and store a listing of Direct recipients using the Direct Certificate Discovery Tool. All certificates listed in both DNS and LDAP must be tested corresponding to the standard specified at § 170.202(a)(2).

       Register Direct Address

       1. The tester verifies the Health IT Module can register a Direct email address using the ETT and has supplied a corresponding Contact Email address for receipt of the ETT validation report.

       Send Health Information Using Direct

       1. Using the ETT validation report, the tester verifies the payload sent to the ETT is encrypted using the ETT’s Public Key and signed using the Health IT Module’s Private Key.
       2. Using the ETT validation report, the tester verifies the identified health information is successfully transmitted to a third party using Direct, in accordance with the standard specified at § 170.202(a)(2), using the RFC-5751 “wrapped” message format.
       3. Using the validation report, the tester verifies the payload was successfully received by the ETT and that the ETT was able to successfully decrypt the message.

       Approved SVAP Version(s)

       • Complete step 1 verification using DCDT in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete verification for step 2-5 using ETT Direct v1.3 validation report in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(A) – Send

       Discover Certificates

       1. The user performs setup tasks to discover Direct Certificate Discovery Tool (DCDT) certificates (by downloading the DCDT Trust Anchor from the Edge Testing Tool (ETT): Direct, “Cert Discovery DCDT,” uploading it into the Health IT Module’s Direct instance, and mapping the Direct address to a non-Direct email address for receiving results) so that the user can discover and use address-bound and domain-bound certificates hosted in both DNS and LDAP in DCDT using identified health IT function(s).

       Register Direct Address

       1. The user selects “Register Direct” within the ETT: Direct Testing and registers a Direct address within the ETT and corresponding Contact Email address for receipt of the ETT validation report.

       Send Health Information Using Direct

       1. The user identifies the payload for sending to the ETT via Direct. ONC-supplied payloads are available for download from the ETT-Documents page.
       2. The user sends encrypted and signed health information to a third party (ETT) using Direct in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2, August 2015 using identified health IT function(s).
       3. Based upon the types of Direct messages the Health IT Module supports for sending of information (“wrapped” RFC-5751 messages required), the user sends health information to a third party using Direct in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2, August 2015.

       Approved SVAP Version(s)

       • Complete step 1 using DCDT in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete steps 2-5 using ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Discover Certificates

       1. The tester verifies the Health IT Module can discover and use address-bound and domain-bound certificates hosted in both DNS and LDAP in order to create and store a listing of Direct recipients using the Direct Certificate Discovery Tool. All certificates listed in both DNS and LDAP must be tested corresponding to the standard specified at § 170.202(a)(2).

       Register Direct Address

       1. The tester verifies the Health IT Module can register a Direct email address using the ETT and has supplied a corresponding Contact Email address for receipt of the ETT validation report.

       Send Health Information Using Direct

       1. Using the ETT validation report, the tester verifies the payload sent to the ETT is encrypted using the ETT’s Public Key and signed using the Health IT Module’s Private Key.
       2. Using the ETT validation report, the tester verifies the identified health information is successfully transmitted to a third party using Direct, in accordance with the standard specified at § 170.202(a)(2), using the RFC-5751 “wrapped” message format.
       3. Using the validation report, the tester verifies the payload was successfully received by the ETT and that the ETT was able to successfully decrypt the message.

       Approved SVAP Version(s)

       • Complete step 1 verification using DCDT in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete verification for step 2-5 using ETT Direct v1.3 validation report in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(A) – Receive

       System Under Test

       Hosting Certificates

       1. The user performs setup tasks to test hosting of certificates (by entering the Health IT Module’s Direct address within the Edge Testing Tool: Direct, “Cert Discovery DCDT”) and executes test cases based upon whether the Health IT Module is able to host either address-bound or domain-bound certificates in either DNS or LDAP servers using the DCDT.

       SUT Connection

       1. The user selects the “Send Direct Message” within the ETT-Direct Testing and performs setup tasks to enable the receipt of Direct Messages including:
          • Completion of the required information, identifying the Direct Address for testing receipt and digital signing of health information in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2.
          • Installation of the ETT’s Valid Trust Anchor within the Health IT Module.
          • Identification and upload of the Health IT Module’s Public Key for encryption of messages to be sent by ETT to the Health IT Module.

       Receive Direct Message

       1. The user receives RFC-5751, “wrapped” health information sent from ETT using Direct in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 and sends corresponding MDNs.

       Reject Receipt of Direct Message (Negative Testing)

       1. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: Invalid Certificate.
       2. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: Expired Certificate.
       3. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: Invalid Trust Relationship (Different Trust Anchor).
       4. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: No Authority Information Access (AIA) Extension.
       5. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: Invalid Message Digest.

       Approved SVAP Version(s)

       • Complete step 1 using DCDT in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete step 2-8 using ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       Test Lab Verification

       Hosting Certificates

       1. The tester verifies the Health IT Module’s hosted certificates are discoverable as displayed on screen for the DCDT test cases executed.

       SUT Connection

       1. No action required.

       Receive Direct Message

       1. The tester verifies that:
          • The health information can be successfully received by the Health IT Module from the ETT in accordance with the standard specified at § 170.202(a)(2) using “wrapped” RFC-575,1 messages.
          • An MDN from the Health IT Module was received from the ETT for all messages in Step 3 of the SUT.

       Reject Receipt of Direct Message (Negative Testing)

       1. Invalid Certificate: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Certificate and no corresponding MDN was received by the ETT from the Health IT Module.
       2. Expired Certificate: The tester verifies the Health IT Module rejects Direct messages received with an Expired Certificate and no corresponding MDN was received by the ETT from the Health IT Module.
       3. Invalid Trust Relationship (Different Trust Anchor): The tester verifies the Health IT Module rejects Direct messages received with an Invalid Trust Relationship (Different Trust Anchor) and no corresponding MDN was received by the ETT from the Health IT Module.
       4. No Authority Information Access (AIA) extension: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Certificate and no corresponding MDN was received by the ETT from the Health IT Module.
       5. Invalid Message Digest: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Message Digest and no corresponding MDN was received by the ETT from the Health IT Module.

       Approved SVAP Version(s)

       • Complete step 1 verification for the DCDT test cases executed in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete step 3-8 verification against the testing outcomes of using ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(A) – Receive

       Hosting Certificates

       1. The user performs setup tasks to test hosting of certificates (by entering the Health IT Module’s Direct address within the Edge Testing Tool: Direct, “Cert Discovery DCDT”) and executes test cases based upon whether the Health IT Module is able to host either address-bound or domain-bound certificates in either DNS or LDAP servers using the DCDT.

       SUT Connection

       1. The user selects the “Send Direct Message” within the ETT-Direct Testing and performs setup tasks to enable the receipt of Direct Messages including:
          • Completion of the required information, identifying the Direct Address for testing receipt and digital signing of health information in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2.
          • Installation of the ETT’s Valid Trust Anchor within the Health IT Module.
          • Identification and upload of the Health IT Module’s Public Key for encryption of messages to be sent by ETT to the Health IT Module.

       Receive Direct Message

       1. The user receives RFC-5751, “wrapped” health information sent from ETT using Direct in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 and sends corresponding MDNs.

       Reject Receipt of Direct Message (Negative Testing)

       1. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: Invalid Certificate.
       2. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: Expired Certificate.
       3. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: Invalid Trust Relationship (Different Trust Anchor).
       4. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: No Authority Information Access (AIA) Extension.
       5. The user rejects health information that is not in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 sent from the ETT to the Health IT Module using the following tool option: Invalid Message Digest.

       Approved SVAP Version(s)

       • Complete step 1 using DCDT in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete step 2-8 using ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Hosting Certificates

       1. The tester verifies the Health IT Module’s hosted certificates are discoverable as displayed on screen for the DCDT test cases executed.

       SUT Connection

       1. No action required.

       Receive Direct Message

       1. The tester verifies that:
          • The health information can be successfully received by the Health IT Module from the ETT in accordance with the standard specified at § 170.202(a)(2) using “wrapped” RFC-575,1 messages.
          • An MDN from the Health IT Module was received from the ETT for all messages in Step 3 of the SUT.

       Reject Receipt of Direct Message (Negative Testing)

       1. Invalid Certificate: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Certificate and no corresponding MDN was received by the ETT from the Health IT Module.
       2. Expired Certificate: The tester verifies the Health IT Module rejects Direct messages received with an Expired Certificate and no corresponding MDN was received by the ETT from the Health IT Module.
       3. Invalid Trust Relationship (Different Trust Anchor): The tester verifies the Health IT Module rejects Direct messages received with an Invalid Trust Relationship (Different Trust Anchor) and no corresponding MDN was received by the ETT from the Health IT Module.
       4. No Authority Information Access (AIA) extension: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Certificate and no corresponding MDN was received by the ETT from the Health IT Module.
       5. Invalid Message Digest: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Message Digest and no corresponding MDN was received by the ETT from the Health IT Module.

       Approved SVAP Version(s)

       • Complete step 1 verification for the DCDT test cases executed in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete step 3-8 verification against the testing outcomes of using ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(B) – Send using Direct + XDM

       System Under Test

       Discover Certificates

       1. The user performs setup tasks to discover Direct Certificate Discovery Tool (DCDT) certificates (by downloading the DCDT Trust Anchor from the ETT: Direct, “Cert Discovery DCDT”, uploading it into the Health IT Module’s Direct instance and mapping the Direct address to a non-Direct email address for receiving results) so that the user can discover and use address-bound and domain-bound certificates hosted in both DNS and LDAP in DCDT using developer-identified health IT function(s).

       Register Direct Address

       1. The user selects “Register Direct” within the ETT-Direct Testing and registers a Direct address within the ETT and optionally a corresponding Contact Email address for receipt of the ETT validation report.

       Send Health Information Using Direct with XDR/XDM

       1. The user identifies the payload for sending to the ETT via Direct with XDM Validation. ONC-supplied payloads are available for download from the Edge Testing Tool - Documents Home Page of the ETT, 2015 Certification C-CDA Test Data.
       2. The user sends encrypted and signed health information to a third party in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification using limited metadata, using RFC-5751, “wrapped” messages.
       3. The user sends encrypted and signed health information to a third party, in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification using full metadata, using RFC-5751, “wrapped” messages.
       4. The XDM package sent by the Health IT Module is able to be successfully validated using the ETT: Direct “Message Validator.”

       Approved SVAP Version(s)

       • Complete Step 1 using DCDT in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete Step 2 – 6 with ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       Test Lab Verification

       Discover Certificates

       1. The tester verifies the Health IT Module can discover and use address-bound and domain-bound certificates hosted in both DNS and LDAP in order to create and store a listing of Direct recipients using the Direct Certificate Discovery Tool. All certificates listed in both DNS and LDAP must be tested corresponding to the § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2, August 2015.

       Register Direct Address

       1. The tester verifies the Health IT Module can register a Direct email address using the ETT and if supplied a corresponding Contact Email address for receipt of the ETT validation report.

       Send Health Information Using Direct with XDR/XDM

       1. Using the ETT validation report, the tester verifies the payload sent to the ETT is encrypted using the ETT’s Public Key and signed using the Health IT Module’s Private Key.
       2. Using the ETT validation report, the tester verifies the identified health information is successfully transmitted to a third party using Direct with XDR/XDM, in accordance with the standard specified at § 170.202(b), using RFC-5751, ”wrapped” messages.
       3. Using the validation report, the tester verifies the payload using limited XDS metadata was successfully received by the ETT and that the ETT was able to successfully decrypt the message.
       4. Using the XDM payload available for download within the validation report, the tester uploads the XDM payloads (sent using both limited and full metadata) to the ETT’s XDM Message Validator. The tester reviews the ETT validation report to verify the XDM package is valid.

       Approved SVAP Version(s)

       • Complete step 1 verification using DCDT in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)
       • Complete step 2 – 6 verifications using ETT Direct v1.3 in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(B) – Send using Direct + XDM

       Discover Certificates

       1. The user performs setup tasks to discover Direct Certificate Discovery Tool (DCDT) certificates (by downloading the DCDT Trust Anchor from the ETT: Direct, “Cert Discovery DCDT”, uploading it into the Health IT Module’s Direct instance and mapping the Direct address to a non-Direct email address for receiving results) so that the user can discover and use address-bound and domain-bound certificates hosted in both DNS and LDAP in DCDT using developer-identified health IT function(s).

       Register Direct Address

       1. The user selects “Register Direct” within the ETT-Direct Testing and registers a Direct address within the ETT and optionally a corresponding Contact Email address for receipt of the ETT validation report.

       Send Health Information Using Direct with XDR/XDM

       1. The user identifies the payload for sending to the ETT via Direct with XDM Validation. ONC-supplied payloads are available for download from the Edge Testing Tool - Documents Home Page of the ETT, 2015 Certification C-CDA Test Data.
       2. The user sends encrypted and signed health information to a third party in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification using limited metadata, using RFC-5751, “wrapped” messages.
       3. The user sends encrypted and signed health information to a third party, in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification using full metadata, using RFC-5751, “wrapped” messages.
       4. The XDM package sent by the Health IT Module is able to be successfully validated using the ETT: Direct “Message Validator.”

       Approved SVAP Version(s)

       • Complete Step 1 using DCDT in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete Step 2 – 6 with ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Discover Certificates

       1. The tester verifies the Health IT Module can discover and use address-bound and domain-bound certificates hosted in both DNS and LDAP in order to create and store a listing of Direct recipients using the Direct Certificate Discovery Tool. All certificates listed in both DNS and LDAP must be tested corresponding to the § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2, August 2015.

       Register Direct Address

       1. The tester verifies the Health IT Module can register a Direct email address using the ETT and if supplied a corresponding Contact Email address for receipt of the ETT validation report.

       Send Health Information Using Direct with XDR/XDM

       1. Using the ETT validation report, the tester verifies the payload sent to the ETT is encrypted using the ETT’s Public Key and signed using the Health IT Module’s Private Key.
       2. Using the ETT validation report, the tester verifies the identified health information is successfully transmitted to a third party using Direct with XDR/XDM, in accordance with the standard specified at § 170.202(b), using RFC-5751, ”wrapped” messages.
       3. Using the validation report, the tester verifies the payload using limited XDS metadata was successfully received by the ETT and that the ETT was able to successfully decrypt the message.
       4. Using the XDM payload available for download within the validation report, the tester uploads the XDM payloads (sent using both limited and full metadata) to the ETT’s XDM Message Validator. The tester reviews the ETT validation report to verify the XDM package is valid.

       Approved SVAP Version(s)

       • Complete step 1 verification using DCDT in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)
       • Complete step 2 – 6 verifications using ETT Direct v1.3 in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(B) – Send conversion using XDR

       System Under Test
       1. Using the ETT: HISP Testing & Delivery Notification, "XDR Test Cases" with “Your System as: Sender,” the Health IT Module receives a Direct message from the ETT (as Sending HISP), translates it to an XDR message, and sends it to the ETT (as Edge) (XDR Test 10).
       2. The Health IT Module receives a Direct + XDM message from the ETT (as Sending HISP), translates it to an XDR message with Limited Metadata, and sends it to the ETT (as Edge) (XDR Test 11).
       3. The Health IT Module receives a Direct + XDM message from the ETT (as Sending HISP), translates it to an XDR message with Full Metadata sent to the ETT (as Edge) (XDR Test 12).

       Approved SVAP Version(s)

       • Complete step 1, 2, and 3 for XRD Test 10, 11, and 12 using ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       Test Lab Verification
       1. Using the visual inspection, the tester verifies the Direct Message was received, translated, and transmitted as an XDR to the ETT (as Edge) (XDR Test 10).
       2. Using the visual inspection, the tester verifies the Direct + XDM message was received, translated, and transmitted as an XDR to the ETT (as Edge) using Limited Metadata (XDR Test 11).
       3. Using the visual inspection, the tester verifies the Direct + XDM message received, translated, and transmitted as an XDR to the ETT (as Edge) using Full Metadata (XDR Test 12).

       Approved SVAP Version(s)

       • Complete step 1-3 verifications using visual inspection for XDR test 10, 11, and 12 using ETT Direct v1.3 in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(B) – Send conversion using XDR

       1. Using the ETT: HISP Testing & Delivery Notification, "XDR Test Cases" with “Your System as: Sender,” the Health IT Module receives a Direct message from the ETT (as Sending HISP), translates it to an XDR message, and sends it to the ETT (as Edge) (XDR Test 10).
       2. The Health IT Module receives a Direct + XDM message from the ETT (as Sending HISP), translates it to an XDR message with Limited Metadata, and sends it to the ETT (as Edge) (XDR Test 11).
       3. The Health IT Module receives a Direct + XDM message from the ETT (as Sending HISP), translates it to an XDR message with Full Metadata sent to the ETT (as Edge) (XDR Test 12).

       Approved SVAP Version(s)

       • Complete step 1, 2, and 3 for XRD Test 10, 11, and 12 using ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       1. Using the visual inspection, the tester verifies the Direct Message was received, translated, and transmitted as an XDR to the ETT (as Edge) (XDR Test 10).
       2. Using the visual inspection, the tester verifies the Direct + XDM message was received, translated, and transmitted as an XDR to the ETT (as Edge) using Limited Metadata (XDR Test 11).
       3. Using the visual inspection, the tester verifies the Direct + XDM message received, translated, and transmitted as an XDR to the ETT (as Edge) using Full Metadata (XDR Test 12).

       Approved SVAP Version(s)

       • Complete step 1-3 verifications using visual inspection for XDR test 10, 11, and 12 using ETT Direct v1.3 in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(B) – Receive using Direct + XDM

       System Under Test

       Hosting Certificates

       1. The user performs setup tasks to test hosting of certificates (by entering the Health IT Module’s Direct address within the ETT: Direct, “Cert Discovery DCDT”) and executes test cases based upon whether the Health IT Module is able to host either address-bound or domain-bound certificates in either DNS or LDAP servers using the DCDT.

       SUT Connection

       1. The user selects “Send Direct Message” within the ETT: Direct Testing and performs setup tasks to enable the receipt of Direct with XDR/XDM Messages including:
          • Completion of the required information, identifying the Direct Address for testing receipt and digital signing of health information in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification.
          • Installation of the ETT’s Valid Trust Anchor within the Health IT Module.
          • Identification and upload of the Health IT Module’s Public Key for encryption of messages to be sent by ETT to the Health IT Module.

       Receive Direct + XDR/XDM Message

       1. The user receives health information sent from ETT using Direct in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification with limited metadata and sends corresponding MDNs, using RFC-5751 “wrapped” messages.
       2. The user receives health information sent from ETT using Direct in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification with full metadata and sends corresponding MDNs.

       Validate XDM Package

       1. The user uploads the XDM payload received from the ETT to the ETT: Message Validators “XDM Validator” to perform validation of the XDM package.

       Reject Receive of Direct Message (Negative Testing)

       1. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: Invalid Certificate.
       2. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: Expired Certificate.
       3. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: Invalid Trust Relationship (Different Trust Anchor).
       4. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: No Authority Information Access (AIA) Extension.
       5. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: Invalid Message Digest.

       Approved SVAP Version(s)

       • Complete step 1 using DCDT SVAP 2022 in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)
       • Complete step 2-4 using ETT Direct v1.3 in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)
       • Complete step 5.
       • Complete step 6 – 10 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       Test Lab Verification

       Hosting Certificates

       1. The tester verifies the Health IT Module’s hosted certificates are discoverable as displayed on screen for the DCDT test cases executed.

       SUT Connection

       1. No Action Required.

       Receive Direct + XDR/XDM Message

       1. The tester verifies health information can be successfully received by the Health IT Module from the ETT in accordance with the standard specified at § 170.202(b) using the limited XDS metadata profile, using RFC-5751, “wrapped” messages and that an MDN from the Health IT Module was received by the ETT for all messages.
       2. The tester verifies health information can be successfully received by the Health IT Module from the ETT in accordance with the standard specified at § 170.202(b), using the full XDS metadata profile and using RFC-5751, “wrapped” messages and that an MDN from the Health IT Module was received by the ETT for all messages.

       Validate XDM Package

       1. Using the ETT validation report, the tester verifies the XDM payload received by the Health IT Module and uploaded to the ETT Validator successfully passes XDM validation.

       Reject Receive of Direct Message (Negative Testing)

       1. Invalid Certificate: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Certificate and that no corresponding MDN was received by the ETT from the Health IT Module.
       2. Expired Certificate: The tester verifies the Health IT Module rejects Direct messages received with an Expired Certificate and that no corresponding MDN was received by the ETT from the Health IT Module.
       3. Invalid Trust Relationship (Different Trust Anchor): The tester verifies the Health IT Module rejects Direct messages received with an Invalid Trust Relationship (Different Trust Anchor) and that no corresponding MDN was received by the ETT from the Health IT Module.
       4. No Authority Information Access (AIA) extension: The tester verifies the Health IT Module rejects Direct messages received with No Authority Information Access (AIA) extension and that no corresponding MDN was received by the ETT from the Health IT Module.
       5. Invalid Message Digest: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Message Digest and that no corresponding MDN was received by the ETT from the Health IT Module.

       Approved SVAP Version(s)

       • Complete step 1 verification for the DCDT test cases executed in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete step 3-4 verifications in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       • Complete step 5 verification/validation using ETT Direct v1.3.
       • Complete step 5-10 verifications for ETT Direct v1.3 messages.

       Paragraph (h)(2)(i)(B) – Receive using Direct + XDM

       Hosting Certificates

       1. The user performs setup tasks to test hosting of certificates (by entering the Health IT Module’s Direct address within the ETT: Direct, “Cert Discovery DCDT”) and executes test cases based upon whether the Health IT Module is able to host either address-bound or domain-bound certificates in either DNS or LDAP servers using the DCDT.

       SUT Connection

       1. The user selects “Send Direct Message” within the ETT: Direct Testing and performs setup tasks to enable the receipt of Direct with XDR/XDM Messages including:
          • Completion of the required information, identifying the Direct Address for testing receipt and digital signing of health information in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification.
          • Installation of the ETT’s Valid Trust Anchor within the Health IT Module.
          • Identification and upload of the Health IT Module’s Public Key for encryption of messages to be sent by ETT to the Health IT Module.

       Receive Direct + XDR/XDM Message

       1. The user receives health information sent from ETT using Direct in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification with limited metadata and sends corresponding MDNs, using RFC-5751 “wrapped” messages.
       2. The user receives health information sent from ETT using Direct in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification with full metadata and sends corresponding MDNs.

       Validate XDM Package

       1. The user uploads the XDM payload received from the ETT to the ETT: Message Validators “XDM Validator” to perform validation of the XDM package.

       Reject Receive of Direct Message (Negative Testing)

       1. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: Invalid Certificate.
       2. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: Expired Certificate.
       3. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: Invalid Trust Relationship (Different Trust Anchor).
       4. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: No Authority Information Access (AIA) Extension.
       5. The user rejects health information not in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification sent from the ETT to the Health IT Module using the following tool option: Invalid Message Digest.

       Approved SVAP Version(s)

       • Complete step 1 using DCDT SVAP 2022 in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)
       • Complete step 2-4 using ETT Direct v1.3 in accordance with the ONC Applicability Statement for Secure Health Transport v1.3, May 2021 (Direct.)
       • Complete step 5.
       • Complete step 6 – 10 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Hosting Certificates

       1. The tester verifies the Health IT Module’s hosted certificates are discoverable as displayed on screen for the DCDT test cases executed.

       SUT Connection

       1. No Action Required.

       Receive Direct + XDR/XDM Message

       1. The tester verifies health information can be successfully received by the Health IT Module from the ETT in accordance with the standard specified at § 170.202(b) using the limited XDS metadata profile, using RFC-5751, “wrapped” messages and that an MDN from the Health IT Module was received by the ETT for all messages.
       2. The tester verifies health information can be successfully received by the Health IT Module from the ETT in accordance with the standard specified at § 170.202(b), using the full XDS metadata profile and using RFC-5751, “wrapped” messages and that an MDN from the Health IT Module was received by the ETT for all messages.

       Validate XDM Package

       1. Using the ETT validation report, the tester verifies the XDM payload received by the Health IT Module and uploaded to the ETT Validator successfully passes XDM validation.

       Reject Receive of Direct Message (Negative Testing)

       1. Invalid Certificate: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Certificate and that no corresponding MDN was received by the ETT from the Health IT Module.
       2. Expired Certificate: The tester verifies the Health IT Module rejects Direct messages received with an Expired Certificate and that no corresponding MDN was received by the ETT from the Health IT Module.
       3. Invalid Trust Relationship (Different Trust Anchor): The tester verifies the Health IT Module rejects Direct messages received with an Invalid Trust Relationship (Different Trust Anchor) and that no corresponding MDN was received by the ETT from the Health IT Module.
       4. No Authority Information Access (AIA) extension: The tester verifies the Health IT Module rejects Direct messages received with No Authority Information Access (AIA) extension and that no corresponding MDN was received by the ETT from the Health IT Module.
       5. Invalid Message Digest: The tester verifies the Health IT Module rejects Direct messages received with an Invalid Message Digest and that no corresponding MDN was received by the ETT from the Health IT Module.

       Approved SVAP Version(s)

       • Complete step 1 verification for the DCDT test cases executed in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       • Complete step 3-4 verifications in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       • Complete step 5 verification/validation using ETT Direct v1.3.
       • Complete step 5-10 verifications for ETT Direct v1.3 messages.

       Paragraph (h)(2)(i)(B) – Receive conversion using XDR

       System Under Test
       1. Using the ETT: HISP Testing & Delivery Notification "XDR Test Cases", with “Your System as: Receiver” the Health IT Module receives a properly formatted XDR message with limited metadata from the ETT (as Edge), and translates it to a Direct message, and sends it to the ETT (as Destination HISP) (XDR Test 13).
       2. The Health IT Module receives a properly formatted XDR message with full metadata from the ETT (as Edge), translates it to a Direct message, and sends it to the ETT (as Destination HISP) (XDR Test 14).

       Approved SVAP Version(s)

       Complete step 1-2 for XRD test 13 1nd 14 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Test Lab Verification
       1. The tester verifies the message received by the Health IT Module was converted to a Direct Message, with Limited Metadata, and returned to the ETT, in accordance with the standard § 170.202(b) ONC XDR and XDM for Direct Messaging Specification, using the ETT validation report, sent to the contact’s registered email address, and the ETT logs (XDR Test 13).
       2. The tester verifies the message received by the Health IT Module was converted to a Direct Message with Full Metadata, and returned to the ETT, in accordance with the standard § 170.202(b), using the ETT validation report, sent to the contact’s registered email address, and the ETT logs (XDR Test 14).

       Approved SVAP Version(s)

       • Complete step 1-2 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(B) – Receive conversion using XDR

       1. Using the ETT: HISP Testing & Delivery Notification "XDR Test Cases", with “Your System as: Receiver” the Health IT Module receives a properly formatted XDR message with limited metadata from the ETT (as Edge), and translates it to a Direct message, and sends it to the ETT (as Destination HISP) (XDR Test 13).
       2. The Health IT Module receives a properly formatted XDR message with full metadata from the ETT (as Edge), translates it to a Direct message, and sends it to the ETT (as Destination HISP) (XDR Test 14).

       Approved SVAP Version(s)

       Complete step 1-2 for XRD test 13 1nd 14 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       1. The tester verifies the message received by the Health IT Module was converted to a Direct Message, with Limited Metadata, and returned to the ETT, in accordance with the standard § 170.202(b) ONC XDR and XDM for Direct Messaging Specification, using the ETT validation report, sent to the contact’s registered email address, and the ETT logs (XDR Test 13).
       2. The tester verifies the message received by the Health IT Module was converted to a Direct Message with Full Metadata, and returned to the ETT, in accordance with the standard § 170.202(b), using the ETT validation report, sent to the contact’s registered email address, and the ETT logs (XDR Test 14).

       Approved SVAP Version(s)

       • Complete step 1-2 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Send Using Edge Protocol for IHE XDR profile for Limited Metadata Document Sources

       System Under Test

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “XDR Cases” with “System as Sender”, the user establishes a Mutual TLS session for the Health IT Module to authenticate to the ETT (XDR Test 16).
       2. The Health IT Module provides documentation of the Health IT Module’s ability to reject the connection for a TLS session initiated with an Edge due to an invalid certificate.

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Send Payload

       1. The user configures the ETT’s endpoints within the Health IT Module and provides the Health IT Module’s Direct “To” address to generate endpoints. Acting as a HISP, the Health IT Module receives and translates a Direct message to an XDR message, and sends the translated message to the ETT (acting as an Edge) for the following types of messages:
          • Direct to send to Edge as an XDR message (XDR Test 10);
          • Direct + XDM to send to Edge as an XDR message with Limited Metadata (XDR Test 11); and
          • Direct + XDM to send to Edge as an XDR message with Full Metadata (XDR Test 12).

       Message Tracking Using Processed MDNs (Negative Tests)

       1. Using the ETT: HISP & Delivery Notification “XDR Cases” with “System as Receiver”, the ETT (as Edge) sends a message to the Health IT Module using a bad address (non-existent), such that the Health IT Module is unable to deliver the message. The Health IT Module delivers a failure message to the ETT (as Edge) using the XDR profile due to a bad address (non-existent) (XDR MT Test 13).
       2. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT (as Destination HISP) is not trusted. The Health IT Module delivers a failure message to the ETT (as Edge) using the XDR profile due to an untrusted HISP (ETT as Destination HISP) (XDR MT Test 14).
       3. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT’s (as Destination HISP) certificates are not published. The Health IT Module delivers a failure message to the ETT (as Edge) using the XDR profile due to an unpublished HISP certificate (ETT as Destination HISP) (XDR MT Test 15).
       4. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT (as Destination HISP) does not respond with a processed MDN. The Health IT Module delivers a failure message to the ETT (as Edge) using the XDR profile, due to exceeded wait period for receiving a processed MDN from the ETT (as Destination HISP) (XDR MT Test 16).

       Approved SVAP Version(s)

       • Complete step 1-8 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       Test Lab Verification

       SUT Connection– Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module initiates a Mutual TLS session with the ETT (XDR Test 16).
       2. The tester verifies evidence of the Health IT Module’s capability to initiate a TLS session but reject the connection with an Edge due to an invalid certificate.

       SUT Connection– Secure Network If Not Using TLS

       1. The tester verifies through evidence that the system provides a “secure network” as described at § 170.202(d).

       Send Payload

       1. Using the ETT validation report, the tester verifies the Health IT Module can translate the following using § 170.202(d):
          • Direct Message to Health IT Module to XDR message (XDR Test 10);
          • Direct + XDM Message to Health IT Module to XDR message with Limited Metadata (XDR Test 11); and
          • Direct + XDM Message to Health IT Module to XDR message with Full Metadata (XDR Test 12).

       Message Tracking Using Processed MDNs (Negative Tests)

       1. Using visual inspection of the ETT logs, the tester verifies the Health IT Module has sent failure messages to the ETT (as Edge) using the XDR profile due to bad address (non-existent) (XDR MT Test 13).
       2. Using visual inspection of the logs, the tester verifies the Health IT Module has sent failure messages to the ETT (as Edge) using the XDR profile due to Untrusted Destination HISP (XDR MT Test 14).
       3. Using visual inspection of the ETT logs, the tester verifies the Health IT Module has sent failure messages to the ETT (as Edge) using the XDR profile due to Unpublished Certificate for Destination HISP (XDR MT Test 15).
       4. Using visual inspection of the ETT logs, the tester verifies the Health IT Module has sent failure messages to the ETT (as Edge) using the XDR profile due to Delivery Failure Timeout (XDR MT Test 16).

       Approved SVAP Version(s)

       • Complete step 1-8 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Send Using Edge Protocol for IHE XDR profile for Limited Metadata Document Sources

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “XDR Cases” with “System as Sender”, the user establishes a Mutual TLS session for the Health IT Module to authenticate to the ETT (XDR Test 16).
       2. The Health IT Module provides documentation of the Health IT Module’s ability to reject the connection for a TLS session initiated with an Edge due to an invalid certificate.

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Send Payload

       1. The user configures the ETT’s endpoints within the Health IT Module and provides the Health IT Module’s Direct “To” address to generate endpoints. Acting as a HISP, the Health IT Module receives and translates a Direct message to an XDR message, and sends the translated message to the ETT (acting as an Edge) for the following types of messages:
          • Direct to send to Edge as an XDR message (XDR Test 10);
          • Direct + XDM to send to Edge as an XDR message with Limited Metadata (XDR Test 11); and
          • Direct + XDM to send to Edge as an XDR message with Full Metadata (XDR Test 12).

       Message Tracking Using Processed MDNs (Negative Tests)

       1. Using the ETT: HISP & Delivery Notification “XDR Cases” with “System as Receiver”, the ETT (as Edge) sends a message to the Health IT Module using a bad address (non-existent), such that the Health IT Module is unable to deliver the message. The Health IT Module delivers a failure message to the ETT (as Edge) using the XDR profile due to a bad address (non-existent) (XDR MT Test 13).
       2. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT (as Destination HISP) is not trusted. The Health IT Module delivers a failure message to the ETT (as Edge) using the XDR profile due to an untrusted HISP (ETT as Destination HISP) (XDR MT Test 14).
       3. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT’s (as Destination HISP) certificates are not published. The Health IT Module delivers a failure message to the ETT (as Edge) using the XDR profile due to an unpublished HISP certificate (ETT as Destination HISP) (XDR MT Test 15).
       4. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT (as Destination HISP) does not respond with a processed MDN. The Health IT Module delivers a failure message to the ETT (as Edge) using the XDR profile, due to exceeded wait period for receiving a processed MDN from the ETT (as Destination HISP) (XDR MT Test 16).

       Approved SVAP Version(s)

       • Complete step 1-8 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       SUT Connection– Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module initiates a Mutual TLS session with the ETT (XDR Test 16).
       2. The tester verifies evidence of the Health IT Module’s capability to initiate a TLS session but reject the connection with an Edge due to an invalid certificate.

       SUT Connection– Secure Network If Not Using TLS

       1. The tester verifies through evidence that the system provides a “secure network” as described at § 170.202(d).

       Send Payload

       1. Using the ETT validation report, the tester verifies the Health IT Module can translate the following using § 170.202(d):
          • Direct Message to Health IT Module to XDR message (XDR Test 10);
          • Direct + XDM Message to Health IT Module to XDR message with Limited Metadata (XDR Test 11); and
          • Direct + XDM Message to Health IT Module to XDR message with Full Metadata (XDR Test 12).

       Message Tracking Using Processed MDNs (Negative Tests)

       1. Using visual inspection of the ETT logs, the tester verifies the Health IT Module has sent failure messages to the ETT (as Edge) using the XDR profile due to bad address (non-existent) (XDR MT Test 13).
       2. Using visual inspection of the logs, the tester verifies the Health IT Module has sent failure messages to the ETT (as Edge) using the XDR profile due to Untrusted Destination HISP (XDR MT Test 14).
       3. Using visual inspection of the ETT logs, the tester verifies the Health IT Module has sent failure messages to the ETT (as Edge) using the XDR profile due to Unpublished Certificate for Destination HISP (XDR MT Test 15).
       4. Using visual inspection of the ETT logs, the tester verifies the Health IT Module has sent failure messages to the ETT (as Edge) using the XDR profile due to Delivery Failure Timeout (XDR MT Test 16).

       Approved SVAP Version(s)

       • Complete step 1-8 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Send Using Edge Protocol for SMTP

       System Under Test

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “SMTP Tests” with “System as Sender”, the user initiates a TLS session for the Health IT Module with the ETT (SMTP Test 8).
       2. The Health IT Module provides documentation of the Heath IT Module’s ability to reject the connection for a TLS session initiated with an Edge due to an invalid certificate.

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Send Payload

       1. The user sends a document to the ETT (SMTP Test 14).

       Message Tracking Using Processed MDNs (Negative Tests)

       1. Using the ETT: HISP & Delivery Notification “Message Tracking” with “System as Sender”, the ETT (as Edge) sends a message to the Health IT Module using a bad address (non-existent), such that the Health IT Module is unable to deliver the message. The Health IT Module delivers a failure message to the ETT (as Edge) using the following edge protocol due to a bad address (non-existent):
          • SMTP MT Test 1 or alternatively;
          • SMTP/IMAP MT Test 5 (Alternative);
          • SMTP/POP MT Test 9 (Alternative).
       2. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT (as Destination HISP) is not trusted. The Health IT Module delivers a failure message to the ETT (as Edge) using the following edge protocol due to an untrusted HISP (ETT as Destination HISP):
          • SMTP MT Test 2 or alternatively;
          • SMTP/IMAP MT Test 6 (Alternative);
          • SMTP/POP MT Test 10 (Alternative).
       3. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT’s (as Destination HISP) certificates are not published. The Health IT Module delivers a failure message to the ETT (as Edge) using the following edge protocol due to an unpublished HISP certificate (ETT as Destination HISP):
          • SMTP MT Test 3 or alternatively;
          • SMTP/IMAP MT Test 7 (Alternative);
          • SMTP/POP MT Test 11 (Alternative).
       4. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT (as Destination HISP) does not respond with a processed MDN. The Health IT Module delivers a failure message to the ETT (as Edge) using the following edge protocol due to exceeded wait period for receiving a processed MDN from the ETT (as Destination HISP), delivery time-out:
          • SMTP MT Test 4 or alternatively;
          • SMTP/IMAP MT Test 8 (Alternative);
          • SMTP/POP MT Test 12 (Alternative).

       Approved SVAP Version(s)

       • Complete step 1-8 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)
       Test Lab Verification

       SUT Connection – Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module initiates a TLS session (SMTP Test 8).
       2. The tester verifies evidence of the Health IT Module’s capability to initiate a TLS session, but reject the connection with an Edge due to an invalid certificate.

       SUT Connection – Secure Network If Not Using TLS

       1. The tester verifies through evidence that the system provides a “secure network” as described at § 170.202(d).

       Send Payload

       1. The tester verifies the Health IT Module can send an SMTP Message using the SMTP Edge Protocol (SMTP Test 14).

       Message Tracking Using Processed MDNs (Negative Tests)

       1. Using visual inspection of the ETT logs to confirm the receipt of the negative delivery status notification message, the tester verifies the Health IT Module has sent a delivery failure message due to a bad address (non-existent) to the ETT (as Edge) for the following tests:
          • SMTP MT Test 1 or alternatively;
          • SMTP/IMAP MT Test 5 (Alternative);
          • SMTP/POP MT Test 9 (Alternative).
       2. Using the ETT, the tester verifies the Health IT Module successfully performs message tracking using processed MDNs. Using visual inspection of the ETT logs to confirm the receipt of the negative delivery status notification message, the tester verifies the Health IT Module has sent a delivery failure messages due to an untrusted HISP to the ETT (as Edge) for the following tests:
          • SMTP MT Test 2 or alternatively;
          • SMTP/IMAP MT Test 6 (Alternative);
          • SMTP/POP MT Test 10 (Alternative).
       3. Using visual inspection of the ETT logs to confirm the receipt of the negative delivery status notification message, the tester verifies the Health IT Module has sent a delivery failure messages due to an unpublished HISP certificate to the ETT (as Edge) for the following tests:
          • SMTP MT Test 3 or alternatively;
          • SMTP/IMAP MT Test 7 (Alternative);
          • SMTP/POP MT Test 11 (Alternative).
       4. Using visual inspection of the ETT logs to confirm the receipt of the negative delivery status notification message, the tester verifies the Health IT Module has sent a delivery failure messages due to exceeded wait period for receiving a processed MDN to the ETT (as Edge) for the following tests:
          • SMTP MT Test 4 or alternatively;
          • SMTP/IMAP MT Test 8 (Alternative);
          • SMTP/POP MT Test 12 (Alternative).

       Approved SVAP Version(s)

       Complete step 1-8 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Send Using Edge Protocol for SMTP

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “SMTP Tests” with “System as Sender”, the user initiates a TLS session for the Health IT Module with the ETT (SMTP Test 8).
       2. The Health IT Module provides documentation of the Heath IT Module’s ability to reject the connection for a TLS session initiated with an Edge due to an invalid certificate.

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Send Payload

       1. The user sends a document to the ETT (SMTP Test 14).

       Message Tracking Using Processed MDNs (Negative Tests)

       1. Using the ETT: HISP & Delivery Notification “Message Tracking” with “System as Sender”, the ETT (as Edge) sends a message to the Health IT Module using a bad address (non-existent), such that the Health IT Module is unable to deliver the message. The Health IT Module delivers a failure message to the ETT (as Edge) using the following edge protocol due to a bad address (non-existent):
          • SMTP MT Test 1 or alternatively;
          • SMTP/IMAP MT Test 5 (Alternative);
          • SMTP/POP MT Test 9 (Alternative).
       2. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT (as Destination HISP) is not trusted. The Health IT Module delivers a failure message to the ETT (as Edge) using the following edge protocol due to an untrusted HISP (ETT as Destination HISP):
          • SMTP MT Test 2 or alternatively;
          • SMTP/IMAP MT Test 6 (Alternative);
          • SMTP/POP MT Test 10 (Alternative).
       3. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT’s (as Destination HISP) certificates are not published. The Health IT Module delivers a failure message to the ETT (as Edge) using the following edge protocol due to an unpublished HISP certificate (ETT as Destination HISP):
          • SMTP MT Test 3 or alternatively;
          • SMTP/IMAP MT Test 7 (Alternative);
          • SMTP/POP MT Test 11 (Alternative).
       4. The ETT (as Edge) sends a message to the Health IT Module using a valid address, but the ETT (as Destination HISP) does not respond with a processed MDN. The Health IT Module delivers a failure message to the ETT (as Edge) using the following edge protocol due to exceeded wait period for receiving a processed MDN from the ETT (as Destination HISP), delivery time-out:
          • SMTP MT Test 4 or alternatively;
          • SMTP/IMAP MT Test 8 (Alternative);
          • SMTP/POP MT Test 12 (Alternative).

       Approved SVAP Version(s)

       • Complete step 1-8 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       SUT Connection – Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module initiates a TLS session (SMTP Test 8).
       2. The tester verifies evidence of the Health IT Module’s capability to initiate a TLS session, but reject the connection with an Edge due to an invalid certificate.

       SUT Connection – Secure Network If Not Using TLS

       1. The tester verifies through evidence that the system provides a “secure network” as described at § 170.202(d).

       Send Payload

       1. The tester verifies the Health IT Module can send an SMTP Message using the SMTP Edge Protocol (SMTP Test 14).

       Message Tracking Using Processed MDNs (Negative Tests)

       1. Using visual inspection of the ETT logs to confirm the receipt of the negative delivery status notification message, the tester verifies the Health IT Module has sent a delivery failure message due to a bad address (non-existent) to the ETT (as Edge) for the following tests:
          • SMTP MT Test 1 or alternatively;
          • SMTP/IMAP MT Test 5 (Alternative);
          • SMTP/POP MT Test 9 (Alternative).
       2. Using the ETT, the tester verifies the Health IT Module successfully performs message tracking using processed MDNs. Using visual inspection of the ETT logs to confirm the receipt of the negative delivery status notification message, the tester verifies the Health IT Module has sent a delivery failure messages due to an untrusted HISP to the ETT (as Edge) for the following tests:
          • SMTP MT Test 2 or alternatively;
          • SMTP/IMAP MT Test 6 (Alternative);
          • SMTP/POP MT Test 10 (Alternative).
       3. Using visual inspection of the ETT logs to confirm the receipt of the negative delivery status notification message, the tester verifies the Health IT Module has sent a delivery failure messages due to an unpublished HISP certificate to the ETT (as Edge) for the following tests:
          • SMTP MT Test 3 or alternatively;
          • SMTP/IMAP MT Test 7 (Alternative);
          • SMTP/POP MT Test 11 (Alternative).
       4. Using visual inspection of the ETT logs to confirm the receipt of the negative delivery status notification message, the tester verifies the Health IT Module has sent a delivery failure messages due to exceeded wait period for receiving a processed MDN to the ETT (as Edge) for the following tests:
          • SMTP MT Test 4 or alternatively;
          • SMTP/IMAP MT Test 8 (Alternative);
          • SMTP/POP MT Test 12 (Alternative).

       Approved SVAP Version(s)

       Complete step 1-8 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Send Using Edge Protocol for IMAP (SMTP Alternative)

       System Under Test

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “IMAP Tests” with the ETT for “System as Sender”, the user initiates an IMAP session to the Health IT Module with STARTTLS (STARTTLS command) and PLAIN SSL authentication (AUTHENTICATE command) (IMAP Test 8, 11, 15).
       2. The Health IT Module provides documentation of the Heath IT Module’s ability to processes connection requests initiated using STARTTLS with valid cipher suite(s) in accordance with RFC 3501 and the subsequently updated standards: RFC 2246, NIST Special Publication 800-52 Revision 1, RFC 7465, and is in accordance with the security standards specified in the § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 (IMAP Test 8, 11, 15).
       3. The Health IT Module provides documentation of the ability to accept a valid authentication mechanism and authenticates the Edge.
       4. Negative Test: The Health IT Module provides documentation of the ability to reject an authentication request from an Edge.

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Execute IMAP4 Commands

       1. Using the ETT: HISP & Delivery Notification “IMAP Tests” with the ETT for “System as Sender”, the user initiates an IMAP session to the Health IT Module using the IMAP4 CAPABILITIES command, NOOP command, and LOGOUT command (or equivalent for a secure network) (IMAP Tests 1, 2, 3).
       2. Using the ETT, the user initiates an IMAP session to the Health IT Module using the STARTTLS and AUTHENTICATE commands (or equivalent for a secure network), LOGIN command, SELECT command, and FETCH command (IMAP Tests 8, 11, 15).

       Reject IMAP4 Connection (Negative Tests)

       1. Negative Test: The user demonstrates the Health IT Module rejects an IMAP4 connection with a bad command syntax by terminating the connection from the ETT (IMAP Test 9).
       2. Negative Test: The user demonstrates the Health IT Module rejects an IMAP4 connections with bad commands using the right syntax based upon the specific state of the connection by terminating the connection from the ETT (IMAP Test 10).

       Message Processing

       1. The ETT (as Edge) is able to fetch attachments from the Health IT Module using an IMAP4 connection (IMAP Test 32).
       2. Negative Test: The Health IT Module rejects authentication requests from the ETT due to an invalid username/password (IMAP Test 17).

       Approved SVAP Version(s)

       • Complete step 1-11 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       Test Lab Verification

       SUT Connection – Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module is able to successfully initiate an IMAP4 session with the Health IT Module (IMAP Test 8, 11, 15).
       2. The tester verifies evidence of the Health IT Module’s capability to process connection requests initiated using STARTTLS with one or more valid cipher suite (IMAP Test 8, 11, 15).
       3. The tester verifies evidence of the Health IT Module’s capability to accept authentication requests.
       4. Negative Test: The tester verifies evidence of the Health IT Module’s capability to reject authentication requests.

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d).

       Execute IMAP4 Commands

       1. Using the ETT logs, the tester verifies the Health IT Module is has successfully implemented the following commands IMAP4 CAPABILITY, NOOP, and LOGOUT (or equivalent for a secure network) (IMAP Test 1, 2, 3).
       2. Using the ETT logs, the tester verifies the Health IT Module is has successfully implemented the following commands IMAP4 STARTTLS and AUTHENTICATE (or equivalent for a secure network), LOGIN, SELECT, and FETCH (IMAP Test 8, 11, 15).

       Reject IMAP4 Connection (Negative Tests)

       1. Negative Tests: Using the ETT logs, the tester verifies the Health IT Module rejects a bad command syntax with the appropriate response and terminates connection with the ETT (IMAP Tests 9).
       2. Negative Tests: Using the ETT logs, the tester verifies the Health IT Module rejects a bad command with correct syntax with the appropriate response and terminates connection with the ETT (IMAP Tests 10).

       Message Processing

       1. Using the ETT logs, the tester verifies the Health IT Module is able to host attachments and make them available for fetching using IMAP (IMAP Test 32).
       2. Negative Test: Using the ETT logs, the tester verifies the Health IT Module rejects authentication requests due to invalid username/password (IMAP Test 17).

       Approved SVAP Version(s)

       • Complete step 1-11 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Send Using Edge Protocol for IMAP (SMTP Alternative)

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “IMAP Tests” with the ETT for “System as Sender”, the user initiates an IMAP session to the Health IT Module with STARTTLS (STARTTLS command) and PLAIN SSL authentication (AUTHENTICATE command) (IMAP Test 8, 11, 15).
       2. The Health IT Module provides documentation of the Heath IT Module’s ability to processes connection requests initiated using STARTTLS with valid cipher suite(s) in accordance with RFC 3501 and the subsequently updated standards: RFC 2246, NIST Special Publication 800-52 Revision 1, RFC 7465, and is in accordance with the security standards specified in the § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 (IMAP Test 8, 11, 15).
       3. The Health IT Module provides documentation of the ability to accept a valid authentication mechanism and authenticates the Edge.
       4. Negative Test: The Health IT Module provides documentation of the ability to reject an authentication request from an Edge.

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Execute IMAP4 Commands

       1. Using the ETT: HISP & Delivery Notification “IMAP Tests” with the ETT for “System as Sender”, the user initiates an IMAP session to the Health IT Module using the IMAP4 CAPABILITIES command, NOOP command, and LOGOUT command (or equivalent for a secure network) (IMAP Tests 1, 2, 3).
       2. Using the ETT, the user initiates an IMAP session to the Health IT Module using the STARTTLS and AUTHENTICATE commands (or equivalent for a secure network), LOGIN command, SELECT command, and FETCH command (IMAP Tests 8, 11, 15).

       Reject IMAP4 Connection (Negative Tests)

       1. Negative Test: The user demonstrates the Health IT Module rejects an IMAP4 connection with a bad command syntax by terminating the connection from the ETT (IMAP Test 9).
       2. Negative Test: The user demonstrates the Health IT Module rejects an IMAP4 connections with bad commands using the right syntax based upon the specific state of the connection by terminating the connection from the ETT (IMAP Test 10).

       Message Processing

       1. The ETT (as Edge) is able to fetch attachments from the Health IT Module using an IMAP4 connection (IMAP Test 32).
       2. Negative Test: The Health IT Module rejects authentication requests from the ETT due to an invalid username/password (IMAP Test 17).

       Approved SVAP Version(s)

       • Complete step 1-11 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       SUT Connection – Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module is able to successfully initiate an IMAP4 session with the Health IT Module (IMAP Test 8, 11, 15).
       2. The tester verifies evidence of the Health IT Module’s capability to process connection requests initiated using STARTTLS with one or more valid cipher suite (IMAP Test 8, 11, 15).
       3. The tester verifies evidence of the Health IT Module’s capability to accept authentication requests.
       4. Negative Test: The tester verifies evidence of the Health IT Module’s capability to reject authentication requests.

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d).

       Execute IMAP4 Commands

       1. Using the ETT logs, the tester verifies the Health IT Module is has successfully implemented the following commands IMAP4 CAPABILITY, NOOP, and LOGOUT (or equivalent for a secure network) (IMAP Test 1, 2, 3).
       2. Using the ETT logs, the tester verifies the Health IT Module is has successfully implemented the following commands IMAP4 STARTTLS and AUTHENTICATE (or equivalent for a secure network), LOGIN, SELECT, and FETCH (IMAP Test 8, 11, 15).

       Reject IMAP4 Connection (Negative Tests)

       1. Negative Tests: Using the ETT logs, the tester verifies the Health IT Module rejects a bad command syntax with the appropriate response and terminates connection with the ETT (IMAP Tests 9).
       2. Negative Tests: Using the ETT logs, the tester verifies the Health IT Module rejects a bad command with correct syntax with the appropriate response and terminates connection with the ETT (IMAP Tests 10).

       Message Processing

       1. Using the ETT logs, the tester verifies the Health IT Module is able to host attachments and make them available for fetching using IMAP (IMAP Test 32).
       2. Negative Test: Using the ETT logs, the tester verifies the Health IT Module rejects authentication requests due to invalid username/password (IMAP Test 17).

       Approved SVAP Version(s)

       • Complete step 1-11 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Send Using Edge Protocol for POP3 (SMTP Alternative)

       System Under Test

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “POP Tests” with the ETT for “System as Sender”, the user initiates a POP session to the Health IT Module with STARTTLS (STARTTLS command) (POP Test 5, 11, 15).
       2. The Health IT Module provides documentation of the Heath IT Module’s ability to processes connection requests initiated using STARTTLS with a valid cipher suite(s) in accordance with RFC 3501, and the subsequently updated standards: RFC 2246, NIST Special Publication 800-52, Revision 1, RFC 7465, and is in accordance with the security standards specified in the § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 (POP Test 5, 11, 15).

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Execute POP3 Commands

       1. Using the ETT: HISP & Delivery Notification “POP Tests” with the ETT for “System as Sender”, the user initiates a POP session to the Health IT Module using the POP3 CAPA command, NOOP command, and QUIT command (or equivalent for a secure network) (POP Test 1, 2).
       2. Using the ETT, the user initiates a POP session to the Health IT Module using the POP3 STAT command, STARTTLS command (or equivalent for a secure network), RETR command, LIST command, and RSET command (POP Test 5, 11, 15).

       Reject POP3 Connection (Negative Tests)

       1. Negative Test: The user demonstrates the Health IT Module rejects a POP3 connection with a bad command syntax by terminating the connection from the ETT (POP Test 9).
       2. Negative Test: The user demonstrates the Health IT Module rejects a POP3 connection with bad commands using the right syntax based upon the specific state of the connection by terminating the connection from the ETT (POP Test 10).

       Message Processing

       1. The ETT (as Edge) is able to fetch attachments from the Health IT Module using an IMAP4 connection (POP Test 32).
       2. Negative Test: The Health IT Module rejects authentication requests from the ETT due to an invalid username/password (POP Test 17).

       Approved SVAP Version(s)

       • Complete step 1-9 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       Test Lab Verification

       SUT Connection – Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module is able to successfully initiate a POP session with the Health IT Module (POP Test 5, 11, 15).
       2. The tester verifies evidence of the Health IT Module’s capability to process connection requests initiated using STARTTLS with one or more valid cipher suite (POP Test 3-5, 11, 15).

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d).

       Execute POP3 Commands

       1. Using the ETT logs, the tester verifies the Health IT Module has successfully implemented the following commands: POP3 CAPA, NOOP, and QUIT (or equivalent for a secure network) (POP Test 1, 2).
       2. Using the ETT logs, the tester verifies the Health IT Module has successfully implemented the following commands POP3 STAT, STARTTLS (or equivalent for a secure network), RETR, LIST, and RSET (POP Test 5, 11, 15).

       Reject POP3 Connection (Negative Tests)

       1. Negative Tests: Using the ETT logs, the tester verifies the Health IT Module rejects bad command syntax commands with the appropriate response and terminates connection with the ETT (POP Test 9).
       2. Negative Tests: Using the ETT logs, the tester verifies the Health IT Module rejects bad commands using the right syntax commands with the appropriate response and terminates connection with the ETT (POP Test 10).

       Message Processing

       1. Using the ETT logs, the tester verifies the Health IT Module is able to host attachments and make them available for fetching using POP (POP Test 32).
       2. Negative Test: Using the ETT logs, the tester verifies the Health IT Module rejects authentication requests due to invalid username/password (POP Test 17).

       Approved SVAP Version(s)

       • Complete step 1-9 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Send Using Edge Protocol for POP3 (SMTP Alternative)

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “POP Tests” with the ETT for “System as Sender”, the user initiates a POP session to the Health IT Module with STARTTLS (STARTTLS command) (POP Test 5, 11, 15).
       2. The Health IT Module provides documentation of the Heath IT Module’s ability to processes connection requests initiated using STARTTLS with a valid cipher suite(s) in accordance with RFC 3501, and the subsequently updated standards: RFC 2246, NIST Special Publication 800-52, Revision 1, RFC 7465, and is in accordance with the security standards specified in the § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2 (POP Test 5, 11, 15).

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Execute POP3 Commands

       1. Using the ETT: HISP & Delivery Notification “POP Tests” with the ETT for “System as Sender”, the user initiates a POP session to the Health IT Module using the POP3 CAPA command, NOOP command, and QUIT command (or equivalent for a secure network) (POP Test 1, 2).
       2. Using the ETT, the user initiates a POP session to the Health IT Module using the POP3 STAT command, STARTTLS command (or equivalent for a secure network), RETR command, LIST command, and RSET command (POP Test 5, 11, 15).

       Reject POP3 Connection (Negative Tests)

       1. Negative Test: The user demonstrates the Health IT Module rejects a POP3 connection with a bad command syntax by terminating the connection from the ETT (POP Test 9).
       2. Negative Test: The user demonstrates the Health IT Module rejects a POP3 connection with bad commands using the right syntax based upon the specific state of the connection by terminating the connection from the ETT (POP Test 10).

       Message Processing

       1. The ETT (as Edge) is able to fetch attachments from the Health IT Module using an IMAP4 connection (POP Test 32).
       2. Negative Test: The Health IT Module rejects authentication requests from the ETT due to an invalid username/password (POP Test 17).

       Approved SVAP Version(s)

       • Complete step 1-9 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       SUT Connection – Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module is able to successfully initiate a POP session with the Health IT Module (POP Test 5, 11, 15).
       2. The tester verifies evidence of the Health IT Module’s capability to process connection requests initiated using STARTTLS with one or more valid cipher suite (POP Test 3-5, 11, 15).

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d).

       Execute POP3 Commands

       1. Using the ETT logs, the tester verifies the Health IT Module has successfully implemented the following commands: POP3 CAPA, NOOP, and QUIT (or equivalent for a secure network) (POP Test 1, 2).
       2. Using the ETT logs, the tester verifies the Health IT Module has successfully implemented the following commands POP3 STAT, STARTTLS (or equivalent for a secure network), RETR, LIST, and RSET (POP Test 5, 11, 15).

       Reject POP3 Connection (Negative Tests)

       1. Negative Tests: Using the ETT logs, the tester verifies the Health IT Module rejects bad command syntax commands with the appropriate response and terminates connection with the ETT (POP Test 9).
       2. Negative Tests: Using the ETT logs, the tester verifies the Health IT Module rejects bad commands using the right syntax commands with the appropriate response and terminates connection with the ETT (POP Test 10).

       Message Processing

       1. Using the ETT logs, the tester verifies the Health IT Module is able to host attachments and make them available for fetching using POP (POP Test 32).
       2. Negative Test: Using the ETT logs, the tester verifies the Health IT Module rejects authentication requests due to invalid username/password (POP Test 17).

       Approved SVAP Version(s)

       • Complete step 1-9 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Receive Using Edge Protocol for IHE XDR profile for Limited Metadata Document Sources

       System Under Test

       SUT Connection– Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “XDR Tests” with the ETT for “System as Receiver”, the user establishes authentication from the ETT to the Health IT Module using Mutual TLS correctly (XDR Test 18).
       2. Using the ETT, the user establishes authentication from the ETT to the Health IT Module using bad certificates (incorrect Mutual TLS configuration) (XDR Test 19).

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Receive Payload

       1. The user enters the Health IT Module’s endpoints for receiving an XDR message from the ETT (as Edge) for Limited Metadata (XDR Test 13) and the Health IT Module receives a properly formatted XDR message with limited metadata from the ETT (as Edge) and translates it to a Direct message sent to the ETT (as Destination HISP) (XDR Test 13).
       2. The user enters the Health IT Module’s endpoints for receiving an XDR message from the ETT (as Edge) for Full Metadata (XDR Test 14) and the Health IT Module receives a properly formatted XDR message with full metadata from the ETT (as Edge) and translates it to a Direct message sent to the ETT (as Destination HISP) (XDR Test 14).

       Incorrect XDR Message Receive

       1. The Health IT Module returns errors when the following incorrect messages are received from the ETT with Invalid SOAP envelope details (XDR Test 15a).
       2. The Health IT Module returns errors when the following incorrect messages are received from the ETT with Invalid SOAP body details (XDR Test 15b), including:
          • Missing metadata elements;
          • Missing associations between ebRIM constructs;
          • Missing Direct Address block.

       Approved SVAP Version(s)

       • Complete step 1-7 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       Test Lab Verification

       SUT Connection– Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module is capable of accepting and validating a Mutual TLS session when authenticating to the ETT. Using visual inspection of the logs, the tester verifies the Health IT Module does not accept connections due to incorrect Mutual TLS configuration (XDR Test 18).
       2. Using visual inspection of the logs, the tester verifies the Health IT Module does not accept connections due to an invalid certificate published by the ETT (XDR Test 19).

       SUT Connection – Secure Network If Not Using TLS

       1. The tester verifies through evidence that the system provides a “secure network” as described at § 170.202(d).

       Receive Payload

       1. Using visual inspection of the logs, the tester verifies the Health IT Module is capable of receiving and processing a valid XDR message with limited metadata and the Health IT Module does not accept invalid messages sent from the ETT (XDR Test 13).
       2. Using visual inspection of the logs, the tester verifies the Health IT Module is capable of receiving and processing a valid XDR message with full metadata and the Health IT Module does not accept invalid messages sent from the ETT (XDR Test 14).

       Incorrect XDR Message Receive

       1. Using logs, the tester verifies the Health IT Module recognizes that the messages sent from the ETT are Invalid messages (XDR Test 15a).
       2. Using logs, the tester verifies the Health IT Module rejects the bad messages (XDR Test 15b).

       Approved SVAP Version(s)

       • Complete step 1-7 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Receive Using Edge Protocol for IHE XDR profile for Limited Metadata Document Sources

       SUT Connection– Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “XDR Tests” with the ETT for “System as Receiver”, the user establishes authentication from the ETT to the Health IT Module using Mutual TLS correctly (XDR Test 18).
       2. Using the ETT, the user establishes authentication from the ETT to the Health IT Module using bad certificates (incorrect Mutual TLS configuration) (XDR Test 19).

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a “secure network” as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Receive Payload

       1. The user enters the Health IT Module’s endpoints for receiving an XDR message from the ETT (as Edge) for Limited Metadata (XDR Test 13) and the Health IT Module receives a properly formatted XDR message with limited metadata from the ETT (as Edge) and translates it to a Direct message sent to the ETT (as Destination HISP) (XDR Test 13).
       2. The user enters the Health IT Module’s endpoints for receiving an XDR message from the ETT (as Edge) for Full Metadata (XDR Test 14) and the Health IT Module receives a properly formatted XDR message with full metadata from the ETT (as Edge) and translates it to a Direct message sent to the ETT (as Destination HISP) (XDR Test 14).

       Incorrect XDR Message Receive

       1. The Health IT Module returns errors when the following incorrect messages are received from the ETT with Invalid SOAP envelope details (XDR Test 15a).
       2. The Health IT Module returns errors when the following incorrect messages are received from the ETT with Invalid SOAP body details (XDR Test 15b), including:
          • Missing metadata elements;
          • Missing associations between ebRIM constructs;
          • Missing Direct Address block.

       Approved SVAP Version(s)

       • Complete step 1-7 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       SUT Connection– Using TLS and SASL

       1. Using the ETT, the tester verifies the Health IT Module is capable of accepting and validating a Mutual TLS session when authenticating to the ETT. Using visual inspection of the logs, the tester verifies the Health IT Module does not accept connections due to incorrect Mutual TLS configuration (XDR Test 18).
       2. Using visual inspection of the logs, the tester verifies the Health IT Module does not accept connections due to an invalid certificate published by the ETT (XDR Test 19).

       SUT Connection – Secure Network If Not Using TLS

       1. The tester verifies through evidence that the system provides a “secure network” as described at § 170.202(d).

       Receive Payload

       1. Using visual inspection of the logs, the tester verifies the Health IT Module is capable of receiving and processing a valid XDR message with limited metadata and the Health IT Module does not accept invalid messages sent from the ETT (XDR Test 13).
       2. Using visual inspection of the logs, the tester verifies the Health IT Module is capable of receiving and processing a valid XDR message with full metadata and the Health IT Module does not accept invalid messages sent from the ETT (XDR Test 14).

       Incorrect XDR Message Receive

       1. Using logs, the tester verifies the Health IT Module recognizes that the messages sent from the ETT are Invalid messages (XDR Test 15a).
       2. Using logs, the tester verifies the Health IT Module rejects the bad messages (XDR Test 15b).

       Approved SVAP Version(s)

       • Complete step 1-7 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Receive Using Edge Protocol for SMTP

       System Under Test

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “SMTP Tests” using the ETT for “System as Receiver”, the user initiates a valid TLS session for the Health IT Module with the ETT sent from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address (SMTP Test 9).
       2. The user authenticates the ETT with the Health IT Module using PLAIN SASL as an SMTP server from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address (SMTP Test 16).
       3. The Health IT Module provides documentation of the ability to authenticate to an Edge using SASL as an SMTP server.
       4. The Health IT Module receives an authentication from the ETT using an Invalid SASL username/password as an SMTP server from the username supplied by the Health IT Module email account being authenticated (SMTP Test 22).

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a "secure network" as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Receive Payload

       1. The user receives a document from the ETT using valid SMTP commands from the username supplied by the Health IT Module email account being authenticated and establishes a connection with the ETT (SMTP Test 20).
       2. The user receives a document from the ETT using invalid data as part of the DATA command from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address (SMTP Test 10).
       3. The user receives a document from the ETT using invalid SMTP commands as part of the DATA command from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address (SMTP Test 11).
       4. The user receives a document from the ETT from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address beyond the allowable time period (SMTP Test 13).

       Approved SVAP Version(s)

       • Complete step 1-9 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       Test Lab Verification

       SUT Connection – Using TLS and SASL

       1. Using the ETT, the tester verifies a secure session was established with the Health IT Module based upon TLS initiation using correct syntax (SMTP Test 9).
       2. Using the ETT with a predetermined username and password, the tester verifies a secure session was established with the Health IT Module with PLAIN SASL authentication (SMTP Test 16).
       3. The tester verifies evidence of the capability to establish a secure session with the Health IT Module based upon successful authentication (SMTP Test 16).
       4. The tester verifies evidence of the capability to reject an authentication (SMTP Test 22).

       SUT Connection – Secure Network If Not Using TLS

       1. The tester verifies through evidence that the system provides a “secure network” as described at § 170.202(d).

       Receive Payload

       1. Using the ETT, the tester verifies the Health IT Module can receive an SMTP Message using § 170.202(d) and the Validation Report indicates the successful sequence of commands for SMTP protocols (SMTP Test 20).
       2. Using the ETT Logs, the tester verifies a secure connection cannot be established based upon invalid data provided and does not accept the data by using appropriate responses to an invalid DATA command (SMTP Test 10).
       3. Using the ETT Logs, the tester verifies a secure connection cannot be established based upon invalid data provided and does not accept the data by using appropriate responses to invalid SMTP commands or invalid size limits of SMTP commands (SMTP Test 11).
       4. Using the ETT, the tester verifies the Health IT Module has kept the transaction open for beyond the specified time constraints found with RFC 2821, Section 4.5.3.2, and therefore cannot accept the incoming message (SMTP Test 13).

       Approved SVAP Version(s)

       Complete step 1-9 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(C) – Receive Using Edge Protocol for SMTP

       SUT Connection – Using TLS and SASL

       1. Using the ETT: HISP & Delivery Notification “SMTP Tests” using the ETT for “System as Receiver”, the user initiates a valid TLS session for the Health IT Module with the ETT sent from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address (SMTP Test 9).
       2. The user authenticates the ETT with the Health IT Module using PLAIN SASL as an SMTP server from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address (SMTP Test 16).
       3. The Health IT Module provides documentation of the ability to authenticate to an Edge using SASL as an SMTP server.
       4. The Health IT Module receives an authentication from the ETT using an Invalid SASL username/password as an SMTP server from the username supplied by the Health IT Module email account being authenticated (SMTP Test 22).

       SUT Connection – Secure Network If Not Using TLS

       1. The user demonstrates the ability to provide a secure connection to the SUT by providing evidence and demonstration that the system uses a "secure network" as described at § 170.202(d) ONC Implementation Guide for Direct Edge Protocols, v1.1.

       Receive Payload

       1. The user receives a document from the ETT using valid SMTP commands from the username supplied by the Health IT Module email account being authenticated and establishes a connection with the ETT (SMTP Test 20).
       2. The user receives a document from the ETT using invalid data as part of the DATA command from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address (SMTP Test 10).
       3. The user receives a document from the ETT using invalid SMTP commands as part of the DATA command from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address (SMTP Test 11).
       4. The user receives a document from the ETT from the username supplied by the Health IT Module email account being authenticated to the Health IT Module SMTP email address beyond the allowable time period (SMTP Test 13).

       Approved SVAP Version(s)

       • Complete step 1-9 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       SUT Connection – Using TLS and SASL

       1. Using the ETT, the tester verifies a secure session was established with the Health IT Module based upon TLS initiation using correct syntax (SMTP Test 9).
       2. Using the ETT with a predetermined username and password, the tester verifies a secure session was established with the Health IT Module with PLAIN SASL authentication (SMTP Test 16).
       3. The tester verifies evidence of the capability to establish a secure session with the Health IT Module based upon successful authentication (SMTP Test 16).
       4. The tester verifies evidence of the capability to reject an authentication (SMTP Test 22).

       SUT Connection – Secure Network If Not Using TLS

       1. The tester verifies through evidence that the system provides a “secure network” as described at § 170.202(d).

       Receive Payload

       1. Using the ETT, the tester verifies the Health IT Module can receive an SMTP Message using § 170.202(d) and the Validation Report indicates the successful sequence of commands for SMTP protocols (SMTP Test 20).
       2. Using the ETT Logs, the tester verifies a secure connection cannot be established based upon invalid data provided and does not accept the data by using appropriate responses to an invalid DATA command (SMTP Test 10).
       3. Using the ETT Logs, the tester verifies a secure connection cannot be established based upon invalid data provided and does not accept the data by using appropriate responses to invalid SMTP commands or invalid size limits of SMTP commands (SMTP Test 11).
       4. Using the ETT, the tester verifies the Health IT Module has kept the transaction open for beyond the specified time constraints found with RFC 2821, Section 4.5.3.2, and therefore cannot accept the incoming message (SMTP Test 13).

       Approved SVAP Version(s)

       Complete step 1-9 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(ii) – Send

       System Under Test

       Disposition-Notification-Options Header

       1. Using the ETT: HISP & Delivery Notification “Message Tracking” using “Your System as Sender”, the Health IT Module is able to successfully process the Disposition-Notifications-Options-Header received from the ETT (as Sending Edge) and include it in the message to the destination (ETT as Destination HISP):
          • SMTP MT Test 21(a) or alternatively;
          • IMAP: SMTP/IMAP MT Test 21(b) (Alternative);
          • POP3: SMTP/POP MT Test 21(c) (Alternative).

       Delivery Failure Due to Bad Destination Address

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a bad address (non-existent) for the destination, send the message to the ETT (as Destination HISP), which will return an error as it will be unable to deliver the message to the address. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 23(a) or alternatively;
          • SMTP/IMAP MT Test 23(b) (Alternative);
          • SMTP/POP MT Test 23(c) (Alternative).

       Delivery Failure Due to Untrusted Destination HISP

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as an untrusted Destination HISP). The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 24(a) or alternatively;
          • SMTP/IMAP MT Test 24(b) (Alternative);
          • SMTP/POP MT Test 24(c) (Alternative).

       Delivery Failure Due to Unpublished Certificate for Destination HISP

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP). Due to the unpublished certificate, security and trust processing fails. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 25(a) or alternatively;
          • SMTP/IMAP MT Test 25(b) (Alternative);
          • SMTP/POP MT Test 25(c) (Alternative).

       Delivery Failure Timeout for Processed MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP). The wait time for the Health IT Module to receive a Processed MDN from the Destination HISP is exceeded. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 26(a) or alternatively;
          • SMTP/IMAP MT Test 26(b) (Alternative);
          • SMTP/POP MT Test 26(c) (Alternative).

       Delivery Failure for Dispatched MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP) which provides a Processed MDN but does not provide a Dispatched MDN to the Health IT Module. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 27(a) or alternatively;
          • SMTP/IMAP MT Test 27(b) (Alternative);
          • SMTP/POP MT Test 27(c) (Alternative).

       Delivery Failure Timeout for Dispatched MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP) which provides a Processed MDN to the Health IT Module. The Health IT Module receives a Dispatched MDN after the expected wait time is exceeded. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification and does not forward the dispatched MDN to the ETT (as Sending Edge) message via:
          • SMTP MT Test 28(a) or alternatively;
          • SMTP/IMAP MT Test 28(b) (Alternative);
          • SMTP/POP MT Test 28(c) (Alternative).

       Positive Delivery Notification

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP) which provides a Processed MDN and Dispatched MDN to the Health IT Module. The Health IT Module only sends the ETT (as Sending Edge) a positive delivery status notification (dispatched MDN) message via:
          • SMTP MT Test 29(a) or alternatively;
          • SMTP/IMAP MT Test 29(b) (Alternative),
          • SMTP/POP MT Test 29(c) (Alternative).

       Requesting Delivery Notification for XDR Edge HISP

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge), using the ETT: HISP & Delivery Notification “XDR Cases” with “System as Receiver”, that includes a valid Direct address block header and valid destination. The Health IT Module includes the header in the message to the ETT (as Destination HISP) within SMTP headers (XDR MT Test 30).
       2. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) that includes a valid Direct address block, header, and invalid destination. The Health IT Module is able to process the header handle an invalid delivery notification request (XDR MT Test 31).

       XDR Delivery Failure: Bad Address

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) that includes an invalid (non-existent) address. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 32).

       XDR Delivery Failure: Untrusted Destination HISP

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) is not trusted and the Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 33).

       XDR Delivery Failure: Unpublished Destination HISP Certificate

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) does not have published certificates, and security and trust processing fails. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 34).

       XDR Delivery Failure: No Processed MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) does not respond with a Processed MDN. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 35).

       XDR Delivery Failure: No Dispatched MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) responds with a Processed MDN, but no Dispatched MDN. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 36).

       XDR Delivery Failure: Timeout for Dispatched MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) responds with a Processed MDN, but the Dispatched MDN is received after the expected wait time has exceeded. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 37).

       XDR Positive Delivery Notification

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) responds with a Processed MDN and Dispatched MDN within the expected time period. The Health IT Module sends only one positive delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 38).

       Approved SVAP Version(s)

       • Complete step 1-17 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       Test Lab Verification

       Disposition-Notification-Options Header

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 21(a) or alternatively;
          • SMTP/IMAP MT Test 21(b) (Alternative);
          • SMTP/POP MT Test 21(c) (Alternative).

       Delivery Failure Due to Bad Destination Address

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 23(a) or alternatively;
          • SMTP/IMAP MT Test 23(b) (Alternative);
          • SMTP/POP MT Test 23(c) (Alternative).

       Delivery Failure Due to Untrusted Destination HISP

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 24(a) or alternatively;
          • SMTP/IMAP MT Test 24(b) (Alternative);
          • SMTP/POP MT Test 24(c) (Alternative).

       Delivery Failure Due to Unpublished Certificate for Destination HISP

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 25(a) or alternatively;
          • SMTP/IMAP MT Test 25(b) (Alternative);
          • SMTP/POP MT Test 25(c) (Alternative).

       Delivery Failure Timeout for Processed MDN

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 26(a) or alternatively;
          • SMTP/IMAP MT Test 26(b) (Alternative);
          • SMTP/POP MT Test 26(c) (Alternative).

       Delivery Failure for Dispatched MDN

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 27(a) or alternatively;
          • SMTP/IMAP MT Test 27(b) (Alternative);
          • SMTP/POP MT Test 27(c) (Alternative).

       Delivery Failure Timeout for Dispatched MDN

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 28(a) or alternatively;
          • SMTP/IMAP MT Test 28(b) (Alternative);
          • SMTP/POP MT Test 28(c) (Alternative).

       Positive Delivery Notification

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 29(a) or alternatively;
          • SMTP/IMAP MT Test 29(b) (Alternative);
          • SMTP/POP MT Test 29(c) (Alternative).

       Requesting Delivery Notification for XDR Edge HISP

       1. The ETT test results for XDR MT Test 30 are successful.
       2. The ETT test results for XDR MT Test 31 are successful.

       XDR Delivery Failure: Bad Address

       1. The ETT test results for XDR MT Test 32 are successful.

       XDR Delivery Failure: Untrusted Destination HISP

       1. The ETT test results for XDR MT Test 33 are successful.

       XDR Delivery Failure: Unpublished Destination HISP Certificate

       1. The ETT test results for XDR MT Test 34 are successful.

       XDR Delivery Failure: No Processed MDN

       1. The ETT test results for XDR MT Test 35 are successful.

       XDR Delivery Failure: No Dispatched MDN

       1. The ETT test results for XDR MT Test 36 are successful.

       XDR Delivery Failure: Timeout for Dispatched MDN

       1. The ETT test results for XDR MT Test 37 are successful.

       XDR Positive Delivery Notification

       1. The ETT test results for XDR MT Test 38 are successful.

       Approved SVAP Version(s)

       • Complete step 1-17 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(ii) – Send

       Disposition-Notification-Options Header

       1. Using the ETT: HISP & Delivery Notification “Message Tracking” using “Your System as Sender”, the Health IT Module is able to successfully process the Disposition-Notifications-Options-Header received from the ETT (as Sending Edge) and include it in the message to the destination (ETT as Destination HISP):
          • SMTP MT Test 21(a) or alternatively;
          • IMAP: SMTP/IMAP MT Test 21(b) (Alternative);
          • POP3: SMTP/POP MT Test 21(c) (Alternative).

       Delivery Failure Due to Bad Destination Address

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a bad address (non-existent) for the destination, send the message to the ETT (as Destination HISP), which will return an error as it will be unable to deliver the message to the address. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 23(a) or alternatively;
          • SMTP/IMAP MT Test 23(b) (Alternative);
          • SMTP/POP MT Test 23(c) (Alternative).

       Delivery Failure Due to Untrusted Destination HISP

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as an untrusted Destination HISP). The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 24(a) or alternatively;
          • SMTP/IMAP MT Test 24(b) (Alternative);
          • SMTP/POP MT Test 24(c) (Alternative).

       Delivery Failure Due to Unpublished Certificate for Destination HISP

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP). Due to the unpublished certificate, security and trust processing fails. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 25(a) or alternatively;
          • SMTP/IMAP MT Test 25(b) (Alternative);
          • SMTP/POP MT Test 25(c) (Alternative).

       Delivery Failure Timeout for Processed MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP). The wait time for the Health IT Module to receive a Processed MDN from the Destination HISP is exceeded. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 26(a) or alternatively;
          • SMTP/IMAP MT Test 26(b) (Alternative);
          • SMTP/POP MT Test 26(c) (Alternative).

       Delivery Failure for Dispatched MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP) which provides a Processed MDN but does not provide a Dispatched MDN to the Health IT Module. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification message via:
          • SMTP MT Test 27(a) or alternatively;
          • SMTP/IMAP MT Test 27(b) (Alternative);
          • SMTP/POP MT Test 27(c) (Alternative).

       Delivery Failure Timeout for Dispatched MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP) which provides a Processed MDN to the Health IT Module. The Health IT Module receives a Dispatched MDN after the expected wait time is exceeded. The Health IT Module sends the ETT (as Sending Edge) a negative delivery status notification and does not forward the dispatched MDN to the ETT (as Sending Edge) message via:
          • SMTP MT Test 28(a) or alternatively;
          • SMTP/IMAP MT Test 28(b) (Alternative);
          • SMTP/POP MT Test 28(c) (Alternative).

       Positive Delivery Notification

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) with a valid address for the destination, send the message to the ETT (as Destination HISP) which provides a Processed MDN and Dispatched MDN to the Health IT Module. The Health IT Module only sends the ETT (as Sending Edge) a positive delivery status notification (dispatched MDN) message via:
          • SMTP MT Test 29(a) or alternatively;
          • SMTP/IMAP MT Test 29(b) (Alternative),
          • SMTP/POP MT Test 29(c) (Alternative).

       Requesting Delivery Notification for XDR Edge HISP

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge), using the ETT: HISP & Delivery Notification “XDR Cases” with “System as Receiver”, that includes a valid Direct address block header and valid destination. The Health IT Module includes the header in the message to the ETT (as Destination HISP) within SMTP headers (XDR MT Test 30).
       2. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) that includes a valid Direct address block, header, and invalid destination. The Health IT Module is able to process the header handle an invalid delivery notification request (XDR MT Test 31).

       XDR Delivery Failure: Bad Address

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) that includes an invalid (non-existent) address. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 32).

       XDR Delivery Failure: Untrusted Destination HISP

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) is not trusted and the Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 33).

       XDR Delivery Failure: Unpublished Destination HISP Certificate

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) does not have published certificates, and security and trust processing fails. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 34).

       XDR Delivery Failure: No Processed MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) does not respond with a Processed MDN. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 35).

       XDR Delivery Failure: No Dispatched MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) responds with a Processed MDN, but no Dispatched MDN. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 36).

       XDR Delivery Failure: Timeout for Dispatched MDN

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) responds with a Processed MDN, but the Dispatched MDN is received after the expected wait time has exceeded. The Health IT Module sends a negative delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 37).

       XDR Positive Delivery Notification

       1. The Health IT Module is able to successfully process a message from the ETT (as Sending Edge) to a valid address. The ETT (as Destination HISP) responds with a Processed MDN and Dispatched MDN within the expected time period. The Health IT Module sends only one positive delivery status notification message to the ETT (as Sending Edge) using XDR profile (XDR MT Test 38).

       Approved SVAP Version(s)

       • Complete step 1-17 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       Disposition-Notification-Options Header

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 21(a) or alternatively;
          • SMTP/IMAP MT Test 21(b) (Alternative);
          • SMTP/POP MT Test 21(c) (Alternative).

       Delivery Failure Due to Bad Destination Address

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 23(a) or alternatively;
          • SMTP/IMAP MT Test 23(b) (Alternative);
          • SMTP/POP MT Test 23(c) (Alternative).

       Delivery Failure Due to Untrusted Destination HISP

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 24(a) or alternatively;
          • SMTP/IMAP MT Test 24(b) (Alternative);
          • SMTP/POP MT Test 24(c) (Alternative).

       Delivery Failure Due to Unpublished Certificate for Destination HISP

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 25(a) or alternatively;
          • SMTP/IMAP MT Test 25(b) (Alternative);
          • SMTP/POP MT Test 25(c) (Alternative).

       Delivery Failure Timeout for Processed MDN

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 26(a) or alternatively;
          • SMTP/IMAP MT Test 26(b) (Alternative);
          • SMTP/POP MT Test 26(c) (Alternative).

       Delivery Failure for Dispatched MDN

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 27(a) or alternatively;
          • SMTP/IMAP MT Test 27(b) (Alternative);
          • SMTP/POP MT Test 27(c) (Alternative).

       Delivery Failure Timeout for Dispatched MDN

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 28(a) or alternatively;
          • SMTP/IMAP MT Test 28(b) (Alternative);
          • SMTP/POP MT Test 28(c) (Alternative).

       Positive Delivery Notification

       1. The ETT test results for the following tests are successful:
          • SMTP MT Test 29(a) or alternatively;
          • SMTP/IMAP MT Test 29(b) (Alternative);
          • SMTP/POP MT Test 29(c) (Alternative).

       Requesting Delivery Notification for XDR Edge HISP

       1. The ETT test results for XDR MT Test 30 are successful.
       2. The ETT test results for XDR MT Test 31 are successful.

       XDR Delivery Failure: Bad Address

       1. The ETT test results for XDR MT Test 32 are successful.

       XDR Delivery Failure: Untrusted Destination HISP

       1. The ETT test results for XDR MT Test 33 are successful.

       XDR Delivery Failure: Unpublished Destination HISP Certificate

       1. The ETT test results for XDR MT Test 34 are successful.

       XDR Delivery Failure: No Processed MDN

       1. The ETT test results for XDR MT Test 35 are successful.

       XDR Delivery Failure: No Dispatched MDN

       1. The ETT test results for XDR MT Test 36 are successful.

       XDR Delivery Failure: Timeout for Dispatched MDN

       1. The ETT test results for XDR MT Test 37 are successful.

       XDR Positive Delivery Notification

       1. The ETT test results for XDR MT Test 38 are successful.

       Approved SVAP Version(s)

       • Complete step 1-17 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(ii) – Receive

       System Under Test

       SMTP: Disposition-Notification-Options Header

       1. Using the ETT: HISP & Delivery Notification “Message Tracking” using “Your System as Receiver”, the Health IT Module is able to receive and successfully process a message from the ETT (as Sending HISP) that contains a valid Disposition-Notification-Options Header and include it in the message to the destination (SMTP MT Test 39).
       2. Negative Test: The Health IT Module is able to receive and successfully process a message from the ETT (as Sending HISP) that contains an invalid Disposition-Notification-Options Header and include it in the message to the destination (SMTP MT Test 40).

       XDR: Failure Notification (Configurable Wait Time Exceeded)

       1. The Health IT Module receives a message from the ETT (as Sending HISP), using the ETT: HISP & Delivery Notification “XDR Cases” with “System as Receiver”, and is unable to deliver the message to its final destination (ETT as Destination Edge). The Health IT Module delivers a Processed MDN to the ETT (as Sending HISP) followed by a delivery failure message to the ETT (as Sending HISP) after the wait time has exceeded for delivering the message to its final destination (XDR MT Test 43).

       XDR: Failure Notification

       1. The Health IT Module receives a message from the ETT (as Sending HISP), and is unable to deliver the message to its final destination (ETT as Destination Edge) due to a bad address (non-existent). The Health IT Module delivers a Processed MDN to the ETT (as Sending HISP) followed by a delivery failure message to the ETT (as Sending HISP) due to the bad address (non-existent) (XDR MT Test 44).

       Approved SVAP Version(s)

       • Complete step 1-17 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       Test Lab Verification

       SMTP: Disposition-Notification-Options Header

       1. The ETT test results for SMTP MT Test 39 are successful.
       2. The ETT test results for SMTP MT Test 40 are successful.

       XDR: Failure Notification (Configurable Wait Time Exceeded)

       1. The ETT test results for XDR MT Test 43 are successful.

       XDR: Failure Notification

       1. The ETT test results for XDR MT Test 44 are successful.

       Approved SVAP Version(s)

       • Complete step 1-4 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(ii) – Receive

       SMTP: Disposition-Notification-Options Header

       1. Using the ETT: HISP & Delivery Notification “Message Tracking” using “Your System as Receiver”, the Health IT Module is able to receive and successfully process a message from the ETT (as Sending HISP) that contains a valid Disposition-Notification-Options Header and include it in the message to the destination (SMTP MT Test 39).
       2. Negative Test: The Health IT Module is able to receive and successfully process a message from the ETT (as Sending HISP) that contains an invalid Disposition-Notification-Options Header and include it in the message to the destination (SMTP MT Test 40).

       XDR: Failure Notification (Configurable Wait Time Exceeded)

       1. The Health IT Module receives a message from the ETT (as Sending HISP), using the ETT: HISP & Delivery Notification “XDR Cases” with “System as Receiver”, and is unable to deliver the message to its final destination (ETT as Destination Edge). The Health IT Module delivers a Processed MDN to the ETT (as Sending HISP) followed by a delivery failure message to the ETT (as Sending HISP) after the wait time has exceeded for delivering the message to its final destination (XDR MT Test 43).

       XDR: Failure Notification

       1. The Health IT Module receives a message from the ETT (as Sending HISP), and is unable to deliver the message to its final destination (ETT as Destination Edge) due to a bad address (non-existent). The Health IT Module delivers a Processed MDN to the ETT (as Sending HISP) followed by a delivery failure message to the ETT (as Sending HISP) due to the bad address (non-existent) (XDR MT Test 44).

       Approved SVAP Version(s)

       • Complete step 1-17 using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       SMTP: Disposition-Notification-Options Header

       1. The ETT test results for SMTP MT Test 39 are successful.
       2. The ETT test results for SMTP MT Test 40 are successful.

       XDR: Failure Notification (Configurable Wait Time Exceeded)

       1. The ETT test results for XDR MT Test 43 are successful.

       XDR: Failure Notification

       1. The ETT test results for XDR MT Test 44 are successful.

       Approved SVAP Version(s)

       • Complete step 1-4 verifications using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(A) – Send

       System Under Test

       The Health IT Module provides evidence of and demonstrates successful send of encrypted and signed health information from the Health IT Module to three partners (e.g., other vendor Health IT Modules (HISPs) that have implemented (h)(1) or (h)(2) capabilities) using ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, which includes:

       • Documentation of the Health IT Module sending “Wrapped” RFC-5751 messages to three partner HISPs.
       • Documentation of the Health IT Module receiving processed Message Disposition Notifications (MDNs) from each of the three partner HISPs generated by the partner HISPs upon receiving the Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete this test using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       Test Lab Verification

       The tester verifies the Health IT Module has successfully sent encrypted and signed health information to three partner HISPs using ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015. The verification includes:

       • Indication through documentation that the Health IT Module sent “Wrapped” RFC-5751, messages to three separate and unrelated HISP partners.
       • Indication through documentation of the Health IT Module receiving processed Message Disposition Notifications (MDNs) from each of the three partner HISPs generated upon receiving the Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete verifications of this test using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Required Enhanced Testing: ETT Direct v1.2

       The Health IT Module submits evidence of multi-partner testing with three different and unrelated partner HISPs using Direct v1.2 (in accordance with the standard specified at § 170.202(a)(2) Direct Project: ONC Applicability Statement for Secure Health Transport, v1.2, August 2015), formatted only as a “wrapped” message.

       Approved SVAP Version(s)

       The Health IT Module submits evidence of multi-partner testing with three different and unrelated partner HISPs using ETT Direct v1.3 in accordance with the standard specified at ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct,) formatted only as a “wrapped” message.

       Paragraph (h)(2)(i)(A) – Send

       The Health IT Module provides evidence of and demonstrates successful send of encrypted and signed health information from the Health IT Module to three partners (e.g., other vendor Health IT Modules (HISPs) that have implemented (h)(1) or (h)(2) capabilities) using ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, which includes:

       • Documentation of the Health IT Module sending “Wrapped” RFC-5751 messages to three partner HISPs.
       • Documentation of the Health IT Module receiving processed Message Disposition Notifications (MDNs) from each of the three partner HISPs generated by the partner HISPs upon receiving the Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete this test using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       The tester verifies the Health IT Module has successfully sent encrypted and signed health information to three partner HISPs using ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015. The verification includes:

       • Indication through documentation that the Health IT Module sent “Wrapped” RFC-5751, messages to three separate and unrelated HISP partners.
       • Indication through documentation of the Health IT Module receiving processed Message Disposition Notifications (MDNs) from each of the three partner HISPs generated upon receiving the Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete verifications of this test using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(A) – Required Enhanced 1 Testing, Receive

       1 Partners with whom the Health IT Module chooses to test do not have to be certified at the time of testing as long as the testing uses ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015, formatted only as a “wrapped” message.

       Approved SVAP Version(s)

       1 Partners with whom the Health IT Module chooses to test do not have to be certified at the time of testing as long as the testing uses ETT Direct v1.3, in accordance with the standard specified at ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct), formatted only as a “wrapped” message.

       System Under Test

       The user provides evidence of successful receipt of encrypted and signed health information from three partners (e.g., other vendor Health IT Modules (HISPs) that have implemented (h)(2) capabilities) using ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015. The evidence includes:

       • Documentation of the Health IT Module receiving “Wrapped” RFC-5751 messages from three partner HISPs.
       • Documentation of the Health IT Module generates and sends processed Message Disposition Notifications (MDNs) that are transmitted to each of the three partner HISPs generated upon successfully receiving a Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete this test using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       Test Lab Verification

       The tester verifies that the Health IT Module has received encrypted and signed health information from three partner HISPs using ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015. The documentation includes:

       • Indication that the Health IT Module successfully received “Wrapped” RFC-5751, messages from three separate and unrelated HISP partners.
       • Indication of the Health IT Module generating and transmitting processed Message Disposition Notification (MDNs) to each of the three partner HISPs generated upon receiving the Direct message from each partner HISP.

       Approved SVAP Version(s)

       • Complete verifications of this test using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(A) – Required Enhanced 1 Testing, Receive

       1 Partners with whom the Health IT Module chooses to test do not have to be certified at the time of testing as long as the testing uses ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015, formatted only as a “wrapped” message.

       Approved SVAP Version(s)

       1 Partners with whom the Health IT Module chooses to test do not have to be certified at the time of testing as long as the testing uses ETT Direct v1.3, in accordance with the standard specified at ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct), formatted only as a “wrapped” message.

       The user provides evidence of successful receipt of encrypted and signed health information from three partners (e.g., other vendor Health IT Modules (HISPs) that have implemented (h)(2) capabilities) using ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015. The evidence includes:

       • Documentation of the Health IT Module receiving “Wrapped” RFC-5751 messages from three partner HISPs.
       • Documentation of the Health IT Module generates and sends processed Message Disposition Notifications (MDNs) that are transmitted to each of the three partner HISPs generated upon successfully receiving a Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete this test using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       The tester verifies that the Health IT Module has received encrypted and signed health information from three partner HISPs using ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015. The documentation includes:

       • Indication that the Health IT Module successfully received “Wrapped” RFC-5751, messages from three separate and unrelated HISP partners.
       • Indication of the Health IT Module generating and transmitting processed Message Disposition Notification (MDNs) to each of the three partner HISPs generated upon receiving the Direct message from each partner HISP.

       Approved SVAP Version(s)

       • Complete verifications of this test using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(B) – Send

       System Under Test

       The Health IT Module provides evidence and demonstrates of successful send of encrypted and signed health information from the Health IT Module to three partners (e.g., other vendor Health IT Modules (HISPs) that have implemented (h)(1) or (h)(2) capabilities) using ETT Direct v1.2, in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification, which includes:

       • Documentation of the Health IT Module sending “Wrapped” RFC-5751, messages to three partner HISPs.
       • Documentation of the Health IT Module receiving processed Message Disposition Notifications (MDNs) from each of the three partner HISPs generated by the partner HISPs upon receiving the Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete this test using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).
       Test Lab Verification

       The tester verifies that the Health IT Module has successfully sent encrypted and signed health information to three partner HISPs using ETT Direct v1.2, in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification. The verification includes:

       • Indication through documentation that the Health IT Module sent “Wrapped” RFC-5751, messages to three separate and unrelated HISP partners.
       • Indication through documentation of the Health IT Module receiving processed Message Disposition Notifications (MDNs) from each of the three partner HISPs generated upon receiving the Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete verifications of this test using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Required Enhanced Testing: ONC XDR and XDM for Direct

       The Health IT Module submits evidence of multi-partner testing with three different and unrelated partner HISPs using ETT Direct v1.2, (in accordance with the standard specified at § 170.202(b): ONC XDR and XDM for Direct Messaging Specification (incorporated by reference in § 170.299)), including support for both limited and full XDS metadata profiles, formatted only as a “wrapped” message.

       Approved SVAP Version(s)

       The Health IT Module submits evidence of multi-partner testing with three different and unrelated partner HISPs using ETT Direct v1.3 in accordance with the standard specified at ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct,) formatted only as a “wrapped” message.

       Paragraph (h)(2)(i)(B) – Send

       The Health IT Module provides evidence and demonstrates of successful send of encrypted and signed health information from the Health IT Module to three partners (e.g., other vendor Health IT Modules (HISPs) that have implemented (h)(1) or (h)(2) capabilities) using ETT Direct v1.2, in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification, which includes:

       • Documentation of the Health IT Module sending “Wrapped” RFC-5751, messages to three partner HISPs.
       • Documentation of the Health IT Module receiving processed Message Disposition Notifications (MDNs) from each of the three partner HISPs generated by the partner HISPs upon receiving the Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete this test using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       The tester verifies that the Health IT Module has successfully sent encrypted and signed health information to three partner HISPs using ETT Direct v1.2, in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification. The verification includes:

       • Indication through documentation that the Health IT Module sent “Wrapped” RFC-5751, messages to three separate and unrelated HISP partners.
       • Indication through documentation of the Health IT Module receiving processed Message Disposition Notifications (MDNs) from each of the three partner HISPs generated upon receiving the Direct message from the Health IT Module.

       Approved SVAP Version(s)

       • Complete verifications of this test using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(B) – Required Enhanced 1 Testing, Receive

       1 Partners with whom the Health IT Module chooses to test do not have to be certified at the time of testing as long as the testing uses the ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015, formatted only as a “wrapped” message.

       Approved SVAP Version(s)

       1 Partners with whom the Health IT Module chooses to test do not have to be certified at the time of testing as long as the testing uses ETT Direct v1.3, in accordance with the standard specified at ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct), formatted only as a “wrapped” message.

       System Under Test

       The user provides evidence of successful receipt of encrypted and signed health information from three partners (e.g., other vendor Health IT Modules (HISPs) that have implemented (h)(2) capabilities) using ETT Direct v1.2, in accordance with the standard specified § 170.202(b) ONC XDR and XDM for Direct Messaging Specification. The evidence includes:

       • Documentation of the Health IT Module receiving “Wrapped” RFC-5751 messages from three partner HISPs.
       • Documentation of the Health IT Module generates and sends processed Message Disposition Notifications (MDNs) that are transmitted to each of the three partner HISPs generated upon successfully receiving a Direct message from the Health IT Module.

       Approved SVAP Version(s)

       Complete this test using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       Test Lab Verification

       The tester verifies that the Health IT Module has received encrypted and signed health information from three partner HISPs using ETT Direct v1.2, in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification. The documentation includes:

       • Indication that the Health IT Module successfully received “Wrapped” RFC-5751 messages from three separate and unrelated HISP partners.
       • Indication of the Health IT Module generating and transmitting processed Message Disposition Notification (MDNs) to each of the three partner HISPs generated upon receiving the Direct message from each partner HISP.

       Approved SVAP Version(s)

       • Complete verifications of this test using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)

       Paragraph (h)(2)(i)(B) – Required Enhanced 1 Testing, Receive

       1 Partners with whom the Health IT Module chooses to test do not have to be certified at the time of testing as long as the testing uses the ETT Direct v1.2, in accordance with the standard specified at § 170.202(a)(2): Applicability Statement for Secure Health Transport v1.2, August 2015, formatted only as a “wrapped” message.

       Approved SVAP Version(s)

       1 Partners with whom the Health IT Module chooses to test do not have to be certified at the time of testing as long as the testing uses ETT Direct v1.3, in accordance with the standard specified at ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct), formatted only as a “wrapped” message.

       The user provides evidence of successful receipt of encrypted and signed health information from three partners (e.g., other vendor Health IT Modules (HISPs) that have implemented (h)(2) capabilities) using ETT Direct v1.2, in accordance with the standard specified § 170.202(b) ONC XDR and XDM for Direct Messaging Specification. The evidence includes:

       • Documentation of the Health IT Module receiving “Wrapped” RFC-5751 messages from three partner HISPs.
       • Documentation of the Health IT Module generates and sends processed Message Disposition Notifications (MDNs) that are transmitted to each of the three partner HISPs generated upon successfully receiving a Direct message from the Health IT Module.

       Approved SVAP Version(s)

       Complete this test using the ETT Direct v1.3 in accordance with the standards specified in ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct).

       The tester verifies that the Health IT Module has received encrypted and signed health information from three partner HISPs using ETT Direct v1.2, in accordance with the standard specified at § 170.202(b) ONC XDR and XDM for Direct Messaging Specification. The documentation includes:

       • Indication that the Health IT Module successfully received “Wrapped” RFC-5751 messages from three separate and unrelated HISP partners.
       • Indication of the Health IT Module generating and transmitting processed Message Disposition Notification (MDNs) to each of the three partner HISPs generated upon receiving the Direct message from each partner HISP.

       Approved SVAP Version(s)

       • Complete verifications of this test using ETT Direct v1.3 in accordance with ONC Applicability Statement for Secure Health Transport, v1.3, May 2021 (Direct.)