Managed Testing of HIE Software Integrated with Multiple EHRs

Customer

The Customer is a US company providing hospitals, pharmacies, and assisted living organizations with health information exchange (HIE) solutions.

Challenge

One of the Customer’s HIE solutions was under development. It comprised several modules, for example, a health monitoring, an electronic medication administration record (EMAR), and a risk management module.

The Customer needed to ensure the system’s high user adoption rate, so the software was to be fully functional, stable, and address special usability requirements. Another challenge was imposed by the system’s internal inter-module integration and external integration with multiple EHR systems, which had to be thoroughly checked.

The software was intended for both web and mobile use. The Customer needed a professional managed testing services provider experienced with both web and mobile application testing.

Thus, the provider should not only come up with optimal testing types’ prioritization, but also cover all the aspects specific to testing of each application type.

Solution

ScienceSoft’s QA manager examined the multi-level software requirements specification (including functionality, operational, architectural, user interface (UI), and performance requirements) and decided on the testing objectives, the scope, the test team composition, and the approximate testing schedule. The test plan included functionality, external integration, compatibility, performance, and usability testing as well as role-based access control validation.

To facilitate and speed up the testing process without compromising on test coverage, two dedicated ScienceSoft’s test engineers created comprehensive checklists to quickly carry out smoke and sanity tests for each new software build. Some of the smoke tests were automated for quicker build verification thus making time for further more complicated testing activities.

To cover the system’s vast functionality required by care coordinators, physicians, pharmacists, and patients, and not to miss out any software requirement, test engineers created 700 checklists for thorough functionality testing. For example, they validated such functions required by medical personnel as patients’ data, medication process, and health risks updates, the process of notification about urgent incidents and patients’ account changes. The testing of the functionality block for patients included checking such functions as setting doctor appointments, medications’ order, emergency calls, and private messages exchange with an assigned attending physician.

Then, the test engineers checked the data flow between the web and mobile applications under test and EHR systems utilized by medical personnel of hospitals and assisted living organizations during integration testing. Different EHR systems provided patients’ health records in multiple file formats, for example:

• Patients’ demographic data, diagnoses, allergies, family medical history, and immunizations as .adt or .xml files.
• Physicians’ notes as free text in .txt format.
• Medical images as .img, .hdr, and .dcm.

The test team outlined the number of data and file formats supported by some EHR systems that weren’t recognized by the Customer’s HIE system.

Compatibility testing was performed to check whether the web application was adequately functional in two target web browsers specified by the Customer, and whether the mobile application provided all the required functionality and its UI was properly rendered on Android and iOS devices of the relevant versions.

Performance testing of the web application implied the automated validation of the maximum number of its users, data transfer rate, and response time under continuous and stress load. And during performance testing of the mobile application, the test engineers focused more on its actual processing power, memory, and battery consumption compliance with minimal hardware requirements stated in the requirements specification.

After that, the test team proceeded to usability testing that was particularly relevant as consumers of healthcare services could experience specific hindrances while using software due to their physical condition and health issues. The test engineers validated such features’ compliance with the system’s usability requirements as:

• The readability of color scheme and contrasts, fonts, and pop-up explanatory messages.
• The clarity and understandability of the system’s navigation and its general structure.
• The logical arrangement of GUI elements.

As a part of usability testing, test engineers checked the process of filling out satisfaction surveys for patients. They identified the following stumbling block - it was impossible to retain a partially filled out survey and auto save it even when the most comprehensive surveys (about 50 A4 pages) were filled out. The test engineers stated their suggestions on usability improvement in a regular test execution report.

Finally, the test engineers carried out role-based access control validation for both web and mobile applications as it was vital to establish that only relevant users can access patients’ sensitive healthcare information.

Results

The Customer got their software thoroughly tested to ensure its smooth and sufficient functionality, proper integration with varied EHR systems, compatibility with required web browsers and versions of mobile OSs, and the system’s performance under continuous load and simultaneous utilization by multiple users. Also, the Customer got sure the applications’ UX would meet the demands of all user groups.

Technologies and Tools

Atlassian JIRA, Atlassian Confluence; Cucumber, Apache JMeter; iOS 5, 6,10, Android 6-8, Firefox, Google Chrome.