From d1e9b92b3283122c8862a99d94eeb1183df5196e Mon Sep 17 00:00:00 2001
From: Stephen MacVicar <Jammjammjamm@users.noreply.github.com>
Date: Thu, 5 Nov 2020 10:01:16 -0500
Subject: [PATCH] FI-903: replace data mapper (#504)

* replace DataMapper with ActiveRecord

* address PR comments

* move scripts to bin directory
---
 .codeclimate.yml                              |   1 +
 .rubocop.yml                                  |   1 +
 .travis.yml                                   |   3 +-
 Dockerfile                                    |   5 +-
 Gemfile                                       |   5 +-
 Gemfile.lock                                  | 106 ++---
 README.md                                     |  22 +
 Rakefile                                      |   3 +
 bin/run.sh                                    |   4 +
 bin/run_tests.sh                              |   3 +
 db/config.yml                                 |  17 +
 db/migrate/20200910183547_initial_db_setup.rb | 180 +++++++
 ...00915144535_add_expect_redirect_failure.rb |   6 +
 db/schema.rb                                  | 194 ++++++++
 docker-compose.yml                            |   2 +-
 .../static/data_absent_reason_checker.rb      |   4 +-
 .../data_absent_reason_checker_test.rb        |   2 +-
 generator/uscore/templates/module.yml.erb     |   2 -
 .../unit_tests/authorization_unit_test.rb.erb |   5 +-
 .../unit_tests/resource_read_unit_test.rb.erb |  15 +-
 .../resource_validation_unit_test.rb.erb      |   2 +-
 .../unit_tests/search_unit_test.rb.erb        |   2 +-
 .../templates/unit_tests/unit_test.rb.erb     |   2 +-
 lib/app.rb                                    |   5 +-
 lib/app/endpoint.rb                           |   3 -
 lib/app/endpoint/home.rb                      |  14 +-
 lib/app/endpoint/oauth2_endpoints.rb          |  10 +-
 lib/app/endpoint/test_set_endpoints.rb        |  26 +-
 lib/app/ext/fhir_client.rb                    |   4 +-
 lib/app/models.rb                             |  14 +-
 lib/app/models/application_record.rb          |  11 +
 lib/app/models/information_message.rb         |  10 +-
 lib/app/models/module/test_group.rb           |   1 +
 lib/app/models/request_response.rb            |  69 ++-
 lib/app/models/resource_reference.rb          |  16 +-
 lib/app/models/sequence_requirement.rb        |  14 +-
 lib/app/models/sequence_result.rb             | 192 ++++----
 lib/app/models/server_capabilities.rb         | 175 ++++---
 lib/app/models/test_result.rb                 |  37 +-
 lib/app/models/test_warning.rb                |  10 +-
 lib/app/models/testing_instance.rb            | 438 ++++++++----------
 lib/app/sequence_base.rb                      |  29 +-
 lib/app/utils/startup_tasks.rb                |  15 +-
 lib/app/views/default.erb                     |   6 +
 ...onaut_allergy_intolerance_sequence_test.rb |   2 +-
 .../test/argonaut_careplan_sequence_test.rb   |   2 +-
 .../test/argonaut_careteam_sequence_test.rb   |   2 +-
 .../test/argonaut_condition_sequence_test.rb  |   2 +-
 .../argonaut_conformance_sequence_test.rb     |   2 +-
 .../test/argonaut_device_sequence_test.rb     |   2 +-
 ...rgonaut_diagnostic_report_sequence_test.rb |   2 +-
 .../test/argonaut_goal_sequence_test.rb       |   2 +-
 .../argonaut_immunization_sequence_test.rb    |   2 +-
 ...argonaut_medication_order_sequence_test.rb |   2 +-
 ...naut_medication_statement_sequence_test.rb |   2 +-
 .../argonaut_observation_sequence_test.rb     |   2 +-
 ...rgonaut_patient_read_only_sequence_test.rb |   4 +-
 .../argonaut_patient_search_sequence_test.rb  |   2 +-
 .../test/argonaut_procedure_sequence_test.rb  |   2 +-
 .../argonaut_smoking_status_sequence_test.rb  |   2 +-
 ...t_vital_signs_observation_sequence_test.rb |   2 +-
 .../core/capability_statement_sequence.rb     |   2 +-
 .../test/onc_ehr_launch_sequence_test.rb      |  12 +-
 .../onc_program_document_reference_test.rb    |   2 +-
 .../test/onc_program_provenance_test.rb       |   2 +-
 .../onc_standalone_launch_sequence_test.rb    |  12 +-
 .../smart/dynamic_registration_sequence.rb    |   2 +-
 lib/modules/smart/ehr_launch_sequence.rb      |  14 +-
 lib/modules/smart/shared_launch_tests.rb      |  12 +-
 lib/modules/smart/smart_discovery_sequence.rb |   4 +-
 .../smart/standalone_launch_sequence.rb       |   4 +-
 .../smart/test/dynamic_registration_test.rb   |  18 +-
 lib/modules/smart/test/ehr_launch_test.rb     |   2 +-
 lib/modules/smart/test/openid_connect_test.rb |  28 +-
 .../smart/test/shared_launch_tests_test.rb    |  50 +-
 .../test/smart_discovery_sequence_test.rb     |   2 +-
 .../smart/test/standalone_launch_test.rb      |   2 +-
 .../smart/test/token_introspection_test.rb    |   2 +-
 .../smart/test/token_refresh_sequence_test.rb |  12 +-
 .../smart/token_introspection_sequence.rb     |   2 +-
 .../test/clinicalnotes_sequence_test.rb       |   2 +-
 ...e_r4_capability_statement_sequence_test.rb |   2 +-
 ...ore_r4_data_absent_reason_sequence_test.rb |   6 +-
 ...core_r4_patient_read_only_sequence_test.rb |   2 +-
 .../data_absent_reason_checker.rb             |   4 +-
 .../uscore_v3.1.0/test/bodyheight_test.rb     |  27 +-
 .../uscore_v3.1.0/test/bodytemp_test.rb       |  27 +-
 .../uscore_v3.1.0/test/bodyweight_test.rb     |  27 +-
 lib/modules/uscore_v3.1.0/test/bp_test.rb     |  27 +-
 .../test/data_absent_reason_checker_test.rb   |   2 +-
 .../uscore_v3.1.0/test/headcircum_test.rb     |  27 +-
 .../uscore_v3.1.0/test/heartrate_test.rb      |  27 +-
 .../test/pediatric_bmi_for_age_test.rb        |  27 +-
 .../test/pediatric_weight_for_height_test.rb  |  27 +-
 .../uscore_v3.1.0/test/resprate_test.rb       |  27 +-
 .../test/us_core_allergyintolerance_test.rb   |  23 +-
 .../test/us_core_careplan_test.rb             |  21 +-
 .../test/us_core_careteam_test.rb             |  19 +-
 .../test/us_core_condition_test.rb            |  27 +-
 .../test/us_core_diagnosticreport_lab_test.rb |  29 +-
 .../us_core_diagnosticreport_note_test.rb     |  29 +-
 .../test/us_core_documentreference_test.rb    |  33 +-
 .../test/us_core_encounter_test.rb            |  17 +-
 .../uscore_v3.1.0/test/us_core_goal_test.rb   |  23 +-
 .../test/us_core_immunization_test.rb         |  23 +-
 .../test/us_core_implantable_device_test.rb   |  21 +-
 .../test/us_core_medicationrequest_test.rb    |  25 +-
 .../test/us_core_observation_lab_test.rb      |  27 +-
 .../test/us_core_organization_test.rb         |  17 +-
 .../test/us_core_patient_test.rb              |  31 +-
 .../test/us_core_practitioner_test.rb         |  17 +-
 .../test/us_core_procedure_test.rb            |  25 +-
 .../test/us_core_provenance_test.rb           |  17 +-
 .../test/us_core_pulse_oximetry_test.rb       |  27 +-
 .../test/us_core_smokingstatus_test.rb        |  19 +-
 lib/modules/uscore_v3.1.0_module.yml          |   2 -
 .../data_absent_reason_checker.rb             |   4 +-
 .../test/data_absent_reason_checker_test.rb   |   2 +-
 ...l_frontal_circumference_percentile_test.rb |  27 +-
 .../test/pediatric_bmi_for_age_test.rb        |  27 +-
 .../test/pediatric_weight_for_height_test.rb  |  27 +-
 .../test/us_core_allergyintolerance_test.rb   |  23 +-
 .../test/us_core_careplan_test.rb             |  21 +-
 .../test/us_core_careteam_test.rb             |  19 +-
 .../test/us_core_condition_test.rb            |  27 +-
 .../test/us_core_diagnosticreport_lab_test.rb |  29 +-
 .../us_core_diagnosticreport_note_test.rb     |  29 +-
 .../test/us_core_documentreference_test.rb    |  33 +-
 .../test/us_core_encounter_test.rb            |  17 +-
 .../uscore_v3.1.1/test/us_core_goal_test.rb   |  23 +-
 .../test/us_core_immunization_test.rb         |  23 +-
 .../test/us_core_implantable_device_test.rb   |  21 +-
 .../test/us_core_medicationrequest_test.rb    |  25 +-
 .../test/us_core_observation_lab_test.rb      |  27 +-
 .../test/us_core_organization_test.rb         |  17 +-
 .../test/us_core_patient_test.rb              |  31 +-
 .../test/us_core_practitioner_test.rb         |  17 +-
 .../test/us_core_procedure_test.rb            |  25 +-
 .../test/us_core_provenance_test.rb           |  17 +-
 .../test/us_core_pulse_oximetry_test.rb       |  27 +-
 .../test/us_core_smokingstatus_test.rb        |  19 +-
 lib/modules/uscore_v3.1.1_module.yml          |   2 -
 lib/tasks/tasks.rake                          |  14 +-
 test/integration/instance_page_test.rb        |   2 +-
 test/integration/oauth2_endpoints_test.rb     |  18 +-
 test/test_helper.rb                           |  39 +-
 test/unit/exceptions_test.rb                  |  16 +-
 test/unit/fhir_client_test.rb                 |  14 +-
 test/unit/sequence_base_test.rb               |  18 +-
 test/unit/sequence_result_test.rb             |  60 +--
 test/unit/server_capabilities_test.rb         |  16 +-
 test/unit/test_result_test.rb                 |   2 +-
 test/unit/testing_instance_test.rb            |  46 +-
 153 files changed, 1890 insertions(+), 1552 deletions(-)
 create mode 100755 bin/run.sh
 create mode 100755 bin/run_tests.sh
 create mode 100644 db/config.yml
 create mode 100644 db/migrate/20200910183547_initial_db_setup.rb
 create mode 100644 db/migrate/20200915144535_add_expect_redirect_failure.rb
 create mode 100644 db/schema.rb
 create mode 100644 lib/app/models/application_record.rb

diff --git a/.codeclimate.yml b/.codeclimate.yml
index bdabd139b..c454eb844 100644
--- a/.codeclimate.yml
+++ b/.codeclimate.yml
@@ -1,6 +1,7 @@
 version: "2"         # required to adjust maintainability checks
 exclude_patterns:
   - "!**/test/"
+  - "!db/**/*"
 checks:
   argument-count:
     enabled: true
diff --git a/.rubocop.yml b/.rubocop.yml
index d457f9e87..d36badbf2 100644
--- a/.rubocop.yml
+++ b/.rubocop.yml
@@ -7,6 +7,7 @@ AllCops:
     - 'vendor/**/*'
     - 'node_modules/**/*'
     - '.git/**/*'
+    - 'db/**/*'
 
 Layout/MultilineMethodCallIndentation:
   EnforcedStyle: 'indented'
diff --git a/.travis.yml b/.travis.yml
index 09f39ae1e..6d9734b4b 100644
--- a/.travis.yml
+++ b/.travis.yml
@@ -9,11 +9,12 @@ before_script:
   - chmod +x ./cc-test-reporter
   - ./cc-test-reporter before-build
 script:
+  - RACK_ENV=test bundle exec rake db:create db:schema:load
   - bundle exec rake
   # For unknown reasons, the test-reporter fails when using docker if run in an
   # after_script section
   - ./cc-test-reporter after-build -t simplecov --exit-code $TRAVIS_TEST_RESULT
-  - docker-compose run ruby_server bundle exec rake
+  - docker-compose run ruby_server ./bin/run_tests.sh 
   - bundle exec rubocop
 notifications:
   email:
diff --git a/Dockerfile b/Dockerfile
index fc3297976..dab5eebee 100644
--- a/Dockerfile
+++ b/Dockerfile
@@ -19,10 +19,13 @@ COPY config* /var/www/inferno/
 COPY Rakefile /var/www/inferno/
 COPY test /var/www/inferno/test
 COPY lib /var/www/inferno/lib
+COPY db /var/www/inferno/db
+COPY bin /var/www/inferno/bin
 
 ### Set up environment
 
 ENV APP_ENV=production
+ENV RACK_ENV=production
 EXPOSE 4567
 
-CMD ["bundle", "exec", "rackup", "-o", "0.0.0.0"]
+CMD ["./bin/run.sh"]
diff --git a/Gemfile b/Gemfile
index 435658736..ee3611e17 100644
--- a/Gemfile
+++ b/Gemfile
@@ -2,13 +2,12 @@
 
 source 'https://rubygems.org'
 
+gem 'activerecord', '~> 5.2'
 gem 'addressable'
 gem 'ast'
 gem 'base62-rb'
 gem 'bloomer'
 gem 'colorize'
-gem 'data_mapper'
-gem 'dm-sqlite-adapter'
 gem 'fhir_client'
 gem 'jwt'
 gem 'kramdown'
@@ -23,10 +22,12 @@ gem 'selenium-webdriver'
 gem 'sinatra'
 gem 'sinatra-contrib'
 gem 'sqlite3'
+gem 'standalone_migrations', '~> 6.0'
 gem 'thin'
 gem 'time_difference'
 
 group :test do
+  gem 'database_cleaner-active_record'
   gem 'minitest'
   gem 'rack-test'
   gem 'rubocop', require: false
diff --git a/Gemfile.lock b/Gemfile.lock
index b0dc048df..3226e88f7 100644
--- a/Gemfile.lock
+++ b/Gemfile.lock
@@ -1,6 +1,25 @@
 GEM
   remote: https://rubygems.org/
   specs:
+    actionpack (5.2.4.3)
+      actionview (= 5.2.4.3)
+      activesupport (= 5.2.4.3)
+      rack (~> 2.0, >= 2.0.8)
+      rack-test (>= 0.6.3)
+      rails-dom-testing (~> 2.0)
+      rails-html-sanitizer (~> 1.0, >= 1.0.2)
+    actionview (5.2.4.3)
+      activesupport (= 5.2.4.3)
+      builder (~> 3.1)
+      erubi (~> 1.4)
+      rails-dom-testing (~> 2.0)
+      rails-html-sanitizer (~> 1.0, >= 1.0.3)
+    activemodel (5.2.4.3)
+      activesupport (= 5.2.4.3)
+    activerecord (5.2.4.3)
+      activemodel (= 5.2.4.3)
+      activesupport (= 5.2.4.3)
+      arel (>= 9.0)
     activesupport (5.2.4.3)
       concurrent-ruby (~> 1.0, >= 1.0.2)
       i18n (>= 0.7, < 2)
@@ -8,18 +27,17 @@ GEM
       tzinfo (~> 1.1)
     addressable (2.7.0)
       public_suffix (>= 2.0.2, < 5.0)
+    arel (9.0.0)
     ast (2.4.0)
     backports (3.15.0)
     base62-rb (0.3.1)
     bcp47 (0.3.3)
       i18n
-    bcrypt (3.1.13)
-    bcrypt-ruby (3.1.5)
-      bcrypt (>= 3.1.3)
     bitarray (1.2.0)
     bloomer (1.0.0)
       bitarray
       msgpack
+    builder (3.2.4)
     byebug (11.0.1)
     childprocess (2.0.0)
       rake (< 13.0)
@@ -28,63 +46,20 @@ GEM
     concurrent-ruby (1.1.6)
     crack (0.4.3)
       safe_yaml (~> 1.0.0)
+    crass (1.0.6)
     daemons (1.3.1)
-    data_mapper (1.2.0)
-      dm-aggregates (~> 1.2.0)
-      dm-constraints (~> 1.2.0)
-      dm-core (~> 1.2.0)
-      dm-migrations (~> 1.2.0)
-      dm-serializer (~> 1.2.0)
-      dm-timestamps (~> 1.2.0)
-      dm-transactions (~> 1.2.0)
-      dm-types (~> 1.2.0)
-      dm-validations (~> 1.2.0)
-    data_objects (0.10.17)
-      addressable (~> 2.1)
+    database_cleaner (1.8.5)
+    database_cleaner-active_record (1.8.0)
+      activerecord
+      database_cleaner (~> 1.8.0)
     date_time_precision (0.8.1)
-    dm-aggregates (1.2.0)
-      dm-core (~> 1.2.0)
-    dm-constraints (1.2.0)
-      dm-core (~> 1.2.0)
-    dm-core (1.2.1)
-      addressable (~> 2.3)
-    dm-do-adapter (1.2.0)
-      data_objects (~> 0.10.6)
-      dm-core (~> 1.2.0)
-    dm-migrations (1.2.0)
-      dm-core (~> 1.2.0)
-    dm-serializer (1.2.2)
-      dm-core (~> 1.2.0)
-      fastercsv (~> 1.5)
-      json (~> 1.6)
-      json_pure (~> 1.6)
-      multi_json (~> 1.0)
-    dm-sqlite-adapter (1.2.0)
-      dm-do-adapter (~> 1.2.0)
-      do_sqlite3 (~> 0.10.6)
-    dm-timestamps (1.2.0)
-      dm-core (~> 1.2.0)
-    dm-transactions (1.2.0)
-      dm-core (~> 1.2.0)
-    dm-types (1.2.2)
-      bcrypt-ruby (~> 3.0)
-      dm-core (~> 1.2.0)
-      fastercsv (~> 1.5)
-      json (~> 1.6)
-      multi_json (~> 1.0)
-      stringex (~> 1.4)
-      uuidtools (~> 2.1)
-    dm-validations (1.2.0)
-      dm-core (~> 1.2.0)
-    do_sqlite3 (0.10.17)
-      data_objects (= 0.10.17)
     docile (1.3.2)
     domain_name (0.5.20190701)
       unf (>= 0.0.5, < 1.0.0)
+    erubi (1.9.0)
     eventmachine (1.2.7)
     faraday (0.15.4)
       multipart-post (>= 1.2, < 3)
-    fastercsv (1.5.5)
     fhir_client (4.0.3)
       activesupport (>= 3)
       addressable (>= 2.3)
@@ -119,10 +94,12 @@ GEM
       concurrent-ruby (~> 1.0)
     jaro_winkler (1.5.3)
     json (1.8.6)
-    json_pure (1.8.6)
     jwt (2.2.1)
     kramdown (2.3.0)
       rexml
+    loofah (2.7.0)
+      crass (~> 1.0.2)
+      nokogiri (>= 1.5.9)
     method_source (0.9.2)
     mime-types (3.3.1)
       mime-types-data (~> 3.2015)
@@ -158,6 +135,17 @@ GEM
       rack
     rack-test (1.1.0)
       rack (>= 1.0, < 3)
+    rails-dom-testing (2.0.3)
+      activesupport (>= 4.2.0)
+      nokogiri (>= 1.6)
+    rails-html-sanitizer (1.3.0)
+      loofah (~> 2.3)
+    railties (5.2.4.3)
+      actionpack (= 5.2.4.3)
+      activesupport (= 5.2.4.3)
+      method_source
+      rake (>= 0.8.7)
+      thor (>= 0.19.0, < 2.0)
     rainbow (3.0.0)
     rake (12.3.3)
     rb-readline (0.5.5)
@@ -201,11 +189,15 @@ GEM
       sinatra (= 2.0.7)
       tilt (~> 2.0)
     sqlite3 (1.4.1)
-    stringex (1.5.1)
+    standalone_migrations (6.0.0)
+      activerecord (>= 4.2.7, < 6.1.0, != 5.2.3.rc1, != 5.2.3)
+      railties (>= 4.2.7, < 6.1.0, != 5.2.3.rc1, != 5.2.3)
+      rake (>= 10.0)
     thin (1.7.2)
       daemons (~> 1.0, >= 1.0.9)
       eventmachine (~> 1.0, >= 1.0.4)
       rack (>= 1, < 3)
+    thor (1.0.1)
     thread_safe (0.3.6)
     tilt (2.0.10)
     time_difference (0.7.0)
@@ -216,7 +208,6 @@ GEM
       unf_ext
     unf_ext (0.0.7.6)
     unicode-display_width (1.6.0)
-    uuidtools (2.1.5)
     webmock (3.7.6)
       addressable (>= 2.3.6)
       crack (>= 0.3.2)
@@ -226,13 +217,13 @@ PLATFORMS
   ruby
 
 DEPENDENCIES
+  activerecord (~> 5.2)
   addressable
   ast
   base62-rb
   bloomer
   colorize
-  data_mapper
-  dm-sqlite-adapter
+  database_cleaner-active_record
   fhir_client
   jwt
   kramdown
@@ -251,6 +242,7 @@ DEPENDENCIES
   sinatra
   sinatra-contrib
   sqlite3
+  standalone_migrations (~> 6.0)
   thin
   time_difference
   webmock
diff --git a/README.md b/README.md
index bd4c36033..c1fee64b1 100644
--- a/README.md
+++ b/README.md
@@ -42,6 +42,7 @@ And run the following commands from the terminal:
 git clone https://github.com/onc-healthit/inferno
 cd inferno
 bundle install
+bundle exec rake db:create db:schema:load
 bundle exec rackup
 ```
 
@@ -61,6 +62,26 @@ Deployment on a remote server can be done by using a modified form of the Docker
 
 Please see the file [deployment-configuration.md](https://github.com/onc-healthit/inferno/blob/master/deployment-configuration.md) for details.
 
+#### Upgrading Inferno
+
+If an Inferno update makes changes to the database schema, migrations will have
+to be run when updating. Run migrations with:
+
+```sh
+bundle exec rake db:migrate
+```
+
+The above will migrate the development database. To migrate a production or test
+database, use:
+
+```sh
+RACK_ENV=production bundle exec rake db:migrate
+RACK_ENV=test bundle exec rake db:migrate
+```
+
+If you are using the provided inferno docker image, migrations will be run
+automatically.
+
 ### Reference Implementation
 
 While it is recommended that users install Inferno locally, a reference implementation of Inferno is hosted at https://inferno.healthit.gov
@@ -76,6 +97,7 @@ Inferno has been tested on the latest versions of Chrome, Firefox, Safari, and E
 Inferno contains a robust set of self-tests to ensure that the test clients conform to the specification and performs as intended.  To run these tests, execute the following command:
 
 ```sh
+RACK_ENV=test bundle exec rake db:create db:schema:load
 bundle exec rake test
 ```
 
diff --git a/Rakefile b/Rakefile
index 1a178660d..dbfd21c0b 100644
--- a/Rakefile
+++ b/Rakefile
@@ -2,6 +2,9 @@
 
 require 'rake/testtask'
 require 'rubocop/rake_task'
+require 'standalone_migrations'
+
+StandaloneMigrations::Tasks.load_tasks
 
 task :default do
   ENV['RACK_ENV'] = 'test'
diff --git a/bin/run.sh b/bin/run.sh
new file mode 100755
index 000000000..31afcc523
--- /dev/null
+++ b/bin/run.sh
@@ -0,0 +1,4 @@
+#!/bin/sh
+
+bundle exec rake db:create db:migrate
+bundle exec rackup -o 0.0.0.0
diff --git a/bin/run_tests.sh b/bin/run_tests.sh
new file mode 100755
index 000000000..f33d35222
--- /dev/null
+++ b/bin/run_tests.sh
@@ -0,0 +1,3 @@
+#!/bin/sh
+
+RACK_ENV=test bundle exec rake db:create db:migrate test
diff --git a/db/config.yml b/db/config.yml
new file mode 100644
index 000000000..ef9c28033
--- /dev/null
+++ b/db/config.yml
@@ -0,0 +1,17 @@
+development:
+  adapter: sqlite3
+  database: data/development_data.db
+  pool: 10
+  timeout: 5000
+
+production:
+  adapter: sqlite3
+  database: data/production_data.db
+  pool: 10
+  timeout: 5000
+
+test: &test
+  adapter: sqlite3
+  database: data/test_data.db
+  pool: 10
+  timeout: 5000
diff --git a/db/migrate/20200910183547_initial_db_setup.rb b/db/migrate/20200910183547_initial_db_setup.rb
new file mode 100644
index 000000000..4aeeccde9
--- /dev/null
+++ b/db/migrate/20200910183547_initial_db_setup.rb
@@ -0,0 +1,180 @@
+class InitialDbSetup < ActiveRecord::Migration[5.2]
+  def change
+    create_table "inferno_models_information_messages", id: :string, limit: 50, force: :cascade do |t|
+      t.string "message", limit: 500
+      t.string "test_result_id", limit: 50, null: false
+      t.index ["test_result_id"], name: "index_inferno_models_information_messages_test_result"
+    end
+
+    create_table "inferno_models_request_response_test_results", primary_key: ["request_response_id", "test_result_id"], force: :cascade do |t|
+      t.string "request_response_id", limit: 50, null: false
+      t.string "test_result_id", limit: 50, null: false
+    end
+
+    create_table "inferno_models_request_responses", id: :string, limit: 50, force: :cascade do |t|
+      t.string "request_method", limit: 50
+      t.string "request_url", limit: 500
+      t.string "request_headers", limit: 1000
+      t.text "request_payload"
+      t.integer "response_code"
+      t.string "response_headers", limit: 1000
+      t.text "response_body"
+      t.string "direction", limit: 50
+      t.string "instance_id", limit: 50
+      t.datetime "timestamp"
+    end
+
+    create_table "inferno_models_resource_references", id: :string, limit: 50, force: :cascade do |t|
+      t.string "resource_type", limit: 50
+      t.string "resource_id", limit: 50
+      t.string "profile", limit: 50
+      t.datetime "created_at"
+      t.string "testing_instance_id", limit: 50, null: false
+      t.index ["testing_instance_id"], name: "index_inferno_models_resource_references_testing_instance"
+    end
+
+    create_table "inferno_models_sequence_requirements", id: :string, limit: 50, force: :cascade do |t|
+      t.string "name", limit: 50
+      t.string "testing_instance_id", limit: 50
+      t.string "value", limit: 50
+      t.string "label", limit: 50
+      t.string "description", limit: 50
+      t.index ["name", "testing_instance_id"], name: "unique_inferno_models_sequence_requirements_name_by_instance", unique: true
+    end
+
+    create_table "inferno_models_sequence_results", id: :string, limit: 50, force: :cascade do |t|
+      t.string "name", limit: 50
+      t.string "result", limit: 50
+      t.string "test_case_id", limit: 50
+      t.string "test_set_id", limit: 50
+      t.string "redirect_to_url", limit: 500
+      t.string "wait_at_endpoint", limit: 50
+      t.integer "required_passed", default: 0
+      t.integer "required_total", default: 0
+      t.integer "error_count", default: 0
+      t.integer "todo_count", default: 0
+      t.integer "skip_count", default: 0
+      t.integer "optional_passed", default: 0
+      t.integer "optional_total", default: 0
+      t.integer "required_omitted", default: 0
+      t.integer "optional_omitted", default: 0
+      t.string "app_version", limit: 50
+      t.boolean "required", default: true
+      t.string "input_params", limit: 50
+      t.string "output_results", limit: 50
+      t.string "next_sequences", limit: 50
+      t.string "next_test_cases", limit: 50
+      t.datetime "created_at"
+      t.string "testing_instance_id", limit: 50, null: false
+      t.index ["testing_instance_id"], name: "index_inferno_models_sequence_results_testing_instance"
+    end
+
+    create_table "inferno_models_server_capabilities", id: :string, limit: 50, force: :cascade do |t|
+      t.text "capabilities"
+      t.string "testing_instance_id", limit: 50, null: false
+      t.index ["testing_instance_id"], name: "index_inferno_models_server_capabilities_testing_instance"
+    end
+
+    create_table "inferno_models_test_results", id: :string, limit: 50, force: :cascade do |t|
+      t.string "test_id", limit: 50
+      t.string "ref", limit: 50
+      t.string "name", limit: 50
+      t.string "result", limit: 50
+      t.string "message", limit: 500
+      t.string "details", limit: 50
+      t.boolean "required", default: true
+      t.string "url", limit: 500
+      t.text "description"
+      t.integer "test_index"
+      t.datetime "created_at"
+      t.string "versions", limit: 50
+      t.string "wait_at_endpoint", limit: 50
+      t.string "redirect_to_url", limit: 50
+      t.string "sequence_result_id", limit: 50, null: false
+      t.index ["sequence_result_id"], name: "index_inferno_models_test_results_sequence_result"
+    end
+
+    create_table "inferno_models_test_warnings", id: :string, limit: 50, force: :cascade do |t|
+      t.string "message", limit: 500
+      t.string "test_result_id", limit: 50, null: false
+      t.index ["test_result_id"], name: "index_inferno_models_test_warnings_test_result"
+    end
+
+    create_table "inferno_models_testing_instances", id: :string, limit: 50, force: :cascade do |t|
+      t.string "url", limit: 50
+      t.string "name", limit: 50
+      t.boolean "confidential_client"
+      t.string "client_id", limit: 50
+      t.string "client_secret", limit: 50
+      t.string "base_url", limit: 50
+      t.string "client_name", limit: 50, default: "Inferno"
+      t.string "scopes", limit: 50
+      t.string "received_scopes", limit: 50
+      t.string "encounter_id", limit: 50
+      t.string "launch_type", limit: 50
+      t.string "state", limit: 50
+      t.string "selected_module", limit: 50
+      t.boolean "conformance_checked"
+      t.string "oauth_authorize_endpoint", limit: 50
+      t.string "oauth_token_endpoint", limit: 50
+      t.string "oauth_register_endpoint", limit: 50
+      t.string "fhir_format", limit: 50
+      t.boolean "dynamically_registered"
+      t.string "client_endpoint_key", limit: 50
+      t.string "token", limit: 50
+      t.datetime "token_retrieved_at"
+      t.integer "token_expires_in"
+      t.string "id_token", limit: 50
+      t.string "refresh_token", limit: 50
+      t.datetime "created_at"
+      t.string "oauth_introspection_endpoint", limit: 50
+      t.string "resource_id", limit: 50
+      t.string "resource_secret", limit: 50
+      t.string "introspect_token", limit: 50
+      t.string "introspect_refresh_token", limit: 50
+      t.string "standalone_launch_script", limit: 50
+      t.string "ehr_launch_script", limit: 50
+      t.string "manual_registration_script", limit: 50
+      t.string "initiate_login_uri", limit: 50
+      t.string "redirect_uris", limit: 50
+      t.string "dynamic_registration_token", limit: 50
+      t.string "must_support_confirmed", limit: 50, default: ""
+      t.string "patient_ids", limit: 50
+      t.string "group_id", limit: 50
+      t.string "bulk_url", limit: 50
+      t.string "bulk_token_endpoint", limit: 50
+      t.string "bulk_client_id", limit: 50
+      t.string "bulk_system_export_endpoint", limit: 50
+      t.string "bulk_patient_export_endpoint", limit: 50
+      t.string "bulk_group_export_endpoint", limit: 50
+      t.string "bulk_fastest_resource", limit: 50
+      t.string "bulk_requires_auth", limit: 50
+      t.string "bulk_since_param", limit: 50
+      t.string "bulk_jwks_url_auth", limit: 50
+      t.string "bulk_jwks_auth", limit: 50
+      t.string "bulk_public_key", limit: 50
+      t.string "bulk_private_key", limit: 50
+      t.string "bulk_access_token", limit: 50
+      t.string "bulk_lines_to_validate", limit: 50
+      t.string "bulk_status_output", limit: 50
+      t.boolean "data_absent_code_found"
+      t.boolean "data_absent_extension_found"
+      t.string "device_system", limit: 50
+      t.string "device_code", limit: 50
+      t.string "device_codes", limit: 50
+      t.string "onc_sl_url", limit: 50
+      t.boolean "onc_sl_confidential_client"
+      t.string "onc_sl_client_id", limit: 50
+      t.string "onc_sl_client_secret", limit: 50
+      t.string "onc_sl_scopes", limit: 50
+      t.string "onc_patient_ids", limit: 50
+      t.string "bulk_encryption_method", limit: 50, default: "ES384"
+      t.string "bulk_data_jwks", limit: 50
+      t.string "bulk_patient_ids_in_group", limit: 50
+      t.string "bulk_stop_after_must_support", limit: 50, default: "true"
+      t.string "onc_sl_restricted_scopes", limit: 50
+      t.string "bulk_scope", limit: 50
+      t.boolean "disable_bulk_data_require_access_token_test", default: false
+    end
+  end
+end
diff --git a/db/migrate/20200915144535_add_expect_redirect_failure.rb b/db/migrate/20200915144535_add_expect_redirect_failure.rb
new file mode 100644
index 000000000..04c13ca1d
--- /dev/null
+++ b/db/migrate/20200915144535_add_expect_redirect_failure.rb
@@ -0,0 +1,6 @@
+class AddExpectRedirectFailure < ActiveRecord::Migration[5.2]
+  def change
+    add_column :inferno_models_test_results, :expect_redirect_failure, :boolean, default: false
+    add_column :inferno_models_sequence_results, :expect_redirect_failure, :boolean, default: false
+  end
+end
diff --git a/db/schema.rb b/db/schema.rb
new file mode 100644
index 000000000..95a69eb36
--- /dev/null
+++ b/db/schema.rb
@@ -0,0 +1,194 @@
+# This file is auto-generated from the current state of the database. Instead
+# of editing this file, please use the migrations feature of Active Record to
+# incrementally modify your database, and then regenerate this schema definition.
+#
+# Note that this schema.rb definition is the authoritative source for your
+# database schema. If you need to create the application database on another
+# system, you should be using db:schema:load, not running all the migrations
+# from scratch. The latter is a flawed and unsustainable approach (the more migrations
+# you'll amass, the slower it'll run and the greater likelihood for issues).
+#
+# It's strongly recommended that you check this file into your version control system.
+
+ActiveRecord::Schema.define(version: 2020_09_15_144535) do
+
+  create_table "inferno_models_information_messages", id: :string, limit: 50, force: :cascade do |t|
+    t.string "message", limit: 500
+    t.string "test_result_id", limit: 50, null: false
+    t.index ["test_result_id"], name: "index_inferno_models_information_messages_test_result"
+  end
+
+  create_table "inferno_models_request_response_test_results", primary_key: ["request_response_id", "test_result_id"], force: :cascade do |t|
+    t.string "request_response_id", limit: 50, null: false
+    t.string "test_result_id", limit: 50, null: false
+  end
+
+  create_table "inferno_models_request_responses", id: :string, limit: 50, force: :cascade do |t|
+    t.string "request_method", limit: 50
+    t.string "request_url", limit: 500
+    t.string "request_headers", limit: 1000
+    t.text "request_payload"
+    t.integer "response_code"
+    t.string "response_headers", limit: 1000
+    t.text "response_body"
+    t.string "direction", limit: 50
+    t.string "instance_id", limit: 50
+    t.datetime "timestamp"
+  end
+
+  create_table "inferno_models_resource_references", id: :string, limit: 50, force: :cascade do |t|
+    t.string "resource_type", limit: 50
+    t.string "resource_id", limit: 50
+    t.string "profile", limit: 50
+    t.datetime "created_at"
+    t.string "testing_instance_id", limit: 50, null: false
+    t.index ["testing_instance_id"], name: "index_inferno_models_resource_references_testing_instance"
+  end
+
+  create_table "inferno_models_sequence_requirements", id: :string, limit: 50, force: :cascade do |t|
+    t.string "name", limit: 50
+    t.string "testing_instance_id", limit: 50
+    t.string "value", limit: 50
+    t.string "label", limit: 50
+    t.string "description", limit: 50
+    t.index ["name", "testing_instance_id"], name: "unique_inferno_models_sequence_requirements_name_by_instance", unique: true
+  end
+
+  create_table "inferno_models_sequence_results", id: :string, limit: 50, force: :cascade do |t|
+    t.string "name", limit: 50
+    t.string "result", limit: 50
+    t.string "test_case_id", limit: 50
+    t.string "test_set_id", limit: 50
+    t.string "redirect_to_url", limit: 500
+    t.string "wait_at_endpoint", limit: 50
+    t.integer "required_passed", default: 0
+    t.integer "required_total", default: 0
+    t.integer "error_count", default: 0
+    t.integer "todo_count", default: 0
+    t.integer "skip_count", default: 0
+    t.integer "optional_passed", default: 0
+    t.integer "optional_total", default: 0
+    t.integer "required_omitted", default: 0
+    t.integer "optional_omitted", default: 0
+    t.string "app_version", limit: 50
+    t.boolean "required", default: true
+    t.string "input_params", limit: 50
+    t.string "output_results", limit: 50
+    t.string "next_sequences", limit: 50
+    t.string "next_test_cases", limit: 50
+    t.datetime "created_at"
+    t.string "testing_instance_id", limit: 50, null: false
+    t.boolean "expect_redirect_failure", default: false
+    t.index ["testing_instance_id"], name: "index_inferno_models_sequence_results_testing_instance"
+  end
+
+  create_table "inferno_models_server_capabilities", id: :string, limit: 50, force: :cascade do |t|
+    t.text "capabilities"
+    t.string "testing_instance_id", limit: 50, null: false
+    t.index ["testing_instance_id"], name: "index_inferno_models_server_capabilities_testing_instance"
+  end
+
+  create_table "inferno_models_test_results", id: :string, limit: 50, force: :cascade do |t|
+    t.string "test_id", limit: 50
+    t.string "ref", limit: 50
+    t.string "name", limit: 50
+    t.string "result", limit: 50
+    t.string "message", limit: 500
+    t.string "details", limit: 50
+    t.boolean "required", default: true
+    t.string "url", limit: 500
+    t.text "description"
+    t.integer "test_index"
+    t.datetime "created_at"
+    t.string "versions", limit: 50
+    t.string "wait_at_endpoint", limit: 50
+    t.string "redirect_to_url", limit: 50
+    t.string "sequence_result_id", limit: 50, null: false
+    t.boolean "expect_redirect_failure", default: false
+    t.index ["sequence_result_id"], name: "index_inferno_models_test_results_sequence_result"
+  end
+
+  create_table "inferno_models_test_warnings", id: :string, limit: 50, force: :cascade do |t|
+    t.string "message", limit: 500
+    t.string "test_result_id", limit: 50, null: false
+    t.index ["test_result_id"], name: "index_inferno_models_test_warnings_test_result"
+  end
+
+  create_table "inferno_models_testing_instances", id: :string, limit: 50, force: :cascade do |t|
+    t.string "url", limit: 50
+    t.string "name", limit: 50
+    t.boolean "confidential_client"
+    t.string "client_id", limit: 50
+    t.string "client_secret", limit: 50
+    t.string "base_url", limit: 50
+    t.string "client_name", limit: 50, default: "Inferno"
+    t.string "scopes", limit: 50
+    t.string "received_scopes", limit: 50
+    t.string "encounter_id", limit: 50
+    t.string "launch_type", limit: 50
+    t.string "state", limit: 50
+    t.string "selected_module", limit: 50
+    t.boolean "conformance_checked"
+    t.string "oauth_authorize_endpoint", limit: 50
+    t.string "oauth_token_endpoint", limit: 50
+    t.string "oauth_register_endpoint", limit: 50
+    t.string "fhir_format", limit: 50
+    t.boolean "dynamically_registered"
+    t.string "client_endpoint_key", limit: 50
+    t.string "token", limit: 50
+    t.datetime "token_retrieved_at"
+    t.integer "token_expires_in"
+    t.string "id_token", limit: 50
+    t.string "refresh_token", limit: 50
+    t.datetime "created_at"
+    t.string "oauth_introspection_endpoint", limit: 50
+    t.string "resource_id", limit: 50
+    t.string "resource_secret", limit: 50
+    t.string "introspect_token", limit: 50
+    t.string "introspect_refresh_token", limit: 50
+    t.string "standalone_launch_script", limit: 50
+    t.string "ehr_launch_script", limit: 50
+    t.string "manual_registration_script", limit: 50
+    t.string "initiate_login_uri", limit: 50
+    t.string "redirect_uris", limit: 50
+    t.string "dynamic_registration_token", limit: 50
+    t.string "must_support_confirmed", limit: 50, default: ""
+    t.string "patient_ids", limit: 50
+    t.string "group_id", limit: 50
+    t.string "bulk_url", limit: 50
+    t.string "bulk_token_endpoint", limit: 50
+    t.string "bulk_client_id", limit: 50
+    t.string "bulk_system_export_endpoint", limit: 50
+    t.string "bulk_patient_export_endpoint", limit: 50
+    t.string "bulk_group_export_endpoint", limit: 50
+    t.string "bulk_fastest_resource", limit: 50
+    t.string "bulk_requires_auth", limit: 50
+    t.string "bulk_since_param", limit: 50
+    t.string "bulk_jwks_url_auth", limit: 50
+    t.string "bulk_jwks_auth", limit: 50
+    t.string "bulk_public_key", limit: 50
+    t.string "bulk_private_key", limit: 50
+    t.string "bulk_access_token", limit: 50
+    t.string "bulk_lines_to_validate", limit: 50
+    t.string "bulk_status_output", limit: 50
+    t.boolean "data_absent_code_found"
+    t.boolean "data_absent_extension_found"
+    t.string "device_system", limit: 50
+    t.string "device_code", limit: 50
+    t.string "device_codes", limit: 50
+    t.string "onc_sl_url", limit: 50
+    t.boolean "onc_sl_confidential_client"
+    t.string "onc_sl_client_id", limit: 50
+    t.string "onc_sl_client_secret", limit: 50
+    t.string "onc_sl_scopes", limit: 50
+    t.string "onc_patient_ids", limit: 50
+    t.string "bulk_encryption_method", limit: 50, default: "ES384"
+    t.string "bulk_data_jwks", limit: 50
+    t.string "bulk_patient_ids_in_group", limit: 50
+    t.string "bulk_stop_after_must_support", limit: 50, default: "true"
+    t.string "onc_sl_restricted_scopes", limit: 50
+    t.string "bulk_scope", limit: 50
+    t.boolean "disable_bulk_data_require_access_token_test", default: false
+  end
+
+end
diff --git a/docker-compose.yml b/docker-compose.yml
index 66b9605fb..94d768004 100644
--- a/docker-compose.yml
+++ b/docker-compose.yml
@@ -19,4 +19,4 @@ services:
       - "4567:80"
     command: [nginx, '-g', 'daemon off;']
     depends_on:
-      - ruby_server
\ No newline at end of file
+      - ruby_server
diff --git a/generator/uscore/static/data_absent_reason_checker.rb b/generator/uscore/static/data_absent_reason_checker.rb
index d920d7b91..f9af65ba2 100644
--- a/generator/uscore/static/data_absent_reason_checker.rb
+++ b/generator/uscore/static/data_absent_reason_checker.rb
@@ -20,7 +20,7 @@ def check_for_data_absent_extension(reply)
       return unless contains_data_absent_extension?(reply.body)
 
       @instance.data_absent_extension_found = true
-      @instance.save
+      @instance.save!
     end
 
     def check_for_data_absent_code(reply)
@@ -29,7 +29,7 @@ def check_for_data_absent_code(reply)
       return unless contains_data_absent_code?(reply.body)
 
       @instance.data_absent_code_found = true
-      @instance.save
+      @instance.save!
     end
 
     def contains_data_absent_extension?(body)
diff --git a/generator/uscore/static_test/data_absent_reason_checker_test.rb b/generator/uscore/static_test/data_absent_reason_checker_test.rb
index eed9bf142..35823e6af 100644
--- a/generator/uscore/static_test/data_absent_reason_checker_test.rb
+++ b/generator/uscore/static_test/data_absent_reason_checker_test.rb
@@ -12,7 +12,7 @@ class DataAbsentReasonCheckerTest
     attr_reader :instance
 
     def initialize
-      @instance = Inferno::Models::TestingInstance.new
+      @instance = Inferno::TestingInstance.new
     end
   end
 
diff --git a/generator/uscore/templates/module.yml.erb b/generator/uscore/templates/module.yml.erb
index 0090b7415..ae41bd6a6 100644
--- a/generator/uscore/templates/module.yml.erb
+++ b/generator/uscore/templates/module.yml.erb
@@ -24,8 +24,6 @@ test_sets:
         - <%=sequence[:class_name]%><% end %>
         - USCoreR4DataAbsentReasonSequence
 sequence_requirements:
-  patient_ids:
-    label: 'Patient IDs'
   device_codes:
     label: 'Implantable Device Type Codes'
     description: 'Enter the code for an Implantable Device type, or multiple codes separated by commas. If blank, Inferno will validate all Device resources against the Implantable Device profile'
diff --git a/generator/uscore/templates/unit_tests/authorization_unit_test.rb.erb b/generator/uscore/templates/unit_tests/authorization_unit_test.rb.erb
index 74b5c969c..fe34d370d 100644
--- a/generator/uscore/templates/unit_tests/authorization_unit_test.rb.erb
+++ b/generator/uscore/templates/unit_tests/authorization_unit_test.rb.erb
@@ -14,9 +14,10 @@ describe 'unauthorized search test' do
   end
 
   it 'skips if the <%= resource_type %> search interaction is not supported' do
-    Inferno::Models::ServerCapabilities.create(
+    Inferno::ServerCapabilities.delete_all
+    Inferno::ServerCapabilities.create(
       testing_instance_id: @instance.id,
-      capabilities: FHIR::CapabilityStatement.new.to_json
+      capabilities: FHIR::CapabilityStatement.new.as_json
     )
     @instance.reload
     exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
diff --git a/generator/uscore/templates/unit_tests/resource_read_unit_test.rb.erb b/generator/uscore/templates/unit_tests/resource_read_unit_test.rb.erb
index d760aeb0a..18d386728 100644
--- a/generator/uscore/templates/unit_tests/resource_read_unit_test.rb.erb
+++ b/generator/uscore/templates/unit_tests/resource_read_unit_test.rb.erb
@@ -9,9 +9,10 @@ describe '<%= resource_type %> read test' do
   end
 
   it 'skips if the <%= resource_type %> read interaction is not supported' do
-    Inferno::Models::ServerCapabilities.create(
+    Inferno::ServerCapabilities.delete_all
+    Inferno::ServerCapabilities.create(
       testing_instance_id: @instance.id,
-      capabilities: FHIR::CapabilityStatement.new.to_json
+      capabilities: FHIR::CapabilityStatement.new.as_json
     )
     @instance.reload
     exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -28,7 +29,7 @@ describe '<%= resource_type %> read test' do
   end
 
   it 'fails if a non-success response code is received' do
-    Inferno::Models::ResourceReference.create(
+    Inferno::ResourceReference.create(
       resource_type: '<%= resource_type %>',
       resource_id: @<%= resource_var_name %>_id,
       testing_instance: @instance
@@ -44,7 +45,7 @@ describe '<%= resource_type %> read test' do
   end
 
   it 'fails if no resource is received' do
-    Inferno::Models::ResourceReference.create(
+    Inferno::ResourceReference.create(
       resource_type: '<%= resource_type %>',
       resource_id: @<%= resource_var_name %>_id,
       testing_instance: @instance
@@ -60,7 +61,7 @@ describe '<%= resource_type %> read test' do
   end
 
   it 'fails if the resource returned is not a <%= resource_type %>' do
-    Inferno::Models::ResourceReference.create(
+    Inferno::ResourceReference.create(
       resource_type: '<%= resource_type %>',
       resource_id: @<%= resource_var_name %>_id,
       testing_instance: @instance
@@ -76,7 +77,7 @@ describe '<%= resource_type %> read test' do
   end
 
   it 'fails if the resource has an incorrect id' do
-   Inferno::Models::ResourceReference.create(
+   Inferno::ResourceReference.create(
       resource_type: '<%= resource_type %>',
       resource_id: @<%= resource_var_name %>_id,
       testing_instance: @instance
@@ -97,7 +98,7 @@ describe '<%= resource_type %> read test' do
     <%= resource_var_name %> = FHIR::<%= resource_type %>.new(
       id: @<%= resource_var_name %>_id
     )
-    Inferno::Models::ResourceReference.create(
+    Inferno::ResourceReference.create(
       resource_type: '<%= resource_type %>',
       resource_id: @<%= resource_var_name %>_id,
       testing_instance: @instance
diff --git a/generator/uscore/templates/unit_tests/resource_validation_unit_test.rb.erb b/generator/uscore/templates/unit_tests/resource_validation_unit_test.rb.erb
index 79e27e4c8..1f1d94522 100644
--- a/generator/uscore/templates/unit_tests/resource_validation_unit_test.rb.erb
+++ b/generator/uscore/templates/unit_tests/resource_validation_unit_test.rb.erb
@@ -5,7 +5,7 @@ describe 'resource validation test' do
     @sequence = @sequence_class.new(@instance, @client)
     @sequence.instance_variable_set(:'@resources_found', true)
 
-    Inferno::Models::ResourceReference.create(
+    Inferno::ResourceReference.create(
       resource_type: '<%= resource_type %>',
       resource_id: @<%= resource_var_name %>.id,
       testing_instance: @instance<% if profile_uri.present? %>,
diff --git a/generator/uscore/templates/unit_tests/search_unit_test.rb.erb b/generator/uscore/templates/unit_tests/search_unit_test.rb.erb
index b9b043961..b320b6259 100644
--- a/generator/uscore/templates/unit_tests/search_unit_test.rb.erb
+++ b/generator/uscore/templates/unit_tests/search_unit_test.rb.erb
@@ -21,7 +21,7 @@ describe '<%= resource_type %> search by <%= search_params.keys.join('+') %> tes
   end
 
   it 'skips if the search params are not supported' do
-    capabilities = Inferno::Models::ServerCapabilities.new
+    capabilities = Inferno::ServerCapabilities.new
     def capabilities.supported_search_params(_)
       [<%=supported_search_params_string%>]
     end
diff --git a/generator/uscore/templates/unit_tests/unit_test.rb.erb b/generator/uscore/templates/unit_tests/unit_test.rb.erb
index 874d2bf9e..27d8e6d78 100644
--- a/generator/uscore/templates/unit_tests/unit_test.rb.erb
+++ b/generator/uscore/templates/unit_tests/unit_test.rb.erb
@@ -10,7 +10,7 @@ describe Inferno::Sequence::<%= class_name %> do
     @sequence_class = Inferno::Sequence::<%= class_name %>
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: '<%= module_name %>')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: '<%= module_name %>')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
diff --git a/lib/app.rb b/lib/app.rb
index 0d2c0db9f..65b1c7700 100644
--- a/lib/app.rb
+++ b/lib/app.rb
@@ -5,24 +5,23 @@
 require 'sinatra/config_file'
 require 'sinatra/namespace'
 require 'sinatra/cookies'
+require 'active_record'
 require 'fhir_client'
 require 'rest-client'
 require 'time_difference'
 require 'pry'
 require 'pry-byebug'
-require 'dm-core'
-require 'dm-migrations'
 require 'jwt'
 require 'kramdown'
 
 require 'rack'
 require_relative 'app/utils/logging'
+require_relative 'app/models'
 require_relative 'app/endpoint'
 require_relative 'app/utils/secure_random_base62'
 require_relative 'app/sequence_base'
 require_relative 'app/models/module'
 require_relative 'version'
-require_relative 'app/models'
 require_relative 'app/utils/terminology'
 require_relative 'app/utils/startup_tasks'
 require_relative 'app/utils/config_manager'
diff --git a/lib/app/endpoint.rb b/lib/app/endpoint.rb
index 2514d6cca..1ad0e284c 100644
--- a/lib/app/endpoint.rb
+++ b/lib/app/endpoint.rb
@@ -39,9 +39,6 @@ class Endpoint < Sinatra::Base
             l
           end
 
-        # FIXME: Really don't want a direct dependency to DataMapper here
-        DataMapper.logger = Inferno.logger if Inferno::ENVIRONMENT == :development
-
         FHIR.logger = FHIR::STU3.logger = FHIR::DSTU2.logger = Inferno.logger
 
         Inferno.logger.info "Environment: #{Inferno::ENVIRONMENT}"
diff --git a/lib/app/endpoint/home.rb b/lib/app/endpoint/home.rb
index 209a76c25..290fb6620 100644
--- a/lib/app/endpoint/home.rb
+++ b/lib/app/endpoint/home.rb
@@ -32,10 +32,10 @@ class Home < Endpoint
             halt 404, "Unknown module: #{params[:module]}"
           end
 
-          @instance = Inferno::Models::TestingInstance.new(url: url,
-                                                           name: params['name'],
-                                                           base_url: request.base_url,
-                                                           selected_module: inferno_module.name)
+          @instance = Inferno::TestingInstance.new(url: url,
+                                                   name: params['name'],
+                                                   base_url: request.base_url,
+                                                   selected_module: inferno_module.name)
 
           @instance.add_sequence_requirements(@instance.module.sequence_requirements)
           @instance.client_endpoint_key = params['client_endpoint_key'] unless params['client_endpoint_key'].nil?
@@ -65,7 +65,7 @@ class Home < Endpoint
 
         # Returns a specific testing instance test page
         get '/:id/?' do
-          instance = Inferno::Models::TestingInstance.get(params[:id])
+          instance = Inferno::TestingInstance.find_by(id: params[:id])
           halt 404 if instance.nil?
 
           redirect "#{base_path}/#{instance.id}/test_sets/#{instance.module.default_test_set}/#{'?error=' + params[:error] unless params[:error].nil?}"
@@ -91,7 +91,7 @@ class Home < Endpoint
         # Returns test details for a specific test including any applicable requests and responses.
         #   This route is typically used for retrieving test metadata and results after the test has been run.
         get '/:id/test_result/:test_result_id/?' do
-          @test_result = Inferno::Models::TestResult.get(params[:test_result_id])
+          @test_result = Inferno::TestResult.find_by(id: params[:test_result_id])
           halt 404 if @test_result.sequence_result.testing_instance.id != params[:id]
           erb :test_result_details, layout: false
         end
@@ -99,7 +99,7 @@ class Home < Endpoint
         # Returns details for a specific request response
         #   This route is typically used for retrieving test metadata and results after the test has been run.
         get '/:id/test_request/:test_request_id/?' do
-          request_response = Inferno::Models::RequestResponse.get(params[:test_request_id])
+          request_response = Inferno::RequestResponse.find_by(id: params[:test_request_id])
           halt 404 if request_response.instance_id != params[:id]
 
           erb :request_details, { layout: false }, rr: request_response
diff --git a/lib/app/endpoint/oauth2_endpoints.rb b/lib/app/endpoint/oauth2_endpoints.rb
index 686d4f99c..2325e8a25 100644
--- a/lib/app/endpoint/oauth2_endpoints.rb
+++ b/lib/app/endpoint/oauth2_endpoints.rb
@@ -18,10 +18,10 @@ def instance_id_from_cookie
           end
 
           get '/oauth2/:key/redirect/?' do
-            @instance = Inferno::Models::TestingInstance.first(state: params[:state])
+            @instance = Inferno::TestingInstance.find_by(state: params[:state])
             return resume_execution if @instance.present?
 
-            @instance = Inferno::Models::TestingInstance.get(instance_id_from_cookie)
+            @instance = Inferno::TestingInstance.find_by(id: instance_id_from_cookie)
             halt 500, no_instance_for_state_error_message if @instance.nil?
 
             if @instance&.waiting_on_sequence&.wait?
@@ -33,10 +33,10 @@ def instance_id_from_cookie
           end
 
           get '/oauth2/:key/launch/?' do
-            @instance = Inferno::Models::SequenceResult.recent_results_for_iss(params[:iss])&.testing_instance
+            @instance = Inferno::SequenceResult.recent_results_for_iss(params[:iss])&.testing_instance
             return resume_execution if @instance.present?
 
-            @instance = Inferno::Models::TestingInstance.get(instance_id_from_cookie)
+            @instance = Inferno::TestingInstance.find_by(id: instance_id_from_cookie)
             halt 500, no_instance_for_iss_error_message if @instance.nil?
 
             if @instance.waiting_on_sequence&.wait?
@@ -180,7 +180,7 @@ def resume_execution
                 out << js_redirect("#{base_path}/#{@instance.id}/test_sets/#{test_set.id}/##{query_target}") if finished
               end
             else
-              latest_sequence_result = Inferno::Models::SequenceResult.first(testing_instance: @instance)
+              latest_sequence_result = Inferno::SequenceResult.find_by(testing_instance: @instance)
               test_set_id = latest_sequence_result&.test_set_id || @instance.module.default_test_set
               redirect "#{BASE_PATH}/#{@instance.id}/test_sets/#{test_set_id}/?error=no_#{params[:endpoint]}"
             end
diff --git a/lib/app/endpoint/test_set_endpoints.rb b/lib/app/endpoint/test_set_endpoints.rb
index b7f6db22f..90bece825 100644
--- a/lib/app/endpoint/test_set_endpoints.rb
+++ b/lib/app/endpoint/test_set_endpoints.rb
@@ -7,7 +7,7 @@ def self.included(klass)
         klass.class_eval do
           # Returns a specific testing instance test page
           get '/:id/test_sets/:test_set_id/?' do
-            instance = Inferno::Models::TestingInstance.get(params[:id])
+            instance = Inferno::TestingInstance.find_by(id: params[:id])
             halt 404 if instance.nil?
             test_set = instance.module.test_sets[params[:test_set_id].to_sym]
             halt 404 if test_set.nil?
@@ -24,16 +24,16 @@ def self.included(klass)
           end
 
           get '/:id/test_sets/:test_set_id/report?' do
-            instance = Inferno::Models::TestingInstance.get(params[:id])
+            instance = Inferno::TestingInstance.find_by(id: params[:id])
             halt 404 if instance.nil?
             test_set = instance.module.test_sets[params[:test_set_id].to_sym]
             halt 404 if test_set.nil?
             sequence_results = instance.latest_results_by_case
 
-            request_response_count = Inferno::Models::RequestResponse.all(instance_id: instance.id).count
+            request_response_count = Inferno::RequestResponse.where(instance_id: instance.id).count
             latest_sequence_time =
               if instance.sequence_results.count.positive?
-                Inferno::Models::SequenceResult.first(testing_instance: instance).created_at.strftime('%m/%d/%Y %H:%M')
+                Inferno::SequenceResult.find_by(testing_instance: instance).created_at.strftime('%m/%d/%Y %H:%M')
               else
                 'No tests ran'
               end
@@ -63,7 +63,7 @@ def self.included(klass)
 
           # Cancels the currently running test
           get '/:id/test_sets/:test_set_id/sequence_result/:sequence_result_id/cancel' do
-            sequence_result = Inferno::Models::SequenceResult.get(params[:sequence_result_id])
+            sequence_result = Inferno::SequenceResult.find(params[:sequence_result_id])
             instance = sequence_result.testing_instance
             halt 404 if instance.id != params[:id]
             test_set = instance.module.test_sets[params[:test_set_id].to_sym]
@@ -87,13 +87,13 @@ def self.included(klass)
             sequence.tests(instance.module).each_with_index do |test, index|
               next if index < current_test_count
 
-              sequence_result.test_results << Inferno::Models::TestResult.new(test_id: test.id,
-                                                                              name: test.name,
-                                                                              result: 'cancel',
-                                                                              url: test.link,
-                                                                              description: test.description,
-                                                                              test_index: test.index,
-                                                                              message: cancel_message)
+              sequence_result.test_results << Inferno::TestResult.new(test_id: test.id,
+                                                                      name: test.name,
+                                                                      result: 'cancel',
+                                                                      url: test.link,
+                                                                      description: test.description,
+                                                                      test_index: test.index,
+                                                                      message: cancel_message)
             end
 
             sequence_result.save!
@@ -112,7 +112,7 @@ def self.included(klass)
 
           # Run a sequence and get the results
           post '/:id/test_sets/:test_set_id/sequence_result?' do
-            instance = Inferno::Models::TestingInstance.get(params[:id])
+            instance = Inferno::TestingInstance.find_by(id: params[:id])
             halt 404 if instance.nil?
             test_set = instance.module.test_sets[params[:test_set_id].to_sym]
             halt 404 if test_set.nil?
diff --git a/lib/app/ext/fhir_client.rb b/lib/app/ext/fhir_client.rb
index d2556f143..b829e657f 100644
--- a/lib/app/ext/fhir_client.rb
+++ b/lib/app/ext/fhir_client.rb
@@ -70,8 +70,8 @@ def perform_refresh
         }
 
         update_params[:refresh_token] = token_response_body['refresh_token'] if token_response_body['refresh_token'].present?
-        testing_instance.save
-        testing_instance.update(update_params)
+        testing_instance.save!
+        testing_instance.update!(update_params)
 
         set_bearer_token(token_response_body['access_token'])
       rescue StandardError => e
diff --git a/lib/app/models.rb b/lib/app/models.rb
index cd0f96852..ddf1e8ef1 100644
--- a/lib/app/models.rb
+++ b/lib/app/models.rb
@@ -1,21 +1,11 @@
 # frozen_string_literal: true
 
-DataMapper::Model.raise_on_save_failure = true
-
-DataMapper.setup(:default, "sqlite3:data/#{Inferno::ENVIRONMENT}_data.db")
-
+require_relative 'models/application_record'
 require_relative 'models/request_response'
 require_relative 'models/resource_reference'
 require_relative 'models/sequence_result'
+require_relative 'models/server_capabilities'
 require_relative 'models/test_result'
 require_relative 'models/test_warning'
 require_relative 'models/testing_instance'
 require_relative 'models/sequence_requirement'
-
-DataMapper.finalize
-
-if Inferno::PURGE_ON_RELOAD || Inferno::ENVIRONMENT == :test
-  DataMapper.auto_migrate!
-else
-  DataMapper.auto_upgrade!
-end
diff --git a/lib/app/models/application_record.rb b/lib/app/models/application_record.rb
new file mode 100644
index 000000000..f6e9afa7a
--- /dev/null
+++ b/lib/app/models/application_record.rb
@@ -0,0 +1,11 @@
+# frozen_string_literal: true
+
+module Inferno
+  class ApplicationRecord < ::ActiveRecord::Base
+    self.abstract_class = true
+
+    def self.table_name_prefix
+      'inferno_models_'
+    end
+  end
+end
diff --git a/lib/app/models/information_message.rb b/lib/app/models/information_message.rb
index c03921cfe..f646c4f3f 100644
--- a/lib/app/models/information_message.rb
+++ b/lib/app/models/information_message.rb
@@ -1,13 +1,9 @@
 # frozen_string_literal: true
 
 module Inferno
-  module Models
-    class InformationMessage
-      include DataMapper::Resource
-      property :id, String, key: true, default: proc { SecureRandom.uuid }
-      property :message, String, length: 500
+  class InformationMessage < ApplicationRecord
+    attribute :id, :string, default: -> { SecureRandom.uuid }
 
-      belongs_to :test_result
-    end
+    belongs_to :test_result
   end
 end
diff --git a/lib/app/models/module/test_group.rb b/lib/app/models/module/test_group.rb
index fbc25976f..ed82773c1 100644
--- a/lib/app/models/module/test_group.rb
+++ b/lib/app/models/module/test_group.rb
@@ -1,6 +1,7 @@
 # frozen_string_literal: true
 
 require_relative 'test_case'
+require_relative '../../sequence_base'
 
 module Inferno
   class Module
diff --git a/lib/app/models/request_response.rb b/lib/app/models/request_response.rb
index 3979206a1..4d8f2e87c 100644
--- a/lib/app/models/request_response.rb
+++ b/lib/app/models/request_response.rb
@@ -1,51 +1,40 @@
 # frozen_string_literal: true
 
 module Inferno
-  module Models
-    class RequestResponse
-      include DataMapper::Resource
-      property :id, String, key: true, default: proc { SecureRandom.uuid }
-      property :request_method, String
-      property :request_url, String, length: 500
-      property :request_headers, String, length: 1000
-      property :request_payload, Text
-      property :response_code, Integer
-      property :response_headers, String, length: 1000
-      property :response_body, Text
-      property :direction, String
-      property :instance_id, String
-      property :request_index, Serial, unique_index: true
+  class RequestResponse < ApplicationRecord
+    attribute :id, :string, default: -> { SecureRandom.uuid }
+    attribute :timestamp, :datetime, default: -> { DateTime.now }
 
-      property :timestamp, DateTime, default: proc { DateTime.now }
+    has_and_belongs_to_many :test_results, join_table: :inferno_models_request_response_test_results
+    belongs_to :instance, class_name: 'TestingInstance'
 
-      has n, :test_results, through: Resource
+    def self.from_request(req, instance_id, direction = nil)
+      request = req.request
+      response = req.response
 
-      def self.from_request(req, instance_id, direction = nil)
-        request = req.request
-        response = req.response
+      response_body = response[:body]
+      response_body = '' if response_body.nil?
+      escaped_body = response_body.dup
+      unescape_unicode(escaped_body)
 
-        escaped_body = response[:body].dup # In case body is frozen from string literal
-        unescape_unicode(escaped_body)
-
-        new(
-          direction: direction || req&.direction,
-          request_method: request[:method],
-          request_url: request[:url],
-          request_headers: request[:headers].to_json,
-          request_payload: request[:payload],
-          response_code: response[:code],
-          response_headers: response[:headers].to_json,
-          response_body: escaped_body,
-          instance_id: instance_id,
-          timestamp: response[:timestamp]
-        )
-      end
+      new(
+        direction: direction || req&.direction,
+        request_method: request[:method],
+        request_url: request[:url],
+        request_headers: request[:headers].to_json,
+        request_payload: request[:payload],
+        response_code: response[:code],
+        response_headers: response[:headers].to_json,
+        response_body: escaped_body,
+        instance_id: instance_id,
+        timestamp: response[:timestamp]
+      )
+    end
 
-      # This is needed to escape HTML when the html tags are unicode escape sequences
-      # https://stackoverflow.com/questions/7015778/is-this-the-best-way-to-unescape-unicode-escape-sequences-in-ruby
-      def self.unescape_unicode(body)
-        body.gsub!(/\\u(\h{4})/) { |_m| [Regexp.last_match(1)].pack('H*').unpack('n*').pack('U*') }
-      end
+    # This is needed to escape HTML when the html tags are unicode escape sequences
+    # https://stackoverflow.com/questions/7015778/is-this-the-best-way-to-unescape-unicode-escape-sequences-in-ruby
+    def self.unescape_unicode(body)
+      body.gsub!(/\\u(\h{4})/) { |_m| [Regexp.last_match(1)].pack('H*').unpack('n*').pack('U*') }
     end
   end
 end
diff --git a/lib/app/models/resource_reference.rb b/lib/app/models/resource_reference.rb
index ee695b36d..eee852862 100644
--- a/lib/app/models/resource_reference.rb
+++ b/lib/app/models/resource_reference.rb
@@ -1,18 +1,10 @@
 # frozen_string_literal: true
 
-require 'dm-timestamps'
-
 module Inferno
-  module Models
-    class ResourceReference
-      include DataMapper::Resource
-      property :id, String, key: true, default: proc { SecureRandom.uuid }
-      property :resource_type, String
-      property :resource_id, String
-      property :profile, String
-      property :created_at, DateTime
+  class ResourceReference < ApplicationRecord
+    attribute :id, :string, default: -> { SecureRandom.uuid }
+    attribute :resource_id, :string
 
-      belongs_to :testing_instance
-    end
+    belongs_to :testing_instance
   end
 end
diff --git a/lib/app/models/sequence_requirement.rb b/lib/app/models/sequence_requirement.rb
index d44bf30bb..e5aa147f8 100644
--- a/lib/app/models/sequence_requirement.rb
+++ b/lib/app/models/sequence_requirement.rb
@@ -1,17 +1,9 @@
 # frozen_string_literal: true
 
 module Inferno
-  module Models
-    class SequenceRequirement
-      include DataMapper::Resource
-      property :id, String, key: true, default: proc { SecureRandom.uuid }
-      property :name, String, unique_index: :name_by_instance
-      property :testing_instance_id, String, unique_index: :name_by_instance
-      property :value, String
-      property :label, String
-      property :description, String
+  class SequenceRequirement < ApplicationRecord
+    attribute :id, :string, default: -> { SecureRandom.uuid }
 
-      belongs_to :testing_instance
-    end
+    belongs_to :testing_instance
   end
 end
diff --git a/lib/app/models/sequence_result.rb b/lib/app/models/sequence_result.rb
index 0004fcd51..11acbec70 100644
--- a/lib/app/models/sequence_result.rb
+++ b/lib/app/models/sequence_result.rb
@@ -4,130 +4,102 @@
 require_relative '../utils/logging'
 
 module Inferno
-  module Models
-    class SequenceResult
-      include ResultStatuses
-      include DataMapper::Resource
-      property :id, String, key: true, default: proc { SecureRandom.uuid }
-      property :name, String
-      property :result, String
-      property :test_case_id, String
-      property :test_set_id, String
-
-      property :redirect_to_url, String, length: 500
-      property :wait_at_endpoint, String
-      property :expect_redirect_failure, Boolean, default: false
-
-      property :required_passed, Integer, default: 0
-      property :required_total, Integer, default: 0
-      property :error_count, Integer, default: 0
-      property :todo_count, Integer, default: 0
-      property :skip_count, Integer, default: 0
-      property :optional_passed, Integer, default: 0
-      property :optional_total, Integer, default: 0
-      property :required_omitted, Integer, default: 0
-      property :optional_omitted, Integer, default: 0
-
-      property :app_version, String
-
-      property :required, Boolean, default: true
-      property :input_params, String
-      property :output_results, String
-
-      property :next_sequences, String
-      property :next_test_cases, String
-
-      property :created_at, DateTime, default: proc { DateTime.now }
-
-      has n, :test_results, order: [:test_index.asc]
-      belongs_to :testing_instance
-
-      def self.recent_results_for_iss(iss)
-        all(
-          :created_at.gte => 5.minutes.ago,
-          :result => 'wait',
-          :order => [:created_at.desc]
-        ).find { |result| normalize_url(result.testing_instance.url) == normalize_url(iss) }
-      end
+  class SequenceResult < ApplicationRecord
+    include ResultStatuses
+
+    attribute :id, :string, default: -> { SecureRandom.uuid }
+    attribute :required, :boolean, default: true
+    attribute :created_at, :datetime, default: -> { DateTime.now }
+    attribute :test_case_id, :string
+    attribute :test_set_id, :string
+
+    has_many :test_results, -> { order 'test_index ASC' }
+    belongs_to :testing_instance
+
+    def self.recent_results_for_iss(iss)
+      where(result: 'wait')
+        .where('created_at >= ?', 5.minutes.ago)
+        .order(created_at: :desc)
+        .find { |result| normalize_url(result.testing_instance.url) == normalize_url(iss) }
+    end
 
-      def failures
-        test_results.select(&:fail?)
-      end
+    def failures
+      test_results.select(&:fail?)
+    end
 
-      def reset!
-        [
-          'required_passed',
-          'required_total',
-          'error_count',
-          'todo_count',
-          'skip_count',
-          'optional_passed',
-          'optional_total',
-          'required_omitted',
-          'optional_omitted'
-        ].each { |field| send("#{field}=", 0) }
-      end
+    def reset!
+      [
+        'required_passed',
+        'required_total',
+        'error_count',
+        'todo_count',
+        'skip_count',
+        'optional_passed',
+        'optional_total',
+        'required_omitted',
+        'optional_omitted'
+      ].each { |field| send("#{field}=", 0) }
+    end
 
-      def result_count
-        test_results.length
-      end
+    def result_count
+      test_results.length
+    end
 
-      def total_omitted
-        required_omitted + optional_omitted
-      end
+    def total_omitted
+      required_omitted + optional_omitted
+    end
 
-      def total_required_tests_except_omitted
-        required_total - required_omitted
-      end
+    def total_required_tests_except_omitted
+      required_total - required_omitted
+    end
 
-      def update_result_counts
-        test_results.each do |result|
+    def update_result_counts
+      test_results.each do |result|
+        if result.required
+          self.required_total += 1
+        else
+          self.optional_total += 1
+        end
+        case result.result
+        when ResultStatuses::PASS
+          if result.required
+            self.required_passed += 1
+          else
+            self.optional_passed += 1
+          end
+          self.result = result.result unless error? || fail? || skip?
+        when ResultStatuses::OMIT
           if result.required
-            self.required_total += 1
+            self.required_omitted += 1
           else
-            self.optional_total += 1
+            self.optional_omitted += 1
           end
-          case result.result
-          when ResultStatuses::PASS
-            if result.required
-              self.required_passed += 1
-            else
-              self.optional_passed += 1
-            end
-            self.result = result.result unless error? || fail? || skip?
-          when ResultStatuses::OMIT
-            if result.required
-              self.required_omitted += 1
-            else
-              self.optional_omitted += 1
-            end
-          when ResultStatuses::TODO
-            self.todo_count += 1
-          when ResultStatuses::FAIL
-            if result.required
-              self.result = result.result unless error?
-            end
-          when ResultStatuses::ERROR
-            if result.required
-              self.error_count += 1
-              self.result = result.result
-            end
-          when ResultStatuses::SKIP
-            if result.required
-              self.result = result.result if pass? || self.result.nil?
-              self.skip_count += 1
-            end
-          when ResultStatuses::WAIT
+        when ResultStatuses::TODO
+          self.todo_count += 1
+        when ResultStatuses::FAIL
+          if result.required
+            self.result = result.result unless error?
+          end
+        when ResultStatuses::ERROR
+          if result.required
+            self.error_count += 1
             self.result = result.result
           end
+        when ResultStatuses::SKIP
+          if result.required
+            self.result = result.result if pass? || self.result.nil?
+            self.skip_count += 1
+          end
+        when ResultStatuses::WAIT
+          self.result = result.result
         end
-        self.result = ResultStatuses::PASS if self.result.nil?
       end
+      self.result = ResultStatuses::PASS if self.result.nil?
+    end
 
-      def self.normalize_url(url)
-        url&.downcase&.split('://')&.last&.chomp('/')
-      end
-      private_class_method :normalize_url
+    def self.normalize_url(url)
+      url&.downcase&.split('://')&.last&.chomp('/')
     end
+    private_class_method :normalize_url
   end
 end
diff --git a/lib/app/models/server_capabilities.rb b/lib/app/models/server_capabilities.rb
index 330d5cb02..1ee490a4b 100644
--- a/lib/app/models/server_capabilities.rb
+++ b/lib/app/models/server_capabilities.rb
@@ -1,123 +1,118 @@
 # frozen_string_literal: true
 
-require 'dm-types'
-
 module Inferno
-  module Models
-    class ServerCapabilities
-      include DataMapper::Resource
-      property :id, String, key: true, default: proc { SecureRandom.uuid }
-      property :capabilities, Json, lazy: false # lazy loading Json properties is broken
+  class ServerCapabilities < ApplicationRecord
+    attribute :id, :string, default: -> { SecureRandom.uuid }
+    serialize :capabilities, JSON
 
-      belongs_to :testing_instance
+    belongs_to :testing_instance
 
-      SMART_EXTENSION_URL = 'http://fhir-registry.smarthealthit.org/StructureDefinition/capabilities'
+    SMART_EXTENSION_URL = 'http://fhir-registry.smarthealthit.org/StructureDefinition/capabilities'
 
-      def supported_resources
-        statement.rest.each_with_object(Set.new) do |rest, resources|
-          rest.resource.each { |resource| resources << resource.type }
-        end
+    def supported_resources
+      statement.rest.each_with_object(Set.new) do |rest, resources|
+        rest.resource.each { |resource| resources << resource.type }
       end
+    end
 
-      def supported_interactions
-        statement.rest.flat_map do |rest|
-          rest.resource.map do |resource|
-            {
-              resource_type: resource.type,
-              interactions: resource_interactions(resource).sort,
-              operations: resource_operations(resource).sort
-            }
-          end
+    def supported_interactions
+      statement.rest.flat_map do |rest|
+        rest.resource.map do |resource|
+          {
+            resource_type: resource.type,
+            interactions: resource_interactions(resource).sort,
+            operations: resource_operations(resource).sort
+          }
         end
       end
+    end
 
-      def supported_profiles
-        profile_urls = statement.rest.flat_map(&:resource)
-          &.flat_map { |resource| resource.supportedProfile + [resource.profile] }
-          &.compact || []
-        profile_urls.map { |profile_url| profile_url.split('|').first }
-      end
+    def supported_profiles
+      profile_urls = statement.rest.flat_map(&:resource)
+        &.flat_map { |resource| resource.supportedProfile + [resource.profile] }
+        &.compact || []
+      profile_urls.map { |profile_url| profile_url.split('|').first }
+    end
 
-      def operation_supported?(operation_name)
-        statement.rest.any? { |rest| rest.operation.any? { |operation| operation.name == operation_name } }
-      end
+    def operation_supported?(operation_name)
+      statement.rest.any? { |rest| rest.operation.any? { |operation| operation.name == operation_name } }
+    end
 
-      def smart_support?
-        smart_extensions.present?
-      end
+    def smart_support?
+      smart_extensions.present?
+    end
 
-      def smart_capabilities
-        smart_extensions.map(&:valueCode)
-      end
+    def smart_capabilities
+      smart_extensions.map(&:valueCode)
+    end
 
-      def search_documented?(resource_type)
-        statement&.rest&.any? do |rest|
-          rest&.resource
-            &.select { |resource| resource&.type == resource_type }
-            &.flat_map(&:interaction)
-            &.select { |interaction| interaction&.code == 'search-type' }
-            &.any? { |interaction| interaction&.documentation&.present? }
-        end
+    def search_documented?(resource_type)
+      statement&.rest&.any? do |rest|
+        rest&.resource
+          &.select { |resource| resource&.type == resource_type }
+          &.flat_map(&:interaction)
+          &.select { |interaction| interaction&.code == 'search-type' }
+          &.any? { |interaction| interaction&.documentation&.present? }
       end
+    end
 
-      def supported_search_params(resource_type)
-        rest_resource(resource_type)&.searchParam&.map(&:name) || []
-      end
+    def supported_search_params(resource_type)
+      rest_resource(resource_type)&.searchParam&.map(&:name) || []
+    end
 
-      def supported_includes(resource_type)
-        rest_resource(resource_type)&.searchInclude || []
-      end
+    def supported_includes(resource_type)
+      rest_resource(resource_type)&.searchInclude || []
+    end
 
-      def include_supported?(resource_type, include)
-        supported_includes(resource_type).include?('*') ||
-          supported_includes(resource_type).include?(include)
-      end
+    def include_supported?(resource_type, include)
+      supported_includes(resource_type).include?('*') ||
+        supported_includes(resource_type).include?(include)
+    end
 
-      def supported_revincludes(resource_type)
-        rest_resource(resource_type)&.searchRevInclude || []
-      end
+    def supported_revincludes(resource_type)
+      rest_resource(resource_type)&.searchRevInclude || []
+    end
 
-      def revinclude_supported?(resource_type, revinclude)
-        supported_revincludes(resource_type).include?('*') ||
-          supported_revincludes(resource_type).include?(revinclude)
-      end
+    def revinclude_supported?(resource_type, revinclude)
+      supported_revincludes(resource_type).include?('*') ||
+        supported_revincludes(resource_type).include?(revinclude)
+    end
 
-      private
+    private
 
-      def statement
-        @statement ||= FHIR::CapabilityStatement.new(capabilities)
-      end
+    def statement
+      @statement ||= FHIR::CapabilityStatement.new(capabilities)
+    end
 
-      def rest_resource(resource_type)
-        statement&.rest&.first&.resource
-          &.find { |resource| resource&.type == resource_type }
-      end
+    def rest_resource(resource_type)
+      statement&.rest&.first&.resource
+        &.find { |resource| resource&.type == resource_type }
+    end
 
-      def security_extensions
-        @security_extensions ||=
-          statement&.rest&.flat_map { |rest| rest&.security&.extension }&.compact || []
-      end
+    def security_extensions
+      @security_extensions ||=
+        statement&.rest&.flat_map { |rest| rest&.security&.extension }&.compact || []
+    end
 
-      def smart_extensions
-        @smart_extensions ||=
-          security_extensions.select { |extension| extension.url == SMART_EXTENSION_URL }
-      end
+    def smart_extensions
+      @smart_extensions ||=
+        security_extensions.select { |extension| extension.url == SMART_EXTENSION_URL }
+    end
 
-      def interaction_display(interaction)
-        if interaction.code == 'search-type'
-          'search'
-        else
-          interaction.code
-        end
+    def interaction_display(interaction)
+      if interaction.code == 'search-type'
+        'search'
+      else
+        interaction.code
       end
+    end
 
-      def resource_interactions(resource)
-        resource.interaction.map { |interaction| interaction_display(interaction) }
-      end
+    def resource_interactions(resource)
+      resource.interaction.map { |interaction| interaction_display(interaction) }
+    end
 
-      def resource_operations(resource)
-        resource.operation.map(&:name)
-      end
+    def resource_operations(resource)
+      resource.operation.map(&:name)
     end
   end
 end
diff --git a/lib/app/models/test_result.rb b/lib/app/models/test_result.rb
index 48bd1db69..aa5f438cd 100644
--- a/lib/app/models/test_result.rb
+++ b/lib/app/models/test_result.rb
@@ -4,33 +4,18 @@
 require_relative 'information_message'
 
 module Inferno
-  module Models
-    class TestResult
-      include ResultStatuses
-      include DataMapper::Resource
-      property :id, String, key: true, default: proc { SecureRandom.uuid }
-      property :test_id, String
-      property :ref, String
-      property :name, String
-      property :result, String
-      property :message, String, length: 500
-      property :details, String
-      property :required, Boolean, default: true
+  class TestResult < ApplicationRecord
+    include ResultStatuses
 
-      property :url, String, length: 500
-      property :description, Text
-      property :test_index, Integer
-      property :created_at, DateTime, default: proc { DateTime.now }
-      property :versions, String
+    attribute :id, :string, default: -> { SecureRandom.uuid }
+    attribute :required, :boolean, default: true
+    attribute :created_at, :datetime, default: -> { DateTime.now }
+    attribute :test_id, :string
 
-      property :wait_at_endpoint, String
-      property :redirect_to_url, String
-      property :expect_redirect_failure, Boolean, default: false
-
-      has n, :request_responses, through: Resource, order: [:request_index.asc]
-      has n, :test_warnings
-      has n, :information_messages
-      belongs_to :sequence_result
-    end
+    has_and_belongs_to_many :request_responses, -> { order 'timestamp ASC' },
+                            join_table: :inferno_models_request_response_test_results
+    has_many :test_warnings
+    has_many :information_messages
+    belongs_to :sequence_result
   end
 end
diff --git a/lib/app/models/test_warning.rb b/lib/app/models/test_warning.rb
index 997971796..398886c55 100644
--- a/lib/app/models/test_warning.rb
+++ b/lib/app/models/test_warning.rb
@@ -1,13 +1,9 @@
 # frozen_string_literal: true
 
 module Inferno
-  module Models
-    class TestWarning
-      include DataMapper::Resource
-      property :id, String, key: true, default: proc { SecureRandom.uuid }
-      property :message, String, length: 500
+  class TestWarning < ApplicationRecord
+    attribute :id, :string, default: -> { SecureRandom.uuid }
 
-      belongs_to :test_result
-    end
+    belongs_to :test_result
   end
 end
diff --git a/lib/app/models/testing_instance.rb b/lib/app/models/testing_instance.rb
index 1eb043924..ad995af6a 100644
--- a/lib/app/models/testing_instance.rb
+++ b/lib/app/models/testing_instance.rb
@@ -1,318 +1,256 @@
 # frozen_string_literal: true
 
-require 'dm-core'
-require 'dm-migrations'
-require_relative 'server_capabilities'
 require_relative '../utils/result_statuses'
 
 module Inferno
-  module Models
-    class TestingInstance
-      include DataMapper::Resource
-      property :id, String, key: true, default: proc { Inferno::SecureRandomBase62.generate(64) }
-      property :url, String
-      property :name, String
-      property :confidential_client, Boolean
-      property :client_id, String
-      property :client_secret, String
-      property :base_url, String
-
-      property :client_name, String, default: 'Inferno'
-      property :scopes, String
-      property :received_scopes, String
-      property :encounter_id, String
-      property :launch_type, String
-      property :state, String
-      property :selected_module, String
-
-      property :conformance_checked, Boolean
-      property :oauth_authorize_endpoint, String
-      property :oauth_token_endpoint, String
-      property :oauth_register_endpoint, String
-      property :fhir_format, String
-
-      property :dynamically_registered, Boolean
-      property :client_endpoint_key, String, default: proc { Inferno::SecureRandomBase62.generate(32) }
-
-      property :token, String
-      property :token_retrieved_at, DateTime
-      property :token_expires_in, Integer
-      property :id_token, String
-      property :refresh_token, String
-      property :created_at, DateTime, default: proc { DateTime.now }
-
-      property :oauth_introspection_endpoint, String
-      property :resource_id, String
-      property :resource_secret, String
-      property :introspect_token, String
-      property :introspect_refresh_token, String
-
-      property :standalone_launch_script, String
-      property :ehr_launch_script, String
-      property :manual_registration_script, String
-
-      property :initiate_login_uri, String
-      property :redirect_uris, String
-
-      property :dynamic_registration_token, String
-
-      property :must_support_confirmed, String, default: ''
-
-      property :group_id, String
-
-      property :data_absent_code_found, Boolean
-      property :data_absent_extension_found, Boolean
-
-      # Bulk Data Parameters
-      property :bulk_url, String
-      property :bulk_token_endpoint, String
-      property :bulk_client_id, String
-      property :bulk_system_export_endpoint, String
-      property :bulk_patient_export_endpoint, String
-      property :bulk_group_export_endpoint, String
-      property :bulk_fastest_resource, String
-      property :bulk_requires_auth, String
-      property :bulk_since_param, String
-      property :bulk_jwks_url_auth, String
-      property :bulk_jwks_auth, String
-      property :bulk_public_key, String
-      property :bulk_private_key, String
-      property :bulk_access_token, String
-      property :bulk_lines_to_validate, String
-      property :bulk_status_output, String
-
-      has n, :sequence_results
-      has n, :resource_references
-      has n, :sequence_requirements
-      has 1, :server_capabilities
-
-      def latest_results
-        sequence_results.each_with_object({}) do |result, hash|
-          hash[result.name] = result if hash[result.name].nil? || hash[result.name].created_at < result.created_at
-        end
+  class TestingInstance < ApplicationRecord
+    attribute :id, :string, default: -> { SecureRandomBase62.generate(64) }
+    attribute :client_name, :string, default: 'Inferno'
+    attribute :client_endpoint_key, :string, default: -> { SecureRandomBase62.generate(32) }
+    attribute :created_at, :datetime, default: -> { DateTime.now }
+    attribute :must_support_confirmed, :string, default: ''
+    attribute :client_id, :string
+    attribute :resource_id, :string
+    attribute :group_id, :string
+    attribute :bulk_client_id, :string
+    attribute :onc_sl_client_id, :string
+
+    has_many :sequence_results
+    has_many :resource_references
+    has_many :sequence_requirements
+    has_one :server_capabilities
+
+    def latest_results
+      sequence_results.each_with_object({}) do |result, hash|
+        hash[result.name] = result if hash[result.name].nil? || hash[result.name].created_at < result.created_at
       end
+    end
 
-      def latest_results_by_case
-        sequence_results.each_with_object({}) do |result, hash|
-          if hash[result.test_case_id].nil? || hash[result.test_case_id].created_at < result.created_at
-            hash[result.test_case_id] = result
-          end
+    def latest_results_by_case
+      sequence_results.each_with_object({}) do |result, hash|
+        if hash[result.test_case_id].nil? || hash[result.test_case_id].created_at < result.created_at
+          hash[result.test_case_id] = result
         end
       end
+    end
 
-      def group_results(test_set_id)
-        return_data = []
-        results = latest_results_by_case
-
-        self.module.test_sets[test_set_id.to_sym].groups.each do |group|
-          result_details = group.test_cases.each_with_object(Hash.new(0)) do |test_case, hash|
-            id = test_case.id
-            next unless results.key?(id)
-
-            hash[results[id].result.to_sym] += 1
-            hash[:total] += 1
-          end
-
-          return_data << {
-            group: group,
-            result_details: result_details,
-            result: group_result(result_details),
-            missing_variables: group.lock_variables.select { |var| send(var.to_sym).nil? }
-          }
-        end
+    def group_results(test_set_id)
+      return_data = []
+      results = latest_results_by_case
 
-        return_data
-      end
+      self.module.test_sets[test_set_id.to_sym].groups.each do |group|
+        result_details = group.test_cases.each_with_object(Hash.new(0)) do |test_case, hash|
+          id = test_case.id
+          next unless results.key?(id)
 
-      def waiting_on_sequence
-        sequence_results.first(result: 'wait')
-      end
+          hash[results[id].result.to_sym] += 1
+          hash[:total] += 1
+        end
 
-      def all_test_cases(test_set_id)
-        self.module.test_sets[test_set_id.to_sym].groups.flat_map(&:test_cases)
+        return_data << {
+          group: group,
+          result_details: result_details,
+          result: group_result(result_details),
+          missing_variables: group.lock_variables.select { |var| send(var.to_sym).nil? }
+        }
       end
 
-      def all_passed?(test_set_id)
-        latest_results = latest_results_by_case
-
-        all_test_cases(test_set_id).all? do |test_case|
-          latest_results[test_case.id]&.pass?
-        end
-      end
+      return_data
+    end
 
-      def any_failed?(test_set_id)
-        latest_results = latest_results_by_case
+    def waiting_on_sequence
+      sequence_results.find_by(result: 'wait')
+    end
 
-        all_test_cases(test_set_id).any? do |test_case|
-          latest_results[test_case.id]&.fail?
-        end
-      end
+    def all_test_cases(test_set_id)
+      self.module.test_sets[test_set_id.to_sym].groups.flat_map(&:test_cases)
+    end
 
-      def final_result(test_set_id)
-        if all_passed?(test_set_id)
-          Inferno::ResultStatuses::PASS
-        else
-          any_failed?(test_set_id) ? Inferno::ResultStatuses::FAIL : Inferno::ResultStatuses::PENDING
-        end
-      end
+    def all_passed?(test_set_id)
+      latest_results = latest_results_by_case
 
-      def fhir_version
-        self.module.fhir_version
+      all_test_cases(test_set_id).all? do |test_case|
+        latest_results[test_case.id]&.pass?
       end
+    end
 
-      def fhir_version_match?(versions)
-        return true if fhir_version.blank?
+    def any_failed?(test_set_id)
+      latest_results = latest_results_by_case
 
-        versions.include? fhir_version.to_sym
+      all_test_cases(test_set_id).any? do |test_case|
+        latest_results[test_case.id]&.fail?
       end
+    end
 
-      def module
-        @module ||= Inferno::Module.get(selected_module)
+    def final_result(test_set_id)
+      if all_passed?(test_set_id)
+        ResultStatuses::PASS
+      else
+        any_failed?(test_set_id) ? ResultStatuses::FAIL : ResultStatuses::PENDING
       end
+    end
 
-      def patient_id
-        resource_references
-          .first(resource_type: 'Patient', order: [:created_at.asc])
-          &.resource_id
-      end
+    def fhir_version
+      self.module.fhir_version
+    end
 
-      def patient_id=(patient_id)
-        return if patient_id.to_s == self.patient_id.to_s
+    def fhir_version_match?(versions)
+      return true if fhir_version.blank?
 
-        resource_references.destroy
+      versions.include? fhir_version.to_sym
+    end
 
-        unless patient_ids.nil?
-          self.patient_ids = patient_ids.split(',').append(patient_id).uniq.join(',')
-        end
+    def module
+      @module ||= Module.get(selected_module)
+    end
 
-        ResourceReference.create(
-          resource_type: 'Patient',
-          resource_id: patient_id,
-          testing_instance: self
-        )
+    def patient_id
+      resource_references
+        .where(resource_type: 'Patient')
+        .order(created_at: :asc)
+        .first
+        &.resource_id
+    end
 
-        save!
+    def patient_id=(patient_id)
+      return if patient_id.to_s == self.patient_id.to_s
 
-        reload
-      end
+      resource_references.destroy_all
 
-      def testable_resources
-        self.module.resources_to_test & (server_capabilities&.supported_resources || Set.new)
+      unless patient_ids.nil?
+        self.patient_ids = patient_ids.split(',').append(patient_id).uniq.join(',')
       end
 
-      def supported_resource_interactions
-        return [] if server_capabilities.blank?
+      ResourceReference.create!(
+        resource_type: 'Patient',
+        resource_id: patient_id,
+        testing_instance: self
+      )
 
-        resources = testable_resources
-        server_capabilities.supported_interactions.select do |interactions|
-          resources.include? interactions[:resource_type]
-        end
-      end
+      save!
+      reload
+    end
 
-      def conformance_supported?(resource, methods = [], operations = [])
-        resource_support = supported_resource_interactions.find do |interactions|
-          interactions[:resource_type] == resource.to_s
-        end
+    def testable_resources
+      self.module.resources_to_test & (server_capabilities&.supported_resources || Set.new)
+    end
 
-        return false if resource_support.blank?
+    def supported_resource_interactions
+      return [] if server_capabilities.blank?
 
-        methods_supported = methods.all? do |method|
-          method = method == :history ? 'history-instance' : method.to_s
+      resources = testable_resources
+      server_capabilities.supported_interactions.select do |interactions|
+        resources.include? interactions[:resource_type]
+      end
+    end
 
-          resource_support[:interactions].include? method
-        end
+    def conformance_supported?(resource, methods = [], operations = [])
+      resource_support = supported_resource_interactions.find do |interactions|
+        interactions[:resource_type] == resource.to_s
+      end
 
-        operations_supported = operations.all? do |operation|
-          resource_support[:operations].include? operation.to_s
-        end
+      return false if resource_support.blank?
 
-        methods_supported && operations_supported
-      end
+      methods_supported = methods.all? do |method|
+        method = method == :history ? 'history-instance' : method.to_s
 
-      def save_resource_reference_without_reloading(type, id, profile = nil)
-        ResourceReference
-          .all(resource_type: type, resource_id: id, testing_instance_id: self.id)
-          .destroy
-
-        ResourceReference.create!(
-          resource_type: type,
-          resource_id: id,
-          profile: profile,
-          testing_instance: self
-        )
+        resource_support[:interactions].include? method
       end
 
-      def save_resource_references(klass, resources, profile = nil)
-        resources
-          .select { |resource| resource.is_a? klass }
-          .each do |resource|
-            save_resource_reference_without_reloading(klass.name.demodulize, resource.id, profile)
-          end
-
-        # Ensure the instance resource references are accurate
-        reload
+      operations_supported = operations.all? do |operation|
+        resource_support[:operations].include? operation.to_s
       end
 
-      def save_resource_ids_in_bundle(klass, reply, profile = nil)
-        return if reply&.resource&.entry&.blank?
+      methods_supported && operations_supported
+    end
 
-        resources = reply.resource.entry.map(&:resource)
+    def save_resource_reference_without_reloading(type, id, profile = nil)
+      ResourceReference
+        .where(resource_type: type, resource_id: id, testing_instance_id: self.id)
+        .delete_all
+
+      ResourceReference.create!(
+        resource_type: type,
+        resource_id: id,
+        profile: profile,
+        testing_instance: self
+      )
+    end
 
-        save_resource_references(klass, resources, profile)
+    def save_resource_references(klass, resources, profile = nil)
+      resources
+        .select { |resource| resource.is_a? klass }
+        .each do |resource|
+        save_resource_reference_without_reloading(klass.name.demodulize, resource.id, profile)
       end
 
-      def versioned_conformance_class
-        if fhir_version == 'dstu2'
-          FHIR::DSTU2::Conformance
-        elsif fhir_version == 'stu3'
-          FHIR::STU3::CapabilityStatement
-        else
-          FHIR::CapabilityStatement
-        end
-      end
+      # Ensure the instance resource references are accurate
+      reload
+    end
 
-      def token_expiration_time
-        token_retrieved_at + token_expires_in.seconds
-      end
+    def save_resource_ids_in_bundle(klass, reply, profile = nil)
+      return if reply&.resource&.entry&.blank?
 
-      def get_sequence_requirement(requirement)
-        return unless requirement&.dig(:name)
+      resources = reply.resource.entry.map(&:resource)
 
-        attributes = { testing_instance: self,
-                       label: requirement[:name],
-                       value: '' }
-          .merge(requirement)
+      save_resource_references(klass, resources, profile)
+    end
 
-        SequenceRequirement.first_or_create({ name: requirement[:name], testing_instance: self }, attributes)
+    def versioned_conformance_class
+      if fhir_version == 'dstu2'
+        FHIR::DSTU2::Conformance
+      elsif fhir_version == 'stu3'
+        FHIR::STU3::CapabilityStatement
+      else
+        FHIR::CapabilityStatement
       end
+    end
+
+    def token_expiration_time
+      token_retrieved_at + token_expires_in.seconds
+    end
 
-      def add_sequence_requirements(requirements)
-        return unless requirements.present?
+    def get_sequence_requirement(requirement)
+      return unless requirement&.dig(:name)
 
-        requirements.each do |requirement, req_desciption|
-          get_sequence_requirement(name: requirement.to_s, label: req_desciption[:label], description: req_desciption[:description])
+      attributes = { testing_instance: self,
+                     label: requirement[:name],
+                     value: '' }
+        .merge(requirement)
+
+      SequenceRequirement
+        .find_or_create_by(name: requirement[:name], testing_instance: self) do |requirement_instance|
+          requirement_instance.assign_attributes(attributes)
+          requirement_instance.save!
         end
-      end
+    end
 
-      def get_requirement_value(requirement_name)
-        get_sequence_requirement(name: requirement_name.to_s, testing_instance: self).value
-      end
+    def add_sequence_requirements(requirements)
+      return unless requirements.present?
 
-      def set_requirement_value(requirement_name, value)
-        get_sequence_requirement(name: requirement_name.to_s, testing_instance: self).update(value: value)
+      requirements.each do |requirement, req_desciption|
+        get_sequence_requirement(name: requirement.to_s, label: req_desciption[:label], description: req_desciption[:description])
       end
+    end
 
-      private
+    def get_requirement_value(requirement_name)
+      get_sequence_requirement(name: requirement_name.to_s, testing_instance: self).value
+    end
 
-      def group_result(results)
-        return :skip if results[:skip].positive?
-        return :fail if results[:fail].positive?
-        return :fail if results[:cancel].positive?
-        return :error if results[:error].positive?
-        return :not_run if results[:total].zero?
+    def set_requirement_value(requirement_name, value)
+      get_sequence_requirement(name: requirement_name.to_s, testing_instance: self).update!(value: value)
+    end
 
-        :pass
-      end
+    private
+
+    def group_result(results)
+      return :skip if results[:skip].positive?
+      return :fail if results[:fail].positive?
+      return :fail if results[:cancel].positive?
+      return :error if results[:error].positive?
+      return :not_run if results[:total].zero?
+
+      :pass
     end
   end
 end
diff --git a/lib/app/sequence_base.rb b/lib/app/sequence_base.rb
index ed93c6643..1bb54a101 100644
--- a/lib/app/sequence_base.rb
+++ b/lib/app/sequence_base.rb
@@ -60,7 +60,7 @@ class SequenceBase
       def initialize(instance, client, disable_tls_tests = false, sequence_result = nil)
         @client = client
         @instance = instance
-        @client.set_bearer_token(@instance.token) unless @client.nil? || @instance.nil? || @instance.token.nil?
+        @client.set_bearer_token(@instance.token) unless @client.nil? || @instance.nil? || @instance.token.blank?
         @client&.monitor_requests
         @sequence_result = sequence_result
         @disable_tls_tests = disable_tls_tests
@@ -78,8 +78,10 @@ def resume(request = nil, headers = nil, params = nil, fail_message = nil, &bloc
           sequence_result.test_results.last.message = fail_message
         end
 
+        sequence_result.test_results.last.save!
+
         unless request.nil?
-          sequence_result.test_results.last.request_responses << Models::RequestResponse.new(
+          sequence_result.test_results.last.request_responses << RequestResponse.new(
             direction: 'inbound',
             request_method: request.request_method.downcase,
             request_url: request.url,
@@ -101,7 +103,7 @@ def resume(request = nil, headers = nil, params = nil, fail_message = nil, &bloc
 
       def start(test_set_id = nil, test_case_id = nil, &block)
         if sequence_result.nil?
-          self.sequence_result = Models::SequenceResult.new(
+          self.sequence_result = SequenceResult.new(
             name: sequence_name,
             result: ResultStatuses::PASS,
             testing_instance: @instance,
@@ -194,11 +196,11 @@ def run_tests(inferno_tests)
           end
 
           @client&.requests&.each do |req|
-            result.request_responses << Models::RequestResponse.from_request(req, @instance.id, 'outbound')
+            result.request_responses << RequestResponse.from_request(req, @instance.id, 'outbound')
           end
 
           LoggedRestClient.requests.each do |req|
-            result.request_responses << Models::RequestResponse.from_request(OpenStruct.new(req), @instance.id)
+            result.request_responses << RequestResponse.from_request(OpenStruct.new(req), @instance.id)
           end
 
           yield result if block_given?
@@ -253,7 +255,8 @@ def self.details(details = nil)
       def self.requires(*requires)
         @@requires[sequence_name] = requires unless requires.empty?
 
-        instance_class = Inferno::Models::TestingInstance
+        instance_class = Inferno::TestingInstance
+        instance_class.new unless instance_class.connected?
         requires.each do |requirement_name|
           requirement_setter_name = "#{requirement_name}=".to_sym
           next if instance_class.method_defined?(requirement_name) && instance_class.method_defined?(requirement_setter_name)
@@ -407,7 +410,7 @@ def wrap_test(test)
         lambda do
           @test_warnings = []
           @information_messages = []
-          Models::TestResult.new(
+          TestResult.new(
             test_id: test.id,
             name: test.name,
             ref: test.ref,
@@ -434,8 +437,8 @@ def wrap_test(test)
               end
             end
 
-            result.test_warnings = @test_warnings.map { |w| Models::TestWarning.new(message: w) }
-            result.information_messages = @information_messages.map { |m| Models::InformationMessage.new(message: m) }
+            result.test_warnings = @test_warnings.map { |w| TestWarning.new(message: w) }
+            result.information_messages = @information_messages.map { |m| InformationMessage.new(message: m) }
             Inferno.logger.info "Finished Test: #{test.id} [#{result.result}]"
           end
         end
@@ -614,7 +617,7 @@ def fetch_resource(resource_type, resource_id)
       end
 
       def test_resources(resource_type, &block)
-        references = @instance.resource_references.all(resource_type: resource_type)
+        references = @instance.resource_references.where(resource_type: resource_type)
         skip_if(
           references.empty?,
           "Skip profile validation since no #{resource_type} resources found for Patient."
@@ -664,7 +667,7 @@ def test_resources_against_profile(resource_type, specified_profile = nil, &bloc
           "Skip profile validation since profile #{specified_profile} is unknown."
         )
 
-        references = @instance.resource_references.all(profile: specified_profile)
+        references = @instance.resource_references.where(profile: specified_profile)
         resources =
           if references.present?
             references.map(&:resource_id).map do |resource_id|
@@ -672,7 +675,7 @@ def test_resources_against_profile(resource_type, specified_profile = nil, &bloc
             end
           else
             @instance.resource_references
-              .all(resource_type: resource_type)
+              .where(resource_type: resource_type)
               .map { |reference| fetch_resource(resource_type, reference.resource_id) }
               .select { |resource| resource.meta&.profile&.include? specified_profile }
           end
@@ -898,7 +901,5 @@ def find_slice_by_values(element, values)
         end
       end
     end
-
-    Dir.glob(File.join(__dir__, '..', 'modules', '**', '*_sequence.rb')).sort.each { |file| require file }
   end
 end
diff --git a/lib/app/utils/startup_tasks.rb b/lib/app/utils/startup_tasks.rb
index ea9cac596..374b5fd85 100644
--- a/lib/app/utils/startup_tasks.rb
+++ b/lib/app/utils/startup_tasks.rb
@@ -3,24 +3,37 @@
 require 'rubygems/package'
 require 'json'
 require_relative './index_builder'
+require_relative '../models/module'
 
 module Inferno
   module StartupTasks
     class << self
       def run
+        establish_db_connection
         check_validator_availability
+        load_all_sequences
         load_all_modules
       end
 
       def load_all_modules
         Dir.glob(File.join(__dir__, '..', '..', 'modules', '*_module.yml')).each do |file|
           module_metadata = YAML.load_file(file).deep_symbolize_keys
-          Module.new(module_metadata)
+          Inferno::Module.new(module_metadata)
 
           load_ig_in_validator(module_metadata) if external_validator? && module_metadata.key?(:resource_path)
         end
       end
 
+      def load_all_sequences
+        Dir.glob(File.join(__dir__, '..', '..', 'modules', '**', '*_sequence.rb')).sort.each { |file| require file }
+      end
+
+      def establish_db_connection
+        path = File.join(__dir__, '..', '..', '..', 'db', 'config.yml')
+        configuration = YAML.load_file(path)[ENV['RACK_ENV']]
+        ActiveRecord::Base.establish_connection(configuration)
+      end
+
       def external_validator?
         App::Endpoint.settings.resource_validator == 'external'
       end
diff --git a/lib/app/views/default.erb b/lib/app/views/default.erb
index 1e4b9dd9b..1268d23e9 100644
--- a/lib/app/views/default.erb
+++ b/lib/app/views/default.erb
@@ -221,6 +221,12 @@
               value: instance.patient_id,
               })%>
 
+        <%= erb(:prerequisite_field,{},{prerequisite: :patient_ids,
+              label: 'Patient IDs',
+              instance: instance,
+              value: instance.patient_ids,
+              })%>
+
         <%= erb(:prerequisite_field,{},{prerequisite: :id_token,
               label: 'OAuth 2.0 ID Token',
               instance: instance,
diff --git a/lib/modules/argonaut/test/argonaut_allergy_intolerance_sequence_test.rb b/lib/modules/argonaut/test/argonaut_allergy_intolerance_sequence_test.rb
index ea1fc9648..cc61187a8 100644
--- a/lib/modules/argonaut/test/argonaut_allergy_intolerance_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_allergy_intolerance_sequence_test.rb
@@ -25,7 +25,7 @@ def setup
     @patient_resource = FHIR::DSTU2::Patient.new(id: @patient_id)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_careplan_sequence_test.rb b/lib/modules/argonaut/test/argonaut_careplan_sequence_test.rb
index 6cfbbc833..6f70798c4 100644
--- a/lib/modules/argonaut/test/argonaut_careplan_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_careplan_sequence_test.rb
@@ -25,7 +25,7 @@ def setup
     @patient_resource = FHIR::DSTU2::Patient.new(id: @patient_id)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_careteam_sequence_test.rb b/lib/modules/argonaut/test/argonaut_careteam_sequence_test.rb
index 61ec87b70..6e9222616 100644
--- a/lib/modules/argonaut/test/argonaut_careteam_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_careteam_sequence_test.rb
@@ -25,7 +25,7 @@ def setup
     @patient_resource = FHIR::DSTU2::Patient.new(id: @patient_id)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_condition_sequence_test.rb b/lib/modules/argonaut/test/argonaut_condition_sequence_test.rb
index 2f9142aca..884a567c8 100644
--- a/lib/modules/argonaut/test/argonaut_condition_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_condition_sequence_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_conformance_sequence_test.rb b/lib/modules/argonaut/test/argonaut_conformance_sequence_test.rb
index 2a2e70a0a..50b58b3de 100644
--- a/lib/modules/argonaut/test/argonaut_conformance_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_conformance_sequence_test.rb
@@ -14,7 +14,7 @@ class ConformanceSequenceTest < MiniTest::Test
   RESPONSE_HEADERS = { 'content-type' => 'application/json+fhir;charset=UTF-8' }.freeze
 
   def setup
-    instance = Inferno::Models::TestingInstance.new(url: 'http://www.example.com', selected_module: 'argonaut')
+    instance = Inferno::TestingInstance.new(url: 'http://www.example.com', selected_module: 'argonaut')
     instance.save! # this is for convenience.  we could rewrite to ensure nothing gets saved within tests.
     client = FHIR::Client.new(instance.url)
     client.use_dstu2
diff --git a/lib/modules/argonaut/test/argonaut_device_sequence_test.rb b/lib/modules/argonaut/test/argonaut_device_sequence_test.rb
index 886a1b101..4b476b3cf 100644
--- a/lib/modules/argonaut/test/argonaut_device_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_device_sequence_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_diagnostic_report_sequence_test.rb b/lib/modules/argonaut/test/argonaut_diagnostic_report_sequence_test.rb
index 70bb7173f..687747059 100644
--- a/lib/modules/argonaut/test/argonaut_diagnostic_report_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_diagnostic_report_sequence_test.rb
@@ -27,7 +27,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_goal_sequence_test.rb b/lib/modules/argonaut/test/argonaut_goal_sequence_test.rb
index a6f17602e..07c4815fb 100644
--- a/lib/modules/argonaut/test/argonaut_goal_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_goal_sequence_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_immunization_sequence_test.rb b/lib/modules/argonaut/test/argonaut_immunization_sequence_test.rb
index e81ac9734..4ef8f7385 100644
--- a/lib/modules/argonaut/test/argonaut_immunization_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_immunization_sequence_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_medication_order_sequence_test.rb b/lib/modules/argonaut/test/argonaut_medication_order_sequence_test.rb
index 3bb30f470..94d861689 100644
--- a/lib/modules/argonaut/test/argonaut_medication_order_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_medication_order_sequence_test.rb
@@ -27,7 +27,7 @@ def setup
 
     @medication_reference = load_json_fixture(:medication_reference)
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_medication_statement_sequence_test.rb b/lib/modules/argonaut/test/argonaut_medication_statement_sequence_test.rb
index 0ab52965a..3a5c2c89a 100644
--- a/lib/modules/argonaut/test/argonaut_medication_statement_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_medication_statement_sequence_test.rb
@@ -27,7 +27,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_observation_sequence_test.rb b/lib/modules/argonaut/test/argonaut_observation_sequence_test.rb
index 9bbf84570..cd128263c 100644
--- a/lib/modules/argonaut/test/argonaut_observation_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_observation_sequence_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_patient_read_only_sequence_test.rb b/lib/modules/argonaut/test/argonaut_patient_read_only_sequence_test.rb
index 508b42fff..4af080b49 100644
--- a/lib/modules/argonaut/test/argonaut_patient_read_only_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_patient_read_only_sequence_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::ArgonautPatientReadOnlySequence
     @client = FHIR::Client.new(@base_url)
     @client.set_bearer_token(@token)
-    @instance = Inferno::Models::TestingInstance.create
+    @instance = Inferno::TestingInstance.create
     @instance.patient_id = @patient_id
   end
 
@@ -115,7 +115,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_patient_search_sequence_test.rb b/lib/modules/argonaut/test/argonaut_patient_search_sequence_test.rb
index bc04201d3..afa320f73 100644
--- a/lib/modules/argonaut/test/argonaut_patient_search_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_patient_search_sequence_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_procedure_sequence_test.rb b/lib/modules/argonaut/test/argonaut_procedure_sequence_test.rb
index e57e7b054..7298c8c3c 100644
--- a/lib/modules/argonaut/test/argonaut_procedure_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_procedure_sequence_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_smoking_status_sequence_test.rb b/lib/modules/argonaut/test/argonaut_smoking_status_sequence_test.rb
index d6793c505..757333b6f 100644
--- a/lib/modules/argonaut/test/argonaut_smoking_status_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_smoking_status_sequence_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/argonaut/test/argonaut_vital_signs_observation_sequence_test.rb b/lib/modules/argonaut/test/argonaut_vital_signs_observation_sequence_test.rb
index a5393d1b8..e87123bad 100644
--- a/lib/modules/argonaut/test/argonaut_vital_signs_observation_sequence_test.rb
+++ b/lib/modules/argonaut/test/argonaut_vital_signs_observation_sequence_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/core/capability_statement_sequence.rb b/lib/modules/core/capability_statement_sequence.rb
index 59f7d6c1c..89d7e5c7d 100644
--- a/lib/modules/core/capability_statement_sequence.rb
+++ b/lib/modules/core/capability_statement_sequence.rb
@@ -120,7 +120,7 @@ def json_formats
         assert_valid_conformance
 
         begin
-          @server_capabilities = Inferno::Models::ServerCapabilities.create(
+          @server_capabilities = Inferno::ServerCapabilities.create(
             testing_instance_id: @instance.id,
             capabilities: @conformance.as_json
           )
diff --git a/lib/modules/onc_program/test/onc_ehr_launch_sequence_test.rb b/lib/modules/onc_program/test/onc_ehr_launch_sequence_test.rb
index 5e84768ed..46d3c2c0f 100644
--- a/lib/modules/onc_program/test/onc_ehr_launch_sequence_test.rb
+++ b/lib/modules/onc_program/test/onc_ehr_launch_sequence_test.rb
@@ -6,7 +6,7 @@
   before do
     @sequence_class = Inferno::Sequence::OncEHRLaunchSequence
     @client = FHIR::Client.new('http://www.example.com/fhir')
-    @instance = Inferno::Models::TestingInstance.new
+    @instance = Inferno::TestingInstance.new
   end
 
   describe 'ONC scopes test' do
@@ -18,7 +18,7 @@
     it 'fails when a required scope is missing' do
       @sequence.required_scopes.each do |scope|
         scopes = @sequence.required_scopes - [scope]
-        @instance.instance_variable_set(:@received_scopes, scopes.join(' '))
+        @instance.received_scopes = scopes.join(' ')
         exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
         assert_equal "Required scopes missing: #{scope}", exception.message
@@ -26,7 +26,7 @@
     end
 
     it 'fails when there is no user-level scope' do
-      @instance.instance_variable_set(:@received_scopes, @sequence.required_scopes.join(' '))
+      @instance.received_scopes = @sequence.required_scopes.join(' ')
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
       assert_equal 'Must contain a user-level scope in the format: user/[ resource | * ].[ read | *].', exception.message
@@ -35,21 +35,21 @@
     it 'fails when there is a badly formatted scope' do
       bad_scopes = ['user/*/*', 'patient/*.read', 'user/*.*.*', 'user/*.write']
       bad_scopes.each do |scope|
-        @instance.instance_variable_set(:@received_scopes, (@sequence.required_scopes + [scope]).join(' '))
+        @instance.received_scopes = (@sequence.required_scopes + [scope]).join(' ')
         exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
         assert_equal "Scope '#{scope}' does not follow the format: user/[ resource | * ].[ read | * ]", exception.message
       end
 
       bad_resource_type = 'ValueSet'
-      @instance.instance_variable_set(:@received_scopes, (@sequence.required_scopes + ["user/#{bad_resource_type}.*"]).join(' '))
+      @instance.received_scopes = (@sequence.required_scopes + ["user/#{bad_resource_type}.*"]).join(' ')
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
       assert_equal "'#{bad_resource_type}' must be either a valid resource type or '*'", exception.message
     end
 
     it 'succeeds when the required scopes and a user-level scope are present' do
-      @instance.instance_variable_set(:@received_scopes, (@sequence.required_scopes + ['user/*.*']).join(' '))
+      @instance.received_scopes = (@sequence.required_scopes + ['user/*.*']).join(' ')
 
       @sequence.run_test(@test)
     end
diff --git a/lib/modules/onc_program/test/onc_program_document_reference_test.rb b/lib/modules/onc_program/test/onc_program_document_reference_test.rb
index 195cebb6c..aa7e65d43 100644
--- a/lib/modules/onc_program/test/onc_program_document_reference_test.rb
+++ b/lib/modules/onc_program/test/onc_program_document_reference_test.rb
@@ -25,7 +25,7 @@ def setup
     @patient_resource = FHIR::DSTU2::Patient.new(id: @patient_id)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/onc_program/test/onc_program_provenance_test.rb b/lib/modules/onc_program/test/onc_program_provenance_test.rb
index 87ab2e6f3..de1f458f0 100644
--- a/lib/modules/onc_program/test/onc_program_provenance_test.rb
+++ b/lib/modules/onc_program/test/onc_program_provenance_test.rb
@@ -26,7 +26,7 @@ def setup
     @practitioner_resource = FHIR::DSTU2::Practitioner.new(id: 432)
 
     # Assume we already have a patient
-    @instance.resource_references << Inferno::Models::ResourceReference.new(
+    @instance.resource_references << Inferno::ResourceReference.new(
       resource_type: 'Patient',
       resource_id: @patient_id
     )
diff --git a/lib/modules/onc_program/test/onc_standalone_launch_sequence_test.rb b/lib/modules/onc_program/test/onc_standalone_launch_sequence_test.rb
index 2953b63b5..83554e86a 100644
--- a/lib/modules/onc_program/test/onc_standalone_launch_sequence_test.rb
+++ b/lib/modules/onc_program/test/onc_standalone_launch_sequence_test.rb
@@ -6,7 +6,7 @@
   before do
     @sequence_class = Inferno::Sequence::OncStandaloneLaunchSequence
     @client = FHIR::Client.new('http://www.example.com/fhir')
-    @instance = Inferno::Models::TestingInstance.new
+    @instance = Inferno::TestingInstance.new
   end
 
   describe 'ONC scopes test' do
@@ -18,7 +18,7 @@
     it 'fails when a required scope is missing' do
       @sequence.required_scopes.each do |scope|
         scopes = @sequence.required_scopes - [scope]
-        @instance.instance_variable_set(:@received_scopes, scopes.join(' '))
+        @instance.received_scopes = scopes.join(' ')
         exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
         assert_equal "Required scopes missing: #{scope}", exception.message
@@ -26,7 +26,7 @@
     end
 
     it 'fails when there is no patient-level scope' do
-      @instance.instance_variable_set(:@received_scopes, @sequence.required_scopes.join(' '))
+      @instance.received_scopes = @sequence.required_scopes.join(' ')
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
       assert_equal 'Must contain a patient-level scope in the format: patient/[ resource | * ].[ read | *].', exception.message
@@ -35,21 +35,21 @@
     it 'fails when there is a badly formatted scope' do
       bad_scopes = ['patient/*/*', 'user/*.read', 'patient/*.*.*', 'patient/*.write']
       bad_scopes.each do |scope|
-        @instance.instance_variable_set(:@received_scopes, (@sequence.required_scopes + [scope]).join(' '))
+        @instance.received_scopes = (@sequence.required_scopes + [scope]).join(' ')
         exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
         assert_equal "Scope '#{scope}' does not follow the format: patient/[ resource | * ].[ read | * ]", exception.message
       end
 
       bad_resource_type = 'ValueSet'
-      @instance.instance_variable_set(:@received_scopes, (@sequence.required_scopes + ["patient/#{bad_resource_type}.*"]).join(' '))
+      @instance.received_scopes = (@sequence.required_scopes + ["patient/#{bad_resource_type}.*"]).join(' ')
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
       assert_equal "'#{bad_resource_type}' must be either a valid resource type or '*'", exception.message
     end
 
     it 'succeeds when the required scopes and a patient-level scope are present' do
-      @instance.instance_variable_set(:@received_scopes, (@sequence.required_scopes + ['patient/*.*']).join(' '))
+      @instance.received_scopes = (@sequence.required_scopes + ['patient/*.*']).join(' ')
 
       @sequence.run_test(@test)
     end
diff --git a/lib/modules/smart/dynamic_registration_sequence.rb b/lib/modules/smart/dynamic_registration_sequence.rb
index efb62b231..a67651fe0 100644
--- a/lib/modules/smart/dynamic_registration_sequence.rb
+++ b/lib/modules/smart/dynamic_registration_sequence.rb
@@ -126,7 +126,7 @@ class DynamicRegistrationSequence < SequenceBase
 
         update_params[:client_secret] = @registration_response_body['client_secret'] if @instance.confidential_client
 
-        @instance.update(update_params)
+        @instance.update!(update_params)
       end
     end
   end
diff --git a/lib/modules/smart/ehr_launch_sequence.rb b/lib/modules/smart/ehr_launch_sequence.rb
index 151494905..92a74caa8 100644
--- a/lib/modules/smart/ehr_launch_sequence.rb
+++ b/lib/modules/smart/ehr_launch_sequence.rb
@@ -92,20 +92,20 @@ class EHRLaunchSequence < SequenceBase
           )
         end
 
-        @instance.save
-        @instance.update(state: SecureRandom.uuid)
+        @instance.save!
+        @instance.update!(state: SecureRandom.uuid)
 
         oauth2_params = {
           'response_type' => 'code',
-          'client_id' => @instance.client_id,
-          'redirect_uri' => @instance.redirect_uris,
-          'scope' => @instance.scopes,
+          'client_id' => @instance.client_id.presence,
+          'redirect_uri' => @instance.redirect_uris.presence,
+          'scope' => @instance.scopes.presence,
           'launch' => @params['launch'],
-          'state' => @instance.state,
+          'state' => @instance.state.presence,
           'aud' => @params['iss']
         }
 
-        oauth2_auth_query = @instance.oauth_authorize_endpoint + '?'
+        oauth2_auth_query = @instance.oauth_authorize_endpoint.presence + '?'
         oauth2_params.each do |key, value|
           oauth2_auth_query += "#{key}=#{CGI.escape(value)}&" unless value.nil? || key.nil?
         end
diff --git a/lib/modules/smart/shared_launch_tests.rb b/lib/modules/smart/shared_launch_tests.rb
index f1162a2df..e77c786d8 100644
--- a/lib/modules/smart/shared_launch_tests.rb
+++ b/lib/modules/smart/shared_launch_tests.rb
@@ -29,13 +29,13 @@ def validate_token_response_contents(token_response, require_expires_in:)
         assert_valid_json(token_response.body)
         @token_response_body = JSON.parse(token_response.body)
 
-        @instance.save
+        @instance.save!
         if @token_response_body.key?('id_token') # rubocop:disable Style/IfUnlessModifier
-          @instance.update(id_token: @token_response_body['id_token'])
+          @instance.update!(id_token: @token_response_body['id_token'])
         end
 
         if @token_response_body.key?('refresh_token') # rubocop:disable Style/IfUnlessModifier
-          @instance.update(refresh_token: @token_response_body['refresh_token'])
+          @instance.update!(refresh_token: @token_response_body['refresh_token'])
         end
 
         assert @token_response_body['access_token'].present?, 'Token response did not contain access_token as required'
@@ -45,14 +45,14 @@ def validate_token_response_contents(token_response, require_expires_in:)
           warning { assert expires_in.is_a?(Numeric), "`expires_in` field is not a number: #{expires_in.inspect}" }
         end
 
-        @instance.update(
+        @instance.update!(
           token: @token_response_body['access_token'],
           token_retrieved_at: DateTime.now,
           token_expires_in: expires_in.to_i
         )
 
         @instance.patient_id = @token_response_body['patient'] if @token_response_body['patient'].present?
-        @instance.update(encounter_id: @token_response_body['encounter']) if @token_response_body['encounter'].present?
+        @instance.update!(encounter_id: @token_response_body['encounter']) if @token_response_body['encounter'].present?
 
         required_keys = ['token_type', 'scope']
         if require_expires_in
@@ -89,7 +89,7 @@ def validate_token_response_contents(token_response, require_expires_in:)
 
         received_scopes = @token_response_body['scope'] || @instance.scopes
 
-        @instance.update(received_scopes: received_scopes)
+        @instance.update!(received_scopes: received_scopes)
       end
 
       def validate_token_response_headers(token_response)
diff --git a/lib/modules/smart/smart_discovery_sequence.rb b/lib/modules/smart/smart_discovery_sequence.rb
index 645c748ab..84ff38e79 100644
--- a/lib/modules/smart/smart_discovery_sequence.rb
+++ b/lib/modules/smart/smart_discovery_sequence.rb
@@ -97,7 +97,7 @@ class SMARTDiscoverySequence < SequenceBase
         @well_known_introspect_url = @well_known_configuration['introspection_endpoint']
         @well_known_revoke_url = @well_known_configuration['revocation_endpoint']
 
-        @instance.update(
+        @instance.update!(
           oauth_authorize_endpoint: @well_known_authorize_url,
           oauth_token_endpoint: @well_known_token_url,
           oauth_register_endpoint: @well_known_configuration['registration_endpoint']
@@ -198,7 +198,7 @@ class SMARTDiscoverySequence < SequenceBase
           end
         end
 
-        @instance.update(
+        @instance.update!(
           oauth_authorize_endpoint: @conformance_authorize_url,
           oauth_token_endpoint: @conformance_token_url,
           oauth_register_endpoint: @conformance_register_url
diff --git a/lib/modules/smart/standalone_launch_sequence.rb b/lib/modules/smart/standalone_launch_sequence.rb
index fb362e5d2..62787a7a4 100644
--- a/lib/modules/smart/standalone_launch_sequence.rb
+++ b/lib/modules/smart/standalone_launch_sequence.rb
@@ -61,8 +61,8 @@ class StandaloneLaunchSequence < SequenceBase
           )
         end
 
-        @instance.save
-        @instance.update(state: SecureRandom.uuid)
+        @instance.save!
+        @instance.update!(state: SecureRandom.uuid)
 
         oauth2_params = {
           'response_type' => 'code',
diff --git a/lib/modules/smart/test/dynamic_registration_test.rb b/lib/modules/smart/test/dynamic_registration_test.rb
index 7a026e14c..9aa90a31c 100644
--- a/lib/modules/smart/test/dynamic_registration_test.rb
+++ b/lib/modules/smart/test/dynamic_registration_test.rb
@@ -14,15 +14,15 @@ class DynamicRegistrationSequenceTest < MiniTest::Test
   DYNAMIC_REGISTRATION_TOKEN = 'AAAAAAAAAAAAAAAAAAAAAAAAAA'
 
   def setup
-    @instance = Inferno::Models::TestingInstance.new(url: 'http://www.example.com',
-                                                     client_name: 'Inferno',
-                                                     base_url: 'http://localhost:4567',
-                                                     client_endpoint_key: Inferno::SecureRandomBase62.generate(32),
-                                                     initiate_login_uri: 'http://localhost:4567/launch',
-                                                     redirect_uris: 'http://localhost:4567/redirect',
-                                                     oauth_register_endpoint: 'https://oauth_reg.example.com/register',
-                                                     scopes: 'launch openid patient/*.* profile',
-                                                     selected_module: 'argonaut')
+    @instance = Inferno::TestingInstance.new(url: 'http://www.example.com',
+                                             client_name: 'Inferno',
+                                             base_url: 'http://localhost:4567',
+                                             client_endpoint_key: Inferno::SecureRandomBase62.generate(32),
+                                             initiate_login_uri: 'http://localhost:4567/launch',
+                                             redirect_uris: 'http://localhost:4567/redirect',
+                                             oauth_register_endpoint: 'https://oauth_reg.example.com/register',
+                                             scopes: 'launch openid patient/*.* profile',
+                                             selected_module: 'argonaut')
     @instance.save! # this is for convenience.  we could rewrite to ensure nothing gets saved within tests.
     client = FHIR::Client.new(@instance.url)
     client.use_dstu2
diff --git a/lib/modules/smart/test/ehr_launch_test.rb b/lib/modules/smart/test/ehr_launch_test.rb
index 269d7610c..8ea1d5d26 100644
--- a/lib/modules/smart/test/ehr_launch_test.rb
+++ b/lib/modules/smart/test/ehr_launch_test.rb
@@ -12,7 +12,7 @@ class EHRLaunchSequenceTest < MiniTest::Test
   RESPONSE_HEADERS = { 'content-type' => 'application/json' }.freeze
 
   def setup
-    @instance = Inferno::Models::TestingInstance.create(
+    @instance = Inferno::TestingInstance.create(
       url: 'http://www.example.com',
       client_name: 'Inferno',
       base_url: 'http://localhost:4567',
diff --git a/lib/modules/smart/test/openid_connect_test.rb b/lib/modules/smart/test/openid_connect_test.rb
index 530defbe0..aa53bb8e9 100644
--- a/lib/modules/smart/test/openid_connect_test.rb
+++ b/lib/modules/smart/test/openid_connect_test.rb
@@ -30,7 +30,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
     @sequence_class = Inferno::Sequence::OpenIDConnectSequence
     @client = FHIR::Client.new('http://www.example.com/fhir')
 
-    @instance = Inferno::Models::TestingInstance.create(
+    @instance = Inferno::TestingInstance.create(
       scopes: 'launch patient/*.read openid fhirUser',
       client_id: 'CLIENT_ID',
       id_token: @signed_id_token
@@ -56,7 +56,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
         'launch patient/*.read fhirUser'
       ]
       invalid_scopes.each do |scopes|
-        @instance.update(scopes: scopes)
+        @instance.update!(scopes: scopes)
 
         exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
 
@@ -65,7 +65,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
     end
 
     it 'fails if no id token is present' do
-      @instance.update(id_token: nil)
+      @instance.update!(id_token: nil)
 
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
@@ -73,7 +73,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
     end
 
     it 'fails if the id token is not a properly constructed jwt' do
-      @instance.update(id_token: 'abc')
+      @instance.update!(id_token: 'abc')
 
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
@@ -97,7 +97,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
         'launch patient/*.read fhirUser'
       ]
       invalid_scopes.each do |scopes|
-        @instance.update(scopes: scopes)
+        @instance.update!(scopes: scopes)
 
         exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
 
@@ -160,7 +160,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
         'launch patient/*.read fhirUser'
       ]
       invalid_scopes.each do |scopes|
-        @instance.update(scopes: scopes)
+        @instance.update!(scopes: scopes)
 
         exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
 
@@ -223,7 +223,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
         'launch patient/*.read fhirUser'
       ]
       invalid_scopes.each do |scopes|
-        @instance.update(scopes: scopes)
+        @instance.update!(scopes: scopes)
 
         exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
 
@@ -322,7 +322,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
         'launch patient/*.read fhirUser'
       ]
       invalid_scopes.each do |scopes|
-        @instance.update(scopes: scopes)
+        @instance.update!(scopes: scopes)
 
         exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
 
@@ -427,7 +427,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
         'launch patient/*.read fhirUser'
       ]
       invalid_scopes.each do |scopes|
-        @instance.update(scopes: scopes)
+        @instance.update!(scopes: scopes)
 
         exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
 
@@ -475,7 +475,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
       payload = @payload.clone
       payload[:iss] = 'BAD_ISS'
       token = create_signed_token(payload: payload)
-      @instance.update(id_token: token)
+      @instance.update!(id_token: token)
 
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
@@ -486,7 +486,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
       payload = @payload.clone
       payload[:aud] = 'BAD_AUD'
       token = create_signed_token(payload: payload)
-      @instance.update(id_token: token)
+      @instance.update!(id_token: token)
 
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
@@ -497,7 +497,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
       payload = @payload.clone
       payload[:exp] = @payload[:exp] - 1.day.to_i
       token = create_signed_token(payload: payload)
-      @instance.update(id_token: token)
+      @instance.update!(id_token: token)
 
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
@@ -506,7 +506,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
 
     it 'fails if the signature is invalid' do
       token = create_signed_token(payload: @payload, key_pair: OpenSSL::PKey::RSA.new(2048))
-      @instance.update(id_token: token)
+      @instance.update!(id_token: token)
 
       exception = assert_raises(Inferno::AssertionException) { @sequence.run_test(@test) }
 
@@ -530,7 +530,7 @@ def create_signed_token(payload: @payload, key_pair: @key_pair, kid: @jwk.kid)
         'launch patient/*.read fhirUser'
       ]
       invalid_scopes.each do |scopes|
-        @instance.update(scopes: scopes)
+        @instance.update!(scopes: scopes)
 
         exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
 
diff --git a/lib/modules/smart/test/shared_launch_tests_test.rb b/lib/modules/smart/test/shared_launch_tests_test.rb
index c312275df..1f6a2a301 100644
--- a/lib/modules/smart/test/shared_launch_tests_test.rb
+++ b/lib/modules/smart/test/shared_launch_tests_test.rb
@@ -19,7 +19,7 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
   before do
     @sequence_class = SharedLaunchTestSequence
     @client = FHIR::Client.new('http://www.example.com/fhir')
-    @instance = Inferno::Models::TestingInstance.new
+    @instance = Inferno::TestingInstance.new
   end
 
   describe 'auth_endpoint_tls_test' do
@@ -123,9 +123,11 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
     before do
       @test = @sequence_class[:invalid_code]
       @sequence = @sequence_class.new(@instance, @client)
-      @instance.redirect_uris = 'http://www.example.com/redirect'
-      @instance.client_id = 'CLIENT_ID'
-      @instance.oauth_token_endpoint = 'http://www.example.com/token'
+      @instance.update!(
+        redirect_uris: 'http://www.example.com/redirect',
+        client_id: 'CLIENT_ID',
+        oauth_token_endpoint: 'http://www.example.com/token'
+      )
       @token_headers = { 'Content-Type' => 'application/x-www-form-urlencoded' }
       @token_params = {
         grant_type: 'authorization_code',
@@ -145,7 +147,7 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
     describe 'with public client' do
       before do
         @token_params[:client_id] = @instance.client_id
-        @instance.confidential_client = false
+        @instance.update!(confidential_client: false)
         @sequence.instance_variable_set(:@params, 'code' => 'CODE')
       end
 
@@ -170,8 +172,10 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
 
     describe 'with a confidential client' do
       before do
-        @instance.confidential_client = true
-        @instance.client_secret = 'CLIENT_SECRET'
+        @instance.update!(
+          confidential_client: true,
+          client_secret: 'CLIENT_SECRET'
+        )
         client_credentials = "#{@instance.client_id}:#{@instance.client_secret}"
         @token_headers['Authorization'] = "Basic #{Base64.strict_encode64(client_credentials)}"
         @sequence.instance_variable_set(:@params, 'code' => 'CODE')
@@ -202,9 +206,11 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
       @test = @sequence_class[:invalid_client_id]
       @sequence = @sequence_class.new(@instance, @client)
       @sequence.instance_variable_set(:@params, 'code' => 'CODE')
-      @instance.redirect_uris = 'http://www.example.com/redirect'
-      @instance.client_id = 'CLIENT_ID'
-      @instance.oauth_token_endpoint = 'http://www.example.com/token'
+      @instance.update!(
+        redirect_uris: 'http://www.example.com/redirect',
+        client_id: 'CLIENT_ID',
+        oauth_token_endpoint: 'http://www.example.com/token'
+      )
       @token_headers = { 'Content-Type' => 'application/x-www-form-urlencoded' }
       @token_params = {
         grant_type: 'authorization_code',
@@ -224,7 +230,7 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
     describe 'with public client' do
       before do
         @token_params[:client_id] = 'INVALID_CLIENT_ID'
-        @instance.confidential_client = false
+        @instance.update!(confidential_client: false)
       end
 
       it 'fails if a successful response is received' do
@@ -248,8 +254,10 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
 
     describe 'with a confidential client' do
       before do
-        @instance.confidential_client = true
-        @instance.client_secret = 'CLIENT_SECRET'
+        @instance.update!(
+          confidential_client: true,
+          client_secret: 'CLIENT_SECRET'
+        )
         client_credentials = "INVALID_CLIENT_ID:#{@instance.client_secret}"
         @token_headers['Authorization'] = "Basic #{Base64.strict_encode64(client_credentials)}"
       end
@@ -279,9 +287,11 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
       @test = @sequence_class[:successful_token_exchange]
       @sequence = @sequence_class.new(@instance, @client)
       @sequence.instance_variable_set(:@params, 'code' => 'CODE')
-      @instance.redirect_uris = 'http://www.example.com/redirect'
-      @instance.client_id = 'CLIENT_ID'
-      @instance.oauth_token_endpoint = 'http://www.example.com/token'
+      @instance.update!(
+        redirect_uris: 'http://www.example.com/redirect',
+        client_id: 'CLIENT_ID',
+        oauth_token_endpoint: 'http://www.example.com/token'
+      )
       @token_headers = { 'Content-Type' => 'application/x-www-form-urlencoded' }
       @token_params = {
         grant_type: 'authorization_code',
@@ -301,7 +311,7 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
     describe 'with public client' do
       before do
         @token_params[:client_id] = @instance.client_id
-        @instance.confidential_client = false
+        @instance.update!(confidential_client: false)
       end
 
       it 'fails if a non-successful response is received' do
@@ -325,8 +335,10 @@ class SharedLaunchTestSequence < Inferno::Sequence::SequenceBase
 
     describe 'with a confidential client' do
       before do
-        @instance.confidential_client = true
-        @instance.client_secret = 'CLIENT_SECRET'
+        @instance.update!(
+          confidential_client: true,
+          client_secret: 'CLIENT_SECRET'
+        )
         client_credentials = "#{@instance.client_id}:#{@instance.client_secret}"
         @token_headers['Authorization'] = "Basic #{Base64.strict_encode64(client_credentials)}"
       end
diff --git a/lib/modules/smart/test/smart_discovery_sequence_test.rb b/lib/modules/smart/test/smart_discovery_sequence_test.rb
index 52c0ac688..e7d10abc2 100644
--- a/lib/modules/smart/test/smart_discovery_sequence_test.rb
+++ b/lib/modules/smart/test/smart_discovery_sequence_test.rb
@@ -5,7 +5,7 @@
 describe Inferno::Sequence::SMARTDiscoverySequence do
   before do
     @sequence_class = Inferno::Sequence::SMARTDiscoverySequence
-    @instance = Inferno::Models::TestingInstance.new
+    @instance = Inferno::TestingInstance.new
   end
 
   describe 'required well-known configuration fields' do
diff --git a/lib/modules/smart/test/standalone_launch_test.rb b/lib/modules/smart/test/standalone_launch_test.rb
index 537fd60e2..2cfaf00a4 100644
--- a/lib/modules/smart/test/standalone_launch_test.rb
+++ b/lib/modules/smart/test/standalone_launch_test.rb
@@ -4,7 +4,7 @@
 
 class StandaloneLaunchSequenceTest < MiniTest::Test
   def setup
-    @instance = Inferno::Models::TestingInstance.create(
+    @instance = Inferno::TestingInstance.create(
       url: 'http://www.example.com',
       client_name: 'Inferno',
       base_url: 'http://localhost:4567',
diff --git a/lib/modules/smart/test/token_introspection_test.rb b/lib/modules/smart/test/token_introspection_test.rb
index e94e05b82..b92eaeeb3 100644
--- a/lib/modules/smart/test/token_introspection_test.rb
+++ b/lib/modules/smart/test/token_introspection_test.rb
@@ -11,7 +11,7 @@ def setup
     resource_id = SecureRandom.uuid
     resource_secret = SecureRandom.hex(32)
 
-    @instance = Inferno::Models::TestingInstance.create(
+    @instance = Inferno::TestingInstance.create(
       url: 'http://www.example.com',
       client_name: 'Inferno',
       base_url: 'http://localhost:4567',
diff --git a/lib/modules/smart/test/token_refresh_sequence_test.rb b/lib/modules/smart/test/token_refresh_sequence_test.rb
index 4a093cc05..7ebfc483b 100644
--- a/lib/modules/smart/test/token_refresh_sequence_test.rb
+++ b/lib/modules/smart/test/token_refresh_sequence_test.rb
@@ -16,7 +16,7 @@
     @sequence_class = Inferno::Sequence::TokenRefreshSequence
     @token_endpoint = 'http://www.example.com/token'
     @client = FHIR::Client.new('http://www.example.com/fhir')
-    @instance = Inferno::Models::TestingInstance.create(
+    @instance = Inferno::TestingInstance.create(
       oauth_token_endpoint: @token_endpoint,
       scopes: 'jkl',
       refresh_token: 'abc'
@@ -93,7 +93,7 @@
     end
 
     it 'skips if no refresh token has been received' do
-      @instance.update(refresh_token: nil)
+      @instance.update!(refresh_token: nil)
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
 
       assert_equal 'No refresh token was received during the SMART launch', exception.message
@@ -124,7 +124,7 @@
     end
 
     it 'skips if no refresh token has been received' do
-      @instance.update(refresh_token: nil)
+      @instance.update!(refresh_token: nil)
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
 
       assert_equal 'No refresh token was received during the SMART launch', exception.message
@@ -244,7 +244,7 @@
 class TokenRefreshSequenceTest < MiniTest::Test
   def setup
     refresh_token = 'REFRESH_TOKEN'
-    @instance = Inferno::Models::TestingInstance.create(
+    @instance = Inferno::TestingInstance.create(
       url: 'http://www.example.com',
       client_name: 'Inferno',
       base_url: 'http://localhost:4567',
@@ -354,7 +354,7 @@ def all_pass
   end
 
   def test_pass_if_confidential_client
-    @instance.update(
+    @instance.update!(
       client_secret: @confidential_client_secret,
       confidential_client: true
     )
@@ -362,7 +362,7 @@ def test_pass_if_confidential_client
   end
 
   def test_pass_if_public_client
-    @instance.update(
+    @instance.update!(
       client_secret: nil,
       confidential_client: false
     )
diff --git a/lib/modules/smart/token_introspection_sequence.rb b/lib/modules/smart/token_introspection_sequence.rb
index 589389b56..760ee38f3 100644
--- a/lib/modules/smart/token_introspection_sequence.rb
+++ b/lib/modules/smart/token_introspection_sequence.rb
@@ -129,7 +129,7 @@ class TokenIntrospectionSequence < SequenceBase
 
         expiration = Time.at(@introspection_response_body['exp']).to_datetime
 
-        token_retrieved_at = @instance.token_retrieved_at
+        token_retrieved_at = @instance.token_retrieved_at.to_datetime
         now = DateTime.now
 
         max_token_seconds = 60 * 60 # one hour expiration?
diff --git a/lib/modules/us_core_guidance/test/clinicalnotes_sequence_test.rb b/lib/modules/us_core_guidance/test/clinicalnotes_sequence_test.rb
index 134950e74..ab076f701 100644
--- a/lib/modules/us_core_guidance/test/clinicalnotes_sequence_test.rb
+++ b/lib/modules/us_core_guidance/test/clinicalnotes_sequence_test.rb
@@ -10,7 +10,7 @@
     @docref_bundle = FHIR.from_contents(load_fixture(:clinicalnotes_docref_bundle))
     @diagrpt_bundle = FHIR.from_contents(load_fixture(:clinicalnotes_diagrpt_bundle))
 
-    @instance = Inferno::Models::TestingInstance.create(
+    @instance = Inferno::TestingInstance.create(
       url: 'http://www.example.com'
     )
     @instance.patient_id = @patient_id
diff --git a/lib/modules/us_core_guidance/test/us_core_r4_capability_statement_sequence_test.rb b/lib/modules/us_core_guidance/test/us_core_r4_capability_statement_sequence_test.rb
index dc27ac0b6..b0179b845 100644
--- a/lib/modules/us_core_guidance/test/us_core_r4_capability_statement_sequence_test.rb
+++ b/lib/modules/us_core_guidance/test/us_core_r4_capability_statement_sequence_test.rb
@@ -6,7 +6,7 @@
   before do
     @sequence_class = Inferno::Sequence::UsCoreR4CapabilityStatementSequence
     @client = FHIR::Client.new('http://www.example.com/fhir')
-    @instance = Inferno::Models::TestingInstance.new(oauth_token_endpoint: @token_endpoint, scopes: 'jkl')
+    @instance = Inferno::TestingInstance.new(oauth_token_endpoint: @token_endpoint, scopes: 'jkl')
     @instance.instance_variable_set(:'@module', OpenStruct.new(fhir_version: 'r4'))
   end
 
diff --git a/lib/modules/us_core_guidance/test/us_core_r4_data_absent_reason_sequence_test.rb b/lib/modules/us_core_guidance/test/us_core_r4_data_absent_reason_sequence_test.rb
index 83a7aad71..0b6cde793 100644
--- a/lib/modules/us_core_guidance/test/us_core_r4_data_absent_reason_sequence_test.rb
+++ b/lib/modules/us_core_guidance/test/us_core_r4_data_absent_reason_sequence_test.rb
@@ -5,7 +5,7 @@
 describe Inferno::Sequence::USCoreR4DataAbsentReasonSequence do
   before do
     @sequence_class = Inferno::Sequence::USCoreR4DataAbsentReasonSequence
-    @instance = Inferno::Models::TestingInstance.create
+    @instance = Inferno::TestingInstance.create
   end
 
   describe 'data absent reason extension test' do
@@ -19,7 +19,7 @@
     end
 
     it 'succeeds if a dar extension has been found' do
-      @instance.update(data_absent_extension_found: true)
+      @instance.update!(data_absent_extension_found: true)
 
       @sequence.run_test(@test)
     end
@@ -36,7 +36,7 @@
     end
 
     it 'succeeds if a dar code has been found' do
-      @instance.update(data_absent_code_found: true)
+      @instance.update!(data_absent_code_found: true)
 
       @sequence.run_test(@test)
     end
diff --git a/lib/modules/us_core_guidance/test/us_core_r4_patient_read_only_sequence_test.rb b/lib/modules/us_core_guidance/test/us_core_r4_patient_read_only_sequence_test.rb
index deac48d80..ec5d1f82d 100644
--- a/lib/modules/us_core_guidance/test/us_core_r4_patient_read_only_sequence_test.rb
+++ b/lib/modules/us_core_guidance/test/us_core_r4_patient_read_only_sequence_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCoreR4PatientReadOnlySequence
     @client = FHIR::Client.new(@base_url)
     @client.set_bearer_token(@token)
-    @instance = Inferno::Models::TestingInstance.create
+    @instance = Inferno::TestingInstance.create
     @instance.patient_id = @patient_id
   end
 
diff --git a/lib/modules/uscore_v3.1.0/data_absent_reason_checker.rb b/lib/modules/uscore_v3.1.0/data_absent_reason_checker.rb
index d920d7b91..f9af65ba2 100644
--- a/lib/modules/uscore_v3.1.0/data_absent_reason_checker.rb
+++ b/lib/modules/uscore_v3.1.0/data_absent_reason_checker.rb
@@ -20,7 +20,7 @@ def check_for_data_absent_extension(reply)
       return unless contains_data_absent_extension?(reply.body)
 
       @instance.data_absent_extension_found = true
-      @instance.save
+      @instance.save!
     end
 
     def check_for_data_absent_code(reply)
@@ -29,7 +29,7 @@ def check_for_data_absent_code(reply)
       return unless contains_data_absent_code?(reply.body)
 
       @instance.data_absent_code_found = true
-      @instance.save
+      @instance.save!
     end
 
     def contains_data_absent_extension?(body)
diff --git a/lib/modules/uscore_v3.1.0/test/bodyheight_test.rb b/lib/modules/uscore_v3.1.0/test/bodyheight_test.rb
index cfc6ea4d0..b916d7d72 100644
--- a/lib/modules/uscore_v3.1.0/test/bodyheight_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/bodyheight_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310BodyheightSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/bodytemp_test.rb b/lib/modules/uscore_v3.1.0/test/bodytemp_test.rb
index b3bd9b874..ba4d3089e 100644
--- a/lib/modules/uscore_v3.1.0/test/bodytemp_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/bodytemp_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310BodytempSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/bodyweight_test.rb b/lib/modules/uscore_v3.1.0/test/bodyweight_test.rb
index 5c1a91b91..075c3b9f9 100644
--- a/lib/modules/uscore_v3.1.0/test/bodyweight_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/bodyweight_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310BodyweightSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/bp_test.rb b/lib/modules/uscore_v3.1.0/test/bp_test.rb
index 38896581b..bea1b9a3b 100644
--- a/lib/modules/uscore_v3.1.0/test/bp_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/bp_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310BpSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/data_absent_reason_checker_test.rb b/lib/modules/uscore_v3.1.0/test/data_absent_reason_checker_test.rb
index eed9bf142..35823e6af 100644
--- a/lib/modules/uscore_v3.1.0/test/data_absent_reason_checker_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/data_absent_reason_checker_test.rb
@@ -12,7 +12,7 @@ class DataAbsentReasonCheckerTest
     attr_reader :instance
 
     def initialize
-      @instance = Inferno::Models::TestingInstance.new
+      @instance = Inferno::TestingInstance.new
     end
   end
 
diff --git a/lib/modules/uscore_v3.1.0/test/headcircum_test.rb b/lib/modules/uscore_v3.1.0/test/headcircum_test.rb
index 51e1f8237..06e1a4a0c 100644
--- a/lib/modules/uscore_v3.1.0/test/headcircum_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/headcircum_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310HeadcircumSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/heartrate_test.rb b/lib/modules/uscore_v3.1.0/test/heartrate_test.rb
index 16cb200bf..ffad4e20e 100644
--- a/lib/modules/uscore_v3.1.0/test/heartrate_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/heartrate_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310HeartrateSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/pediatric_bmi_for_age_test.rb b/lib/modules/uscore_v3.1.0/test/pediatric_bmi_for_age_test.rb
index 25b2a8c49..0f93326ae 100644
--- a/lib/modules/uscore_v3.1.0/test/pediatric_bmi_for_age_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/pediatric_bmi_for_age_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310PediatricBmiForAgeSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/pediatric_weight_for_height_test.rb b/lib/modules/uscore_v3.1.0/test/pediatric_weight_for_height_test.rb
index 3d23b7934..5990ae11c 100644
--- a/lib/modules/uscore_v3.1.0/test/pediatric_weight_for_height_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/pediatric_weight_for_height_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310PediatricWeightForHeightSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/resprate_test.rb b/lib/modules/uscore_v3.1.0/test/resprate_test.rb
index e0bf5a05c..5785cab37 100644
--- a/lib/modules/uscore_v3.1.0/test/resprate_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/resprate_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310ResprateSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_allergyintolerance_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_allergyintolerance_test.rb
index fd36ed8bc..5e746770b 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_allergyintolerance_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_allergyintolerance_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310AllergyintoleranceSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -187,7 +187,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -267,9 +267,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the AllergyIntolerance read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -286,7 +287,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -302,7 +303,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -318,7 +319,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a AllergyIntolerance' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -334,7 +335,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -355,7 +356,7 @@ def capabilities.supported_search_params(_)
       allergy_intolerance = FHIR::AllergyIntolerance.new(
         id: @allergy_intolerance_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -376,7 +377,7 @@ def capabilities.supported_search_params(_)
       @sequence = @sequence_class.new(@instance, @client)
       @sequence.instance_variable_set(:'@resources_found', true)
 
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance.id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_careplan_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_careplan_test.rb
index ad843e6ae..d21963f43 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_careplan_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_careplan_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310CareplanSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -353,9 +353,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the CarePlan read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -372,7 +373,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
@@ -388,7 +389,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
@@ -404,7 +405,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a CarePlan' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
@@ -420,7 +421,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
@@ -441,7 +442,7 @@ def capabilities.supported_search_params(_)
       care_plan = FHIR::CarePlan.new(
         id: @care_plan_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_careteam_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_careteam_test.rb
index 8254d067e..6dcae870a 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_careteam_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_careteam_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310CareteamSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -33,7 +33,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -143,9 +143,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the CareTeam read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -162,7 +163,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
@@ -178,7 +179,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
@@ -194,7 +195,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a CareTeam' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
@@ -210,7 +211,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
@@ -231,7 +232,7 @@ def capabilities.supported_search_params(_)
       care_team = FHIR::CareTeam.new(
         id: @care_team_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_condition_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_condition_test.rb
index 3ea8cd144..90599378f 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_condition_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_condition_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310ConditionSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -187,7 +187,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -347,7 +347,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -440,7 +440,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -587,9 +587,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Condition read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -606,7 +607,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -622,7 +623,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -638,7 +639,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Condition' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -654,7 +655,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -675,7 +676,7 @@ def capabilities.supported_search_params(_)
       condition = FHIR::Condition.new(
         id: @condition_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -696,7 +697,7 @@ def capabilities.supported_search_params(_)
       @sequence = @sequence_class.new(@instance, @client)
       @sequence.instance_variable_set(:'@resources_found', true)
 
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition.id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_diagnosticreport_lab_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_diagnosticreport_lab_test.rb
index eef293e77..2edeb6c54 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_diagnosticreport_lab_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_diagnosticreport_lab_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310DiagnosticreportLabSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -265,7 +265,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -409,7 +409,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -571,7 +571,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -699,7 +699,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -790,7 +790,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -910,9 +910,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the DiagnosticReport read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -929,7 +930,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -945,7 +946,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -961,7 +962,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a DiagnosticReport' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -977,7 +978,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -998,7 +999,7 @@ def capabilities.supported_search_params(_)
       diagnostic_report = FHIR::DiagnosticReport.new(
         id: @diagnostic_report_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_diagnosticreport_note_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_diagnosticreport_note_test.rb
index 2f55e2d82..8720f1fbb 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_diagnosticreport_note_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_diagnosticreport_note_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310DiagnosticreportNoteSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -265,7 +265,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -409,7 +409,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -571,7 +571,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -699,7 +699,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -790,7 +790,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -910,9 +910,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the DiagnosticReport read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -929,7 +930,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -945,7 +946,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -961,7 +962,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a DiagnosticReport' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -977,7 +978,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -998,7 +999,7 @@ def capabilities.supported_search_params(_)
       diagnostic_report = FHIR::DiagnosticReport.new(
         id: @diagnostic_report_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_documentreference_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_documentreference_test.rb
index c08b246a8..ea3c44ca4 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_documentreference_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_documentreference_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310DocumentreferenceSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -181,7 +181,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -333,7 +333,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -495,7 +495,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -655,7 +655,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -817,7 +817,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'type']
       end
@@ -945,7 +945,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -1021,9 +1021,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the DocumentReference read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -1040,7 +1041,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1056,7 +1057,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1072,7 +1073,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a DocumentReference' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1088,7 +1089,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1109,7 +1110,7 @@ def capabilities.supported_search_params(_)
       document_reference = FHIR::DocumentReference.new(
         id: @document_reference_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1130,7 +1131,7 @@ def capabilities.supported_search_params(_)
       @sequence = @sequence_class.new(@instance, @client)
       @sequence.instance_variable_set(:'@resources_found', true)
 
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference.id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_encounter_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_encounter_test.rb
index e7b9ca03f..cd9698a29 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_encounter_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_encounter_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310EncounterSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -25,9 +25,10 @@
     end
 
     it 'skips if the Encounter read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -43,7 +44,7 @@
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
@@ -59,7 +60,7 @@
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
@@ -75,7 +76,7 @@
     end
 
     it 'fails if the resource returned is not a Encounter' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
@@ -91,7 +92,7 @@
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
@@ -112,7 +113,7 @@
       encounter = FHIR::Encounter.new(
         id: @encounter_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_goal_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_goal_test.rb
index fe312f9aa..9a59eb984 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_goal_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_goal_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310GoalSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -182,7 +182,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -310,7 +310,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -386,9 +386,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Goal read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -405,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
@@ -421,7 +422,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
@@ -437,7 +438,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Goal' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
@@ -453,7 +454,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
@@ -474,7 +475,7 @@ def capabilities.supported_search_params(_)
       goal = FHIR::Goal.new(
         id: @goal_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_immunization_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_immunization_test.rb
index 66197b7d8..357994d8f 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_immunization_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_immunization_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310ImmunizationSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -182,7 +182,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -310,7 +310,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -386,9 +386,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Immunization read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -405,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
@@ -421,7 +422,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
@@ -437,7 +438,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Immunization' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
@@ -453,7 +454,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
@@ -474,7 +475,7 @@ def capabilities.supported_search_params(_)
       immunization = FHIR::Immunization.new(
         id: @immunization_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_implantable_device_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_implantable_device_test.rb
index 6e0406867..809373438 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_implantable_device_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_implantable_device_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310ImplantableDeviceSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -120,7 +120,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -200,9 +200,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Device read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -219,7 +220,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
@@ -235,7 +236,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
@@ -251,7 +252,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Device' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
@@ -267,7 +268,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
@@ -288,7 +289,7 @@ def capabilities.supported_search_params(_)
       device = FHIR::Device.new(
         id: @device_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_medicationrequest_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_medicationrequest_test.rb
index a1f57b9a1..aca82ecd3 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_medicationrequest_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_medicationrequest_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310MedicationrequestSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -33,7 +33,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -280,7 +280,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'intent']
       end
@@ -391,7 +391,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'intent']
       end
@@ -565,7 +565,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'intent']
       end
@@ -730,9 +730,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the MedicationRequest read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -749,7 +750,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
@@ -765,7 +766,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
@@ -781,7 +782,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a MedicationRequest' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
@@ -797,7 +798,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
       medication_request = FHIR::MedicationRequest.new(
         id: @medication_request_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_observation_lab_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_observation_lab_test.rb
index 659c4099a..97f3165e6 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_observation_lab_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_observation_lab_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310ObservationLabSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -271,7 +271,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -433,7 +433,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_organization_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_organization_test.rb
index b0b99753b..08f222c1e 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_organization_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_organization_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310OrganizationSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -25,9 +25,10 @@
     end
 
     it 'skips if the Organization read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -43,7 +44,7 @@
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
@@ -59,7 +60,7 @@
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
@@ -75,7 +76,7 @@
     end
 
     it 'fails if the resource returned is not a Organization' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
@@ -91,7 +92,7 @@
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
@@ -112,7 +113,7 @@
       organization = FHIR::Organization.new(
         id: @organization_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_patient_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_patient_test.rb
index b8e38ede3..5891372f9 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_patient_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_patient_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310PatientSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -113,7 +113,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -200,7 +200,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -284,7 +284,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['gender']
       end
@@ -368,7 +368,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['birthdate']
       end
@@ -452,7 +452,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['birthdate']
       end
@@ -536,7 +536,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['family']
       end
@@ -612,9 +612,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Patient read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -631,7 +632,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
@@ -647,7 +648,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
@@ -663,7 +664,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Patient' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
@@ -679,7 +680,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
@@ -700,7 +701,7 @@ def capabilities.supported_search_params(_)
       patient = FHIR::Patient.new(
         id: @patient_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_practitioner_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_practitioner_test.rb
index a2b70bd24..103fcf2c4 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_practitioner_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_practitioner_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310PractitionerSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -25,9 +25,10 @@
     end
 
     it 'skips if the Practitioner read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -43,7 +44,7 @@
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
@@ -59,7 +60,7 @@
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
@@ -75,7 +76,7 @@
     end
 
     it 'fails if the resource returned is not a Practitioner' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
@@ -91,7 +92,7 @@
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
@@ -112,7 +113,7 @@
       practitioner = FHIR::Practitioner.new(
         id: @practitioner_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_procedure_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_procedure_test.rb
index 9f5e4f27b..80631d758 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_procedure_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_procedure_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310ProcedureSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -182,7 +182,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -317,7 +317,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -445,7 +445,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -521,9 +521,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Procedure read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -540,7 +541,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
@@ -556,7 +557,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
@@ -572,7 +573,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Procedure' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
@@ -588,7 +589,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
@@ -609,7 +610,7 @@ def capabilities.supported_search_params(_)
       procedure = FHIR::Procedure.new(
         id: @procedure_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_provenance_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_provenance_test.rb
index f5c969301..c34d14de8 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_provenance_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_provenance_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310ProvenanceSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -25,9 +25,10 @@
     end
 
     it 'skips if the Provenance read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -43,7 +44,7 @@
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
@@ -59,7 +60,7 @@
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
@@ -75,7 +76,7 @@
     end
 
     it 'fails if the resource returned is not a Provenance' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
@@ -91,7 +92,7 @@
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
@@ -112,7 +113,7 @@
       provenance = FHIR::Provenance.new(
         id: @provenance_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_pulse_oximetry_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_pulse_oximetry_test.rb
index d5b33a11f..7088ed934 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_pulse_oximetry_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_pulse_oximetry_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310PulseOximetrySequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -703,7 +703,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0/test/us_core_smokingstatus_test.rb b/lib/modules/uscore_v3.1.0/test/us_core_smokingstatus_test.rb
index d49ac642a..80799247e 100644
--- a/lib/modules/uscore_v3.1.0/test/us_core_smokingstatus_test.rb
+++ b/lib/modules/uscore_v3.1.0/test/us_core_smokingstatus_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore310SmokingstatusSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.0')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -258,9 +258,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -277,7 +278,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -293,7 +294,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -309,7 +310,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -325,7 +326,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -346,7 +347,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.0_module.yml b/lib/modules/uscore_v3.1.0_module.yml
index b999539f6..ef983cac6 100644
--- a/lib/modules/uscore_v3.1.0_module.yml
+++ b/lib/modules/uscore_v3.1.0_module.yml
@@ -50,8 +50,6 @@ test_sets:
         - USCore310ProvenanceSequence
         - USCoreR4DataAbsentReasonSequence
 sequence_requirements:
-  patient_ids:
-    label: 'Patient IDs'
   device_codes:
     label: 'Implantable Device Type Codes'
     description: 'Enter the code for an Implantable Device type, or multiple codes separated by commas. If blank, Inferno will validate all Device resources against the Implantable Device profile'
diff --git a/lib/modules/uscore_v3.1.1/data_absent_reason_checker.rb b/lib/modules/uscore_v3.1.1/data_absent_reason_checker.rb
index d920d7b91..f9af65ba2 100644
--- a/lib/modules/uscore_v3.1.1/data_absent_reason_checker.rb
+++ b/lib/modules/uscore_v3.1.1/data_absent_reason_checker.rb
@@ -20,7 +20,7 @@ def check_for_data_absent_extension(reply)
       return unless contains_data_absent_extension?(reply.body)
 
       @instance.data_absent_extension_found = true
-      @instance.save
+      @instance.save!
     end
 
     def check_for_data_absent_code(reply)
@@ -29,7 +29,7 @@ def check_for_data_absent_code(reply)
       return unless contains_data_absent_code?(reply.body)
 
       @instance.data_absent_code_found = true
-      @instance.save
+      @instance.save!
     end
 
     def contains_data_absent_extension?(body)
diff --git a/lib/modules/uscore_v3.1.1/test/data_absent_reason_checker_test.rb b/lib/modules/uscore_v3.1.1/test/data_absent_reason_checker_test.rb
index eed9bf142..35823e6af 100644
--- a/lib/modules/uscore_v3.1.1/test/data_absent_reason_checker_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/data_absent_reason_checker_test.rb
@@ -12,7 +12,7 @@ class DataAbsentReasonCheckerTest
     attr_reader :instance
 
     def initialize
-      @instance = Inferno::Models::TestingInstance.new
+      @instance = Inferno::TestingInstance.new
     end
   end
 
diff --git a/lib/modules/uscore_v3.1.1/test/head_occipital_frontal_circumference_percentile_test.rb b/lib/modules/uscore_v3.1.1/test/head_occipital_frontal_circumference_percentile_test.rb
index d82d03668..94ecc061a 100644
--- a/lib/modules/uscore_v3.1.1/test/head_occipital_frontal_circumference_percentile_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/head_occipital_frontal_circumference_percentile_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311HeadOccipitalFrontalCircumferencePercentileSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -40,7 +40,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -215,7 +215,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -375,7 +375,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -537,7 +537,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -632,7 +632,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -752,9 +752,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -771,7 +772,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -787,7 +788,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -803,7 +804,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -819,7 +820,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -840,7 +841,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/pediatric_bmi_for_age_test.rb b/lib/modules/uscore_v3.1.1/test/pediatric_bmi_for_age_test.rb
index 7e3391cea..07a6c0419 100644
--- a/lib/modules/uscore_v3.1.1/test/pediatric_bmi_for_age_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/pediatric_bmi_for_age_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311PediatricBmiForAgeSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -40,7 +40,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -215,7 +215,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -375,7 +375,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -537,7 +537,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -632,7 +632,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -752,9 +752,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -771,7 +772,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -787,7 +788,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -803,7 +804,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -819,7 +820,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -840,7 +841,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/pediatric_weight_for_height_test.rb b/lib/modules/uscore_v3.1.1/test/pediatric_weight_for_height_test.rb
index efd7bc94e..8ca08eeb7 100644
--- a/lib/modules/uscore_v3.1.1/test/pediatric_weight_for_height_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/pediatric_weight_for_height_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311PediatricWeightForHeightSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -40,7 +40,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -215,7 +215,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -375,7 +375,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -537,7 +537,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -632,7 +632,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -752,9 +752,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -771,7 +772,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -787,7 +788,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -803,7 +804,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -819,7 +820,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -840,7 +841,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_allergyintolerance_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_allergyintolerance_test.rb
index 1227181c3..d7c020bb9 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_allergyintolerance_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_allergyintolerance_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311AllergyintoleranceSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -187,7 +187,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -267,9 +267,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the AllergyIntolerance read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -286,7 +287,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -302,7 +303,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -318,7 +319,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a AllergyIntolerance' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -334,7 +335,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -355,7 +356,7 @@ def capabilities.supported_search_params(_)
       allergy_intolerance = FHIR::AllergyIntolerance.new(
         id: @allergy_intolerance_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance_id,
         testing_instance: @instance
@@ -376,7 +377,7 @@ def capabilities.supported_search_params(_)
       @sequence = @sequence_class.new(@instance, @client)
       @sequence.instance_variable_set(:'@resources_found', true)
 
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'AllergyIntolerance',
         resource_id: @allergy_intolerance.id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_careplan_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_careplan_test.rb
index 243ffa2b5..f839e470e 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_careplan_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_careplan_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311CareplanSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -353,9 +353,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the CarePlan read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -372,7 +373,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
@@ -388,7 +389,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
@@ -404,7 +405,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a CarePlan' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
@@ -420,7 +421,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
@@ -441,7 +442,7 @@ def capabilities.supported_search_params(_)
       care_plan = FHIR::CarePlan.new(
         id: @care_plan_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CarePlan',
         resource_id: @care_plan_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_careteam_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_careteam_test.rb
index 68d39f713..80d96b610 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_careteam_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_careteam_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311CareteamSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -33,7 +33,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -143,9 +143,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the CareTeam read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -162,7 +163,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
@@ -178,7 +179,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
@@ -194,7 +195,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a CareTeam' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
@@ -210,7 +211,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
@@ -231,7 +232,7 @@ def capabilities.supported_search_params(_)
       care_team = FHIR::CareTeam.new(
         id: @care_team_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'CareTeam',
         resource_id: @care_team_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_condition_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_condition_test.rb
index 7710ec7cb..5bafb5123 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_condition_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_condition_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311ConditionSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -187,7 +187,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -347,7 +347,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -440,7 +440,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -587,9 +587,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Condition read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -606,7 +607,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -622,7 +623,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -638,7 +639,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Condition' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -654,7 +655,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -675,7 +676,7 @@ def capabilities.supported_search_params(_)
       condition = FHIR::Condition.new(
         id: @condition_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition_id,
         testing_instance: @instance
@@ -696,7 +697,7 @@ def capabilities.supported_search_params(_)
       @sequence = @sequence_class.new(@instance, @client)
       @sequence.instance_variable_set(:'@resources_found', true)
 
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Condition',
         resource_id: @condition.id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_diagnosticreport_lab_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_diagnosticreport_lab_test.rb
index 270e9312a..7d03d1c63 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_diagnosticreport_lab_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_diagnosticreport_lab_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311DiagnosticreportLabSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -265,7 +265,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -411,7 +411,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -544,7 +544,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -699,7 +699,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -790,7 +790,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -910,9 +910,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the DiagnosticReport read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -929,7 +930,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -945,7 +946,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -961,7 +962,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a DiagnosticReport' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -977,7 +978,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -998,7 +999,7 @@ def capabilities.supported_search_params(_)
       diagnostic_report = FHIR::DiagnosticReport.new(
         id: @diagnostic_report_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_diagnosticreport_note_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_diagnosticreport_note_test.rb
index 459cafde1..6cafda14c 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_diagnosticreport_note_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_diagnosticreport_note_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311DiagnosticreportNoteSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -265,7 +265,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -411,7 +411,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -544,7 +544,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -699,7 +699,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -790,7 +790,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -910,9 +910,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the DiagnosticReport read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -929,7 +930,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -945,7 +946,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -961,7 +962,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a DiagnosticReport' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -977,7 +978,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
@@ -998,7 +999,7 @@ def capabilities.supported_search_params(_)
       diagnostic_report = FHIR::DiagnosticReport.new(
         id: @diagnostic_report_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DiagnosticReport',
         resource_id: @diagnostic_report_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_documentreference_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_documentreference_test.rb
index 57435be83..59001ad15 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_documentreference_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_documentreference_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311DocumentreferenceSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -181,7 +181,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -333,7 +333,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -495,7 +495,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -655,7 +655,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -817,7 +817,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'type']
       end
@@ -945,7 +945,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -1021,9 +1021,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the DocumentReference read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -1040,7 +1041,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1056,7 +1057,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1072,7 +1073,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a DocumentReference' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1088,7 +1089,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1109,7 +1110,7 @@ def capabilities.supported_search_params(_)
       document_reference = FHIR::DocumentReference.new(
         id: @document_reference_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference_id,
         testing_instance: @instance
@@ -1130,7 +1131,7 @@ def capabilities.supported_search_params(_)
       @sequence = @sequence_class.new(@instance, @client)
       @sequence.instance_variable_set(:'@resources_found', true)
 
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'DocumentReference',
         resource_id: @document_reference.id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_encounter_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_encounter_test.rb
index 5adb2ee60..de4ebb587 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_encounter_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_encounter_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311EncounterSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -25,9 +25,10 @@
     end
 
     it 'skips if the Encounter read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -43,7 +44,7 @@
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
@@ -59,7 +60,7 @@
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
@@ -75,7 +76,7 @@
     end
 
     it 'fails if the resource returned is not a Encounter' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
@@ -91,7 +92,7 @@
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
@@ -112,7 +113,7 @@
       encounter = FHIR::Encounter.new(
         id: @encounter_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Encounter',
         resource_id: @encounter_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_goal_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_goal_test.rb
index 14c11ad2a..c76af861b 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_goal_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_goal_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311GoalSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -182,7 +182,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -266,7 +266,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -386,9 +386,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Goal read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -405,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
@@ -421,7 +422,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
@@ -437,7 +438,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Goal' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
@@ -453,7 +454,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
@@ -474,7 +475,7 @@ def capabilities.supported_search_params(_)
       goal = FHIR::Goal.new(
         id: @goal_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Goal',
         resource_id: @goal_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_immunization_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_immunization_test.rb
index da339bfac..0578dde68 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_immunization_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_immunization_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311ImmunizationSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -182,7 +182,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -310,7 +310,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -386,9 +386,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Immunization read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -405,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
@@ -421,7 +422,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
@@ -437,7 +438,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Immunization' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
@@ -453,7 +454,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
@@ -474,7 +475,7 @@ def capabilities.supported_search_params(_)
       immunization = FHIR::Immunization.new(
         id: @immunization_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Immunization',
         resource_id: @immunization_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_implantable_device_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_implantable_device_test.rb
index 5504d646e..510c1c0c6 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_implantable_device_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_implantable_device_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311ImplantableDeviceSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -120,7 +120,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -200,9 +200,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Device read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -219,7 +220,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
@@ -235,7 +236,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
@@ -251,7 +252,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Device' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
@@ -267,7 +268,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
@@ -288,7 +289,7 @@ def capabilities.supported_search_params(_)
       device = FHIR::Device.new(
         id: @device_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Device',
         resource_id: @device_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_medicationrequest_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_medicationrequest_test.rb
index cf9e3dbba..977c3dec4 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_medicationrequest_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_medicationrequest_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311MedicationrequestSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -33,7 +33,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -280,7 +280,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'intent']
       end
@@ -391,7 +391,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'intent']
       end
@@ -565,7 +565,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'intent']
       end
@@ -730,9 +730,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the MedicationRequest read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -749,7 +750,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
@@ -765,7 +766,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
@@ -781,7 +782,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a MedicationRequest' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
@@ -797,7 +798,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
       medication_request = FHIR::MedicationRequest.new(
         id: @medication_request_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'MedicationRequest',
         resource_id: @medication_request_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_observation_lab_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_observation_lab_test.rb
index 85bb68e6d..d932db7e7 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_observation_lab_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_observation_lab_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311ObservationLabSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -273,7 +273,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -406,7 +406,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -568,7 +568,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -663,7 +663,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -783,9 +783,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -802,7 +803,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -818,7 +819,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -834,7 +835,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -850,7 +851,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -871,7 +872,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_organization_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_organization_test.rb
index fd197b396..6965dd3b4 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_organization_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_organization_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311OrganizationSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -25,9 +25,10 @@
     end
 
     it 'skips if the Organization read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -43,7 +44,7 @@
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
@@ -59,7 +60,7 @@
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
@@ -75,7 +76,7 @@
     end
 
     it 'fails if the resource returned is not a Organization' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
@@ -91,7 +92,7 @@
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
@@ -112,7 +113,7 @@
       organization = FHIR::Organization.new(
         id: @organization_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Organization',
         resource_id: @organization_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_patient_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_patient_test.rb
index 4a4ab629a..a861f62e6 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_patient_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_patient_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311PatientSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -113,7 +113,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -200,7 +200,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -284,7 +284,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['birthdate']
       end
@@ -368,7 +368,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['gender']
       end
@@ -452,7 +452,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['birthdate']
       end
@@ -536,7 +536,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['family']
       end
@@ -612,9 +612,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Patient read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -631,7 +632,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
@@ -647,7 +648,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
@@ -663,7 +664,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Patient' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
@@ -679,7 +680,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
@@ -700,7 +701,7 @@ def capabilities.supported_search_params(_)
       patient = FHIR::Patient.new(
         id: @patient_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Patient',
         resource_id: @patient_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_practitioner_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_practitioner_test.rb
index fb8a1a0f6..b689b999d 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_practitioner_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_practitioner_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311PractitionerSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -25,9 +25,10 @@
     end
 
     it 'skips if the Practitioner read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -43,7 +44,7 @@
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
@@ -59,7 +60,7 @@
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
@@ -75,7 +76,7 @@
     end
 
     it 'fails if the resource returned is not a Practitioner' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
@@ -91,7 +92,7 @@
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
@@ -112,7 +113,7 @@
       practitioner = FHIR::Practitioner.new(
         id: @practitioner_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Practitioner',
         resource_id: @practitioner_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_procedure_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_procedure_test.rb
index fb0be735b..c95e44df5 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_procedure_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_procedure_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311ProcedureSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -32,7 +32,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         []
       end
@@ -182,7 +182,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -310,7 +310,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -401,7 +401,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -521,9 +521,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Procedure read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -540,7 +541,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
@@ -556,7 +557,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
@@ -572,7 +573,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Procedure' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
@@ -588,7 +589,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
@@ -609,7 +610,7 @@ def capabilities.supported_search_params(_)
       procedure = FHIR::Procedure.new(
         id: @procedure_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Procedure',
         resource_id: @procedure_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_provenance_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_provenance_test.rb
index 5ebc22eae..1526fc4c1 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_provenance_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_provenance_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311ProvenanceSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -25,9 +25,10 @@
     end
 
     it 'skips if the Provenance read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -43,7 +44,7 @@
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
@@ -59,7 +60,7 @@
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
@@ -75,7 +76,7 @@
     end
 
     it 'fails if the resource returned is not a Provenance' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
@@ -91,7 +92,7 @@
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
@@ -112,7 +113,7 @@
       provenance = FHIR::Provenance.new(
         id: @provenance_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Provenance',
         resource_id: @provenance_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_pulse_oximetry_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_pulse_oximetry_test.rb
index be74db9dd..9a48849f1 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_pulse_oximetry_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_pulse_oximetry_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311PulseOximetrySequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -40,7 +40,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -215,7 +215,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -375,7 +375,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -537,7 +537,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'category']
       end
@@ -632,7 +632,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient', 'code']
       end
@@ -752,9 +752,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -771,7 +772,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -787,7 +788,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -803,7 +804,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -819,7 +820,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -840,7 +841,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1/test/us_core_smokingstatus_test.rb b/lib/modules/uscore_v3.1.1/test/us_core_smokingstatus_test.rb
index 83df11f17..2dbfaaf07 100644
--- a/lib/modules/uscore_v3.1.1/test/us_core_smokingstatus_test.rb
+++ b/lib/modules/uscore_v3.1.1/test/us_core_smokingstatus_test.rb
@@ -10,7 +10,7 @@
     @sequence_class = Inferno::Sequence::USCore311SmokingstatusSequence
     @base_url = 'http://www.example.com/fhir'
     @token = 'ABC'
-    @instance = Inferno::Models::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
+    @instance = Inferno::TestingInstance.create(url: @base_url, token: @token, selected_module: 'uscore_v3.1.1')
     @client = FHIR::Client.for_testing_instance(@instance)
     @patient_ids = 'example'
     @instance.patient_ids = @patient_ids
@@ -38,7 +38,7 @@
     end
 
     it 'skips if the search params are not supported' do
-      capabilities = Inferno::Models::ServerCapabilities.new
+      capabilities = Inferno::ServerCapabilities.new
       def capabilities.supported_search_params(_)
         ['patient']
       end
@@ -258,9 +258,10 @@ def capabilities.supported_search_params(_)
     end
 
     it 'skips if the Observation read interaction is not supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.delete_all
+      Inferno::ServerCapabilities.create(
         testing_instance_id: @instance.id,
-        capabilities: FHIR::CapabilityStatement.new.to_json
+        capabilities: FHIR::CapabilityStatement.new.as_json
       )
       @instance.reload
       exception = assert_raises(Inferno::SkipException) { @sequence.run_test(@test) }
@@ -277,7 +278,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if a non-success response code is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -293,7 +294,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if no resource is received' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -309,7 +310,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource returned is not a Observation' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -325,7 +326,7 @@ def capabilities.supported_search_params(_)
     end
 
     it 'fails if the resource has an incorrect id' do
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
@@ -346,7 +347,7 @@ def capabilities.supported_search_params(_)
       observation = FHIR::Observation.new(
         id: @observation_id
       )
-      Inferno::Models::ResourceReference.create(
+      Inferno::ResourceReference.create(
         resource_type: 'Observation',
         resource_id: @observation_id,
         testing_instance: @instance
diff --git a/lib/modules/uscore_v3.1.1_module.yml b/lib/modules/uscore_v3.1.1_module.yml
index 072d9e4b0..25628304f 100644
--- a/lib/modules/uscore_v3.1.1_module.yml
+++ b/lib/modules/uscore_v3.1.1_module.yml
@@ -44,8 +44,6 @@ test_sets:
         - USCore311ProvenanceSequence
         - USCoreR4DataAbsentReasonSequence
 sequence_requirements:
-  patient_ids:
-    label: 'Patient IDs'
   device_codes:
     label: 'Implantable Device Type Codes'
     description: 'Enter the code for an Implantable Device type, or multiple codes separated by commas. If blank, Inferno will validate all Device resources against the Implantable Device profile'
diff --git a/lib/tasks/tasks.rake b/lib/tasks/tasks.rake
index d90a4847d..f3b9bc903 100644
--- a/lib/tasks/tasks.rake
+++ b/lib/tasks/tasks.rake
@@ -3,7 +3,6 @@
 require 'fhir_client'
 require 'pry'
 require 'pry-byebug'
-require 'dm-core'
 require 'csv'
 require 'colorize'
 require 'optparse'
@@ -76,7 +75,7 @@ def execute(instance, sequences)
         end
       end
     end
-    instance.save
+    instance.save!
     sequence_instance = sequence.new(instance, client, false)
     sequence_result = nil
 
@@ -300,7 +299,7 @@ namespace :inferno do |_argv|
 
     output = { server: args[:server], module: args[:module], arguments: {}, sequences: [] }
 
-    instance = Inferno::Models::TestingInstance.new(url: args[:server], selected_module: args[:module])
+    instance = Inferno::TestingInstance.new(url: args[:server], selected_module: args[:module])
     instance.save!
 
     instance.module.sequences.each do |seq|
@@ -350,7 +349,7 @@ namespace :inferno do |_argv|
     requires = []
     defines = []
 
-    instance = Inferno::Models::TestingInstance.new(url: args[:server], selected_module: args[:module])
+    instance = Inferno::TestingInstance.new(url: args[:server], selected_module: args[:module])
     instance.save!
 
     instance.module.sequences.each do |seq|
@@ -415,11 +414,6 @@ namespace :inferno do |_argv|
     exit execute(instance, sequences.map { |s| { 'sequence' => s } })
   end
 
-  desc 'Cleans the database of all models'
-  task :drop_database, [] do |_task|
-    DataMapper.auto_migrate!
-  end
-
   desc 'Execute sequence against a FHIR server'
   task :execute_batch, [:config] do |_task, args|
     Inferno::StartupTasks.run
@@ -427,7 +421,7 @@ namespace :inferno do |_argv|
     file = File.read(args.config)
     config = JSON.parse(file)
 
-    instance = Inferno::Models::TestingInstance.new(
+    instance = Inferno::TestingInstance.new(
       url: config['server'],
       selected_module: config['module'],
       initiate_login_uri: 'http://localhost:4568/launch',
diff --git a/test/integration/instance_page_test.rb b/test/integration/instance_page_test.rb
index 874c5173a..ffd6a9b63 100644
--- a/test/integration/instance_page_test.rb
+++ b/test/integration/instance_page_test.rb
@@ -16,7 +16,7 @@ def setup
     assert last_response.ok?
     @instance_path = last_request.url
     instance_id = @instance_path.split('/').last(3).first # third to last
-    @instance = Inferno::Models::TestingInstance.get(instance_id)
+    @instance = Inferno::TestingInstance.find(instance_id)
     assert !@instance.nil?, "No instance id #{instance_id}"
   end
 
diff --git a/test/integration/oauth2_endpoints_test.rb b/test/integration/oauth2_endpoints_test.rb
index d8822f38b..7a375c3b7 100644
--- a/test/integration/oauth2_endpoints_test.rb
+++ b/test/integration/oauth2_endpoints_test.rb
@@ -23,7 +23,7 @@ def create_testing_instance(params = {})
       initiate_login_uri: '/login'
     }
 
-    Inferno::Models::TestingInstance.create(default_params.merge(params))
+    Inferno::TestingInstance.create!(default_params.merge(params))
   end
 
   def create_sequence_result(params = {})
@@ -34,7 +34,7 @@ def create_sequence_result(params = {})
       next_test_cases: ''
     }
 
-    Inferno::Models::SequenceResult.create(default_params.merge(params))
+    Inferno::SequenceResult.create!(default_params.merge(params))
   end
 
   def setup
@@ -48,7 +48,7 @@ def test_launch_response_success
       wait_at_endpoint: 'launch',
       redirect_to_url: '/redirect'
     )
-    Inferno::Models::TestResult.create(
+    Inferno::TestResult.create!(
       sequence_result: sequence_result
     )
 
@@ -85,7 +85,7 @@ def test_launch_response_no_iss
       wait_at_endpoint: 'launch',
       redirect_to_url: '/redirect'
     )
-    Inferno::Models::TestResult.create(
+    Inferno::TestResult.create!(
       sequence_result: sequence_result
     )
 
@@ -115,7 +115,7 @@ def test_launch_response_unknown_iss
       wait_at_endpoint: 'launch',
       redirect_to_url: '/redirect'
     )
-    Inferno::Models::TestResult.create(
+    Inferno::TestResult.create!(
       sequence_result: sequence_result
     )
 
@@ -143,7 +143,7 @@ def test_launch_response_not_waiting
       testing_instance: instance,
       result: 'pass'
     )
-    Inferno::Models::TestResult.create(
+    Inferno::TestResult.create!(
       sequence_result: sequence_result
     )
 
@@ -164,7 +164,7 @@ def test_redirect_response_success
       testing_instance: instance,
       wait_at_endpoint: 'redirect'
     )
-    Inferno::Models::TestResult.create(
+    Inferno::TestResult.create!(
       sequence_result: sequence_result
     )
 
@@ -201,7 +201,7 @@ def test_redirect_response_bad_state
       testing_instance: instance,
       wait_at_endpoint: 'redirect'
     )
-    Inferno::Models::TestResult.create(
+    Inferno::TestResult.create!(
       sequence_result: sequence_result
     )
 
@@ -230,7 +230,7 @@ def test_redirect_response_not_waiting
       testing_instance: instance,
       result: 'pass'
     )
-    Inferno::Models::TestResult.create(
+    Inferno::TestResult.create!(
       sequence_result: sequence_result
     )
 
diff --git a/test/test_helper.rb b/test/test_helper.rb
index 5e3320267..2e6ec4989 100644
--- a/test/test_helper.rb
+++ b/test/test_helper.rb
@@ -10,6 +10,7 @@
 require 'minitest/autorun'
 require 'webmock/minitest'
 require 'rack/test'
+require 'database_cleaner/active_record'
 test_log_filename = File.join('tmp', 'test.log')
 FileUtils.rm test_log_filename if File.exist? test_log_filename
 
@@ -25,7 +26,21 @@ def create_assertion_report?
 
 require_relative '../lib/app'
 Inferno::App::Endpoint.settings.resource_validator = 'internal'
-Inferno::StartupTasks.load_all_modules
+Inferno::StartupTasks.run
+
+DatabaseCleaner.strategy = :truncation
+
+module Minitest
+  class Spec
+    before :each do
+      DatabaseCleaner.start
+    end
+
+    after :each do
+      DatabaseCleaner.clean
+    end
+  end
+end
 
 def find_fixture_directory(test_directory = nil)
   test_directory ||=
@@ -94,16 +109,16 @@ def get_test_instance(url: 'http://www.example.com',
                       selected_module: 'argonaut',
                       token: 'ACCESS_TOKEN')
 
-  @instance = Inferno::Models::TestingInstance.new(url: url,
-                                                   client_name: client_name,
-                                                   base_url: base_url,
-                                                   client_endpoint_key: client_endpoint_key,
-                                                   client_id: client_id,
-                                                   oauth_authorize_endpoint: oauth_authorize_endpoint,
-                                                   oauth_token_endpoint: oauth_token_endpoint,
-                                                   scopes: scopes,
-                                                   selected_module: selected_module,
-                                                   token: token)
+  @instance = Inferno::TestingInstance.new(url: url,
+                                           client_name: client_name,
+                                           base_url: base_url,
+                                           client_endpoint_key: client_endpoint_key,
+                                           client_id: client_id,
+                                           oauth_authorize_endpoint: oauth_authorize_endpoint,
+                                           oauth_token_endpoint: oauth_token_endpoint,
+                                           scopes: scopes,
+                                           selected_module: selected_module,
+                                           token: token)
 end
 
 def get_client(instance)
@@ -119,7 +134,7 @@ def set_resource_support(instance, resource)
       code: interaction
     }
   end
-  Inferno::Models::ServerCapabilities.create(
+  Inferno::ServerCapabilities.create!(
     testing_instance_id: instance.id,
     capabilities: {
       rest: [
diff --git a/test/unit/exceptions_test.rb b/test/unit/exceptions_test.rb
index acaa7fb26..2eb4a2c9a 100644
--- a/test/unit/exceptions_test.rb
+++ b/test/unit/exceptions_test.rb
@@ -7,7 +7,7 @@
     it 'fails the test and sets message and details' do
       message = 'MESSAGE'
       details = 'DETAILS'
-      result = Inferno::Models::TestResult.new
+      result = Inferno::TestResult.new
 
       Inferno::AssertionException.new(message, details).update_result(result)
 
@@ -23,7 +23,7 @@
     it 'skips the test and sets message and details' do
       message = 'MESSAGE'
       details = 'DETAILS'
-      result = Inferno::Models::TestResult.new
+      result = Inferno::TestResult.new
 
       Inferno::SkipException.new(message, details).update_result(result)
 
@@ -38,7 +38,7 @@
   describe '#update_result' do
     it 'todos the test and sets message' do
       message = 'MESSAGE'
-      result = Inferno::Models::TestResult.new
+      result = Inferno::TestResult.new
 
       Inferno::TodoException.new(message).update_result(result)
 
@@ -52,7 +52,7 @@
   describe '#update_result' do
     it 'passes the test and sets message' do
       message = 'MESSAGE'
-      result = Inferno::Models::TestResult.new
+      result = Inferno::TestResult.new
 
       Inferno::PassException.new(message).update_result(result)
 
@@ -66,7 +66,7 @@
   describe '#update_result' do
     it 'omits the test and sets message' do
       message = 'MESSAGE'
-      result = Inferno::Models::TestResult.new
+      result = Inferno::TestResult.new
 
       Inferno::OmitException.new(message).update_result(result)
 
@@ -80,7 +80,7 @@
   describe '#update_result' do
     it 'waits and sets endpoint' do
       endpoint = 'ENDPOINT'
-      result = Inferno::Models::TestResult.new
+      result = Inferno::TestResult.new
 
       Inferno::WaitException.new(endpoint).update_result(result)
 
@@ -95,7 +95,7 @@
     it 'waits and sets endpoint and redirection url' do
       endpoint = 'ENDPOINT'
       url = 'URL'
-      result = Inferno::Models::TestResult.new
+      result = Inferno::TestResult.new
 
       Inferno::RedirectException.new(url, endpoint).update_result(result)
 
@@ -110,7 +110,7 @@
   describe '#update_result' do
     it 'fails the test and sets message' do
       message = 'MESSAGE'
-      result = Inferno::Models::TestResult.new
+      result = Inferno::TestResult.new
 
       ClientException.new(message).update_result(result)
 
diff --git a/test/unit/fhir_client_test.rb b/test/unit/fhir_client_test.rb
index 391b2a0c6..bde4062a5 100644
--- a/test/unit/fhir_client_test.rb
+++ b/test/unit/fhir_client_test.rb
@@ -5,7 +5,7 @@
 describe FHIR::Client do
   before do
     @client = FHIR::Client.new('http://www.example.com/fhir')
-    @instance = Inferno::Models::TestingInstance.create(
+    @instance = Inferno::TestingInstance.create!(
       oauth_token_endpoint: 'http://www.example.com/token',
       client_id: 'CLIENT_ID'
     )
@@ -19,10 +19,10 @@
 
     it 'returns false if the token expiration time is more than a minute in the future' do
       now = DateTime.now
-      @instance.update(token_retrieved_at: now)
+      @instance.update!(token_retrieved_at: now)
       [now + 65.seconds, now + 1.hour, now + 1.year].each do |time|
         expires_in = time.to_i - now.to_i
-        @instance.update(token_expires_in: expires_in)
+        @instance.update!(token_expires_in: expires_in)
 
         assert_equal false, @client.time_to_refresh?
       end
@@ -30,10 +30,10 @@
 
     it 'returns trueif the token has expired or is about to expire' do
       now = DateTime.now
-      @instance.update(token_retrieved_at: now)
+      @instance.update!(token_retrieved_at: now)
       [now + 55.seconds, now - 1.hour, now - 1.year].each do |time|
         expires_in = time.to_i - now.to_i
-        @instance.update(token_expires_in: expires_in)
+        @instance.update!(token_expires_in: expires_in)
 
         assert_equal true, @client.time_to_refresh?
       end
@@ -45,7 +45,7 @@
       @refresh_token = 'OLD_REFRESH_TOKEN'
       @access_token = 'OLD_ACCESS_TOKEN'
       @expires_in = 123
-      @instance.update(
+      @instance.update!(
         refresh_token: @refresh_token,
         token: @access_token,
         token_expires_in: @expires_in
@@ -91,7 +91,7 @@
     end
 
     it 'updates the token if the refresh is successful for confidential clients' do
-      @instance.update(
+      @instance.update!(
         client_secret: 'CLIENT_SECRET',
         confidential_client: true
       )
diff --git a/test/unit/sequence_base_test.rb b/test/unit/sequence_base_test.rb
index 0477ecf94..72640da44 100644
--- a/test/unit/sequence_base_test.rb
+++ b/test/unit/sequence_base_test.rb
@@ -6,7 +6,7 @@ class SequenceBaseTest < MiniTest::Test
   def setup
     allergy_intolerance_bundle = FHIR.from_contents(load_fixture(:us_core_r4_allergy_intolerance))
     @allergy_intolerance_resource = allergy_intolerance_bundle.entry.first.resource
-    @instance = Inferno::Models::TestingInstance.new(
+    @instance = Inferno::TestingInstance.new(
       url: 'http://www.example.com',
       client_name: 'Inferno',
       base_url: 'http://localhost:4567',
@@ -29,7 +29,7 @@ def setup
 
   describe '#validate_reply_entries' do
     before do
-      @instance = Inferno::Models::TestingInstance.create
+      @instance = Inferno::TestingInstance.create!
       client = FHIR::Client.new('')
       @sequence = Inferno::Sequence::USCore310AllergyintoleranceSequence.new(@instance, client, true)
       allergy_intolerance_bundle = FHIR.from_contents(load_fixture(:us_core_r4_allergy_intolerance))
@@ -86,7 +86,7 @@ def setup
 
   describe '#date_comparator_value' do
     before do
-      @instance = Inferno::Models::TestingInstance.create(selected_module: 'uscore_v3.0.0')
+      @instance = Inferno::TestingInstance.create!(selected_module: 'uscore_v3.0.0')
       client = FHIR::Client.new('')
       @sequence = Inferno::Sequence::SequenceBase.new(@instance, client, true)
     end
@@ -115,7 +115,7 @@ def setup
 
   describe '#save_delayed_sequence_references' do
     before do
-      @instance = Inferno::Models::TestingInstance.create(selected_module: 'uscore_v3.0.0')
+      @instance = Inferno::TestingInstance.create!(selected_module: 'uscore_v3.0.0')
       client = FHIR::Client.new('')
       @sequence = Inferno::Sequence::SequenceBase.new(@instance, client, true)
       @diagnostic_report_resource = FHIR.from_contents(load_fixture(:us_core_r4_diagnostic_report_note))
@@ -146,7 +146,7 @@ def setup
 
   describe '#get_value_for_search_param' do
     before do
-      instance = Inferno::Models::TestingInstance.create(selected_module: 'uscore_v3.0.0')
+      instance = Inferno::TestingInstance.create!(selected_module: 'uscore_v3.0.0')
       client = FHIR::Client.new('')
       @sequence = Inferno::Sequence::SequenceBase.new(instance, client, true)
     end
@@ -214,7 +214,7 @@ def setup
       @bundle1 = FHIR.from_contents(load_fixture(:bundle_1))
       @bundle2 = load_fixture(:bundle_2)
 
-      instance = Inferno::Models::TestingInstance.create(selected_module: 'uscore_v3.0.0')
+      instance = Inferno::TestingInstance.create!(selected_module: 'uscore_v3.0.0')
       client = FHIR::Client.new('')
       @bundle1.client = client
       @sequence = Inferno::Sequence::SequenceBase.new(instance, client, true)
@@ -325,7 +325,7 @@ class OptionalTestSequence < Inferno::Sequence::SequenceBase
 
   describe '#tests' do
     before do
-      @instance = Inferno::Models::TestingInstance.create
+      @instance = Inferno::TestingInstance.create!
       client = FHIR::Client.new('')
       @sequence = OptionalTestSequence.new(@instance, client)
     end
@@ -344,7 +344,7 @@ class OptionalTestSequence < Inferno::Sequence::SequenceBase
 
   describe '#test_count' do
     before do
-      @instance = Inferno::Models::TestingInstance.create
+      @instance = Inferno::TestingInstance.create!
       client = FHIR::Client.new('')
       @sequence = OptionalTestSequence.new(@instance, client)
     end
@@ -363,7 +363,7 @@ class OptionalTestSequence < Inferno::Sequence::SequenceBase
 
   describe '#find_slice_by_values' do
     before do
-      @instance = Inferno::Models::TestingInstance.create
+      @instance = Inferno::TestingInstance.create!
       client = FHIR::Client.new('')
       @sequence = Inferno::Sequence::SequenceBase.new(@instance, client, true)
     end
diff --git a/test/unit/sequence_result_test.rb b/test/unit/sequence_result_test.rb
index b9ddb21e1..93a486868 100644
--- a/test/unit/sequence_result_test.rb
+++ b/test/unit/sequence_result_test.rb
@@ -9,11 +9,11 @@ class SequenceResultTest < MiniTest::Test
   include Inferno::ResultStatusTests
 
   def setup
-    @result = Inferno::Models::SequenceResult.new
+    @result = Inferno::SequenceResult.new
   end
 
   def test_reset!
-    result = Inferno::Models::SequenceResult.new
+    result = Inferno::SequenceResult.new
     result.required_passed = 20
     result.required_total = 15
     result.error_count = 2
@@ -38,15 +38,15 @@ def test_reset!
   end
 
   def test_result_count
-    result = Inferno::Models::SequenceResult.new
-    result.test_results << Inferno::Models::TestResult.new
-    result.test_results << Inferno::Models::TestResult.new
+    result = Inferno::SequenceResult.new
+    result.test_results << Inferno::TestResult.new
+    result.test_results << Inferno::TestResult.new
 
     assert_equal 2, result.result_count
   end
 
   def test_total_omitted
-    result = Inferno::Models::SequenceResult.new
+    result = Inferno::SequenceResult.new
 
     result.required_omitted = 4
     result.optional_omitted = 300
@@ -55,7 +55,7 @@ def test_total_omitted
   end
 
   def test_update_result_counts
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::PASS },
@@ -68,7 +68,7 @@ def test_update_result_counts
       { required: false, result: Inferno::ResultStatuses::WAIT }
     ]
 
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -84,13 +84,13 @@ def test_update_result_counts
   end
 
   def test_sequence_result_pass
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::PASS },
       { required: true, result: Inferno::ResultStatuses::TODO }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -98,13 +98,13 @@ def test_sequence_result_pass
   end
 
   def test_sequence_result_pass_even_with_omit
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::PASS },
       { required: true, result: Inferno::ResultStatuses::OMIT }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -112,13 +112,13 @@ def test_sequence_result_pass_even_with_omit
   end
 
   def test_sequence_result_pass_when_skip_test_is_optional
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::PASS },
       { required: false, result: Inferno::ResultStatuses::SKIP }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -126,13 +126,13 @@ def test_sequence_result_pass_when_skip_test_is_optional
   end
 
   def test_sequence_result_skip_when_skip_test_is_required
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::PASS },
       { required: true, result: Inferno::ResultStatuses::SKIP }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -140,12 +140,12 @@ def test_sequence_result_skip_when_skip_test_is_required
   end
 
   def test_sequence_result_required_skip_when_no_pass_tests
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::SKIP }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -153,12 +153,12 @@ def test_sequence_result_required_skip_when_no_pass_tests
   end
 
   def test_sequence_result_pass_when_only_1_optional_skip_test
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: false, result: Inferno::ResultStatuses::SKIP }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -166,14 +166,14 @@ def test_sequence_result_pass_when_only_1_optional_skip_test
   end
 
   def test_sequence_result_fail
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::PASS },
       { required: true, result: Inferno::ResultStatuses::SKIP },
       { required: true, result: Inferno::ResultStatuses::FAIL }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -181,13 +181,13 @@ def test_sequence_result_fail
   end
 
   def test_sequence_result_pass_when_fail_optional
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::PASS },
       { required: false, result: Inferno::ResultStatuses::FAIL }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -195,14 +195,14 @@ def test_sequence_result_pass_when_fail_optional
   end
 
   def test_sequence_result_error
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::PASS },
       { required: true, result: Inferno::ResultStatuses::SKIP },
       { required: true, result: Inferno::ResultStatuses::ERROR }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -210,13 +210,13 @@ def test_sequence_result_error
   end
 
   def test_sequence_result_pass_when_error_optional
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::PASS },
       { required: false, result: Inferno::ResultStatuses::ERROR }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
@@ -224,13 +224,13 @@ def test_sequence_result_pass_when_error_optional
   end
 
   def test_sequence_result_error_when_pass_fail_and_error_tests_in_sequence
-    sequence_result = Inferno::Models::SequenceResult.new
+    sequence_result = Inferno::SequenceResult.new
 
     test_result_params = [
       { required: true, result: Inferno::ResultStatuses::FAIL },
       { required: true, result: Inferno::ResultStatuses::ERROR }
     ]
-    sequence_result.test_results = test_result_params.map { |params| Inferno::Models::TestResult.new(params) }
+    sequence_result.test_results = test_result_params.map { |params| Inferno::TestResult.new(params) }
 
     sequence_result.update_result_counts
 
diff --git a/test/unit/server_capabilities_test.rb b/test/unit/server_capabilities_test.rb
index c3f19570e..f49162f2b 100644
--- a/test/unit/server_capabilities_test.rb
+++ b/test/unit/server_capabilities_test.rb
@@ -40,8 +40,8 @@ def setup
       ]
     }
 
-    @capabilities = Inferno::Models::ServerCapabilities.new(
-      testing_instance_id: Inferno::Models::TestingInstance.create.id,
+    @capabilities = Inferno::ServerCapabilities.new(
+      testing_instance_id: Inferno::TestingInstance.create!.id,
       capabilities: @capability_statement
     )
 
@@ -64,8 +64,8 @@ def setup
       ]
     }
 
-    @smart_capabilities = Inferno::Models::ServerCapabilities.new(
-      testing_instance_id: Inferno::Models::TestingInstance.create.id,
+    @smart_capabilities = Inferno::ServerCapabilities.new(
+      testing_instance_id: Inferno::TestingInstance.create!.id,
       capabilities: @smart_capability_statement
     )
   end
@@ -101,8 +101,8 @@ def test_supported_interactions
   def test_operation_supported_pass
     conformance = load_json_fixture(:bulk_data_conformance)
 
-    server_capabilities = Inferno::Models::ServerCapabilities.new(
-      testing_instance_id: Inferno::Models::TestingInstance.create.id,
+    server_capabilities = Inferno::ServerCapabilities.new(
+      testing_instance_id: Inferno::TestingInstance.create!.id,
       capabilities: conformance.as_json
     )
 
@@ -112,8 +112,8 @@ def test_operation_supported_pass
   def test_operation_supported_fail_invalid_name
     conformance = load_json_fixture(:bulk_data_conformance)
 
-    server_capabilities = Inferno::Models::ServerCapabilities.new(
-      testing_instance_id: Inferno::Models::TestingInstance.create.id,
+    server_capabilities = Inferno::ServerCapabilities.new(
+      testing_instance_id: Inferno::TestingInstance.create!.id,
       capabilities: conformance.as_json
     )
 
diff --git a/test/unit/test_result_test.rb b/test/unit/test_result_test.rb
index fc27da5e7..4fd42a193 100644
--- a/test/unit/test_result_test.rb
+++ b/test/unit/test_result_test.rb
@@ -8,6 +8,6 @@ class TestResultTest < MiniTest::Test
   include Inferno::ResultStatusTests
 
   def setup
-    @result = Inferno::Models::TestResult.new
+    @result = Inferno::TestResult.new
   end
 end
diff --git a/test/unit/testing_instance_test.rb b/test/unit/testing_instance_test.rb
index 5d5f52684..eebca17cf 100644
--- a/test/unit/testing_instance_test.rb
+++ b/test/unit/testing_instance_test.rb
@@ -3,9 +3,9 @@
 require_relative '../test_helper'
 require_relative '../../lib/app/models/testing_instance'
 
-describe Inferno::Models::TestingInstance do
+describe Inferno::TestingInstance do
   before do
-    @instance = Inferno::Models::TestingInstance.create(selected_module: 'uscore_v3.1.0')
+    @instance = Inferno::TestingInstance.create!(selected_module: 'uscore_v3.1.0')
   end
 
   describe '#conformance_supported?' do
@@ -14,7 +14,7 @@
     end
 
     it 'returns true if the resource is supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.create!(
         testing_instance_id: @instance.id,
         capabilities: @conformance.as_json
       )
@@ -23,7 +23,7 @@
     end
 
     it 'returns true if the resource and operations are supported' do
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.create!(
         testing_instance_id: @instance.id,
         capabilities: @conformance.as_json
       )
@@ -34,7 +34,7 @@
 
     it 'returns false if the resource is not supported' do
       @conformance.rest.first.resource.reject! { |r| r.type == 'Patient' }
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.create!(
         testing_instance_id: @instance.id,
         capabilities: @conformance.as_json
       )
@@ -46,7 +46,7 @@
 
     it 'returns false if the operations are not supported' do
       @conformance.rest.first.resource.find { |r| r.type == 'Patient' }.interaction.reject! { |i| i.code == 'read' }
-      Inferno::Models::ServerCapabilities.create(
+      Inferno::ServerCapabilities.create!(
         testing_instance_id: @instance.id,
         capabilities: @conformance.as_json
       )
@@ -79,7 +79,7 @@
   describe '#patient_id' do
     it 'returns the id of the Patient reference which was created first' do
       10.times do |index|
-        Inferno::Models::ResourceReference.create(
+        Inferno::ResourceReference.create!(
           resource_type: 'Patient',
           resource_id: index.to_s,
           testing_instance: @instance
@@ -102,35 +102,3 @@
     end
   end
 end
-
-class TestingInstanceTest < MiniTest::Test
-  def setup
-    @patient_id1 = '1'
-    @patient_id2 = '2'
-    @testing_instance = Inferno::Models::TestingInstance.new
-    @testing_instance.resource_references << Inferno::Models::ResourceReference.new(
-      resource_type: 'Patient',
-      resource_id: @patient_id1
-    )
-    @testing_instance.save!
-  end
-
-  def test_patient_id_assignment
-    assert(@testing_instance.resource_references.length == 1)
-
-    @testing_instance.patient_id = @patient_id2
-
-    assert(@testing_instance.patient_id == @patient_id2)
-    assert(@testing_instance.resource_references.length == 1)
-    assert(@testing_instance.resource_references.first.resource_id == @patient_id2)
-  end
-
-  def test_patient_id_reassignment
-    resource_references = @testing_instance.resource_references
-    assert(resource_references.length == 1)
-
-    @testing_instance.patient_id = @patient_id1
-
-    assert(@testing_instance.resource_references == resource_references)
-  end
-end