Real World Testing Result for Smile CDR

These are the real world test results for 2025 for the Smile CDR Product . It provides the real world test measurements and metrics that meet the intent and objectives of ONC’s Condition of Certification and Maintenance of Certification requirement for real world testing (§ 170.405 Real World Testing) to evaluate compliance with the certification criteria and interoperability of exchanging electronic health information (EHI) within the care and practice setting which it is targeted for use.

This document provides the targeted testing measurements and metrics that Smile Digital Health will use to evaluate the Smile CDR product interoperability within typical production settings. For each measure, the associated testing methodology, ONC criteria, justification for measurement, and expected outcomes from the testing are presented.  

General Information 

Test Report ID Number:
Developer Name: Smile Digital Health
Product Name: Smile CDR
Version Number: 2025
Certified Health IT Product List (CHPL) ID(s): 15.04.04.3129.Smil.24.03.0.250414
Developer Real World Testing Result Page URL: https://www.smiledigitalhealth.com/cdr-real-world-test

The 2025 Real World Testing Plan originally included Smile CDR v2024 (CHPL ID: 15.04.04.3129.Smil.03.01.0.231117). However, version 2024 was withdrawn, and its capabilities were fully inherited by Smile CDR version 2025. The 2025 version maintains all functionalities tested in 2024 while incorporating enhancements for interoperability. FHIR API performance, and compliance with ONC certification standards. This ensures that real world testing remains aligned with previous implementation efforts.

Justification for Real World Testing

Real World Testing is intended to verify that deployed Certified Health IT continues to perform as intended, ensuring successful interoperability and data exchange across various clinical settings and practices. Smile CDR supports a broad range of use cases and can be utilized by many clinical practices, including ambulatory settings such as outpatient clinics. All measures reasonably align with the §170.315(g)(7), §170.315(g)(10) and §170.315(b)(10) certification criteria.

Developer Attestation

This Real World Testing result is complete with all required elements, including measures that address all certification criteria and care settings. All information in this result is up to date and fully addresses the health IT developer’s Real World Testing requirements.

Authorized Representative Name: James Agnew
Authorized Representative Email: compliance@smiledigitalhealth.com
Authorized Representative Phone: +1 (877) 537 3343
Authorized Representative Signature: James Agnew
DATE: February 4th, 2026

Timeline and Milestones for Real World Testing 2025

• 2025-Q1: Draft test plan. Identify and allocate resources for RWT activities..  
• 2025-Q2.Execute draft test plan and capture results for review. Create an internal review committee to  
  review initial results.  
• 2025-Q3. Complete RWT test plan according to ONC and ONC-ACB requirements and expectations. 2025  
  RWT Test Report will be prepared for submission before the end of the year. 
• 2026-Q1. Submit RWT Test Results to ONC-ACB.  
  
  

Standards Updates Standard and Version

Real World Testing Measurement Methodology  

The measurements for the Smile CDR product RWT Result contains the following:

• Testing Methodology used
• Associated ONC criteria
• Justification for the measurement/metric
• Expected outcomes in testing for the measurement/metric

In each measurement evaluated, the justification for selecting this measure is provided. All measurements were  
selected to best evaluate compliance with the certification criteria and interoperability of exchanging electronic  
health information (EHI) with the Smile CDR Product.  

Testing Methodology 

For each measurement, we will leverage the logging and FHIR reporting capabilities of Smile CDR to examine  functionality performed in the solution. This methodology often provides historical measurement reports which can be accessed for different time intervals and evaluate interoperability functionality, and it may serve as  a benchmark for evaluating real world testing over multiple time intervals.  

MEASUREMENTS

Measurement 2025-CDR-01  

Associated Certification Criterion: 170.315 (g)(7) Application Access - Patient Selection  

Measurement: Count the number of API queries for a patient search made in a real world setting  

Description: Using the Smile CDR FHIR API, the product is able to demonstrate meeting the requirement (g)(7)(i)  respond to requests for a single patient’s data according to the standard adopted in § 170.215(a)(1) and  implementation specification adopted in §170.215(a)(2)  

Justification: Demonstrating the ability Smile CDR API module to respond to (i)(A) requests

Expected Outcomes: Demonstrate the compliance of the standard by confirming that Smile CDR can process queries as expected and with less than 1% errors.

Testing Results:

Reporting Interval: 3 months (October 1, 2025 through December 31, 2025)

Testing Measurement: Number of API queries are 4,428 counts and 0 errors. The error count is below the 1%  
intended threshold.  

Measurement 2025-CDR-02

Associated Certification Criterion: 170.315 (g)(10) Standardized API of Patient and Population Services  

Measurement: Count the number of API queries for the category of clinical data set made in a real world setting.  

Description: During the testing period, a report will be generated which tracks and logs the FHIR API queries made for specific data category requests in the real world.  

Justification: Demonstrate the capability of Smile CDR to process FHIR API queries with a patient as a subject and  fetch that patient-specific data by category.  

Expected Outcomes: Demonstrate the compliance of the standard by confirming that Smile CDR can process queries as expected and with less than 1% errors.  

Testing Results:

Reporting Interval: 3 months (October 1, 2025 through December 31, 2025)  

Testing Measurement: Number of API queries are 155,368 counts and 0 errors. The error count is below the 1%  intended threshold.  

Measurement 2025-CDR-03

Associated Certification Criterion: 170.315 (b)(10) Electronic Health Information Export  

Measurement: Count the number of API queries for EHI exports made in a real world setting.  

Description: During the testing period, a report will be generated which tracks and logs the FHIR API queries made for exporting Electronic Health Information requests in the real world.  

Justification: Demonstrate the capability of Smile CDR to export Electronic Health Information.  

Expected Outcomes: Demonstrate the compliance of the standard by confirming that Smile CDR can process  
queries as expected and with less than 1% errors.  

Testing Results:

Reporting Interval: 3 months (October 1, 2025 through December 31, 2025)  

Testing Measurement: Number of API queries are 7 counts and 0 errors. The error count is below the 1%  intended threshold.