Five Effective Testing Practices to Assure Meaningful Use of Electronic Health Records

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1 Poit of View Five Effective Testig Practices to Assure Meaigful of Electroic Health Records Abstract Meaigful ' has bee the buzzword i the US healthcare commuity as every care provider is gearig up for its successful implemetatio. To demostrate Meaigful, a Electroic Health Record (EHR) eeds to be vetted with effective quality assurace practices. With the adoptio of EHRs, the federal govermet iteds to develop a robust health iformatio techology (IT) ifrastructure that ca address emergig medical eeds. This paper provides a detailed implemetatio process of EHRs, ad describes the role of testig i certifyig the EHR for Meaigful. Itroductio Health service providers i the US have bee strugglig with risig costs of care while tryig to improve service quality ad accessibility. I 2009, the US Federal Govermet implemeted the Health Iformatio Techology for Ecoomic ad Cliical Health (HITECH) Act to revive the health ecoomy. Uder this Act, legislators allotted $20 billio of the total $787 billio budget to the America Recovery ad Reivestmet Act (ARRA) to improve health IT ifrastructure ad esure Meaigful. The govermet believed this iitiative would cotrol escalatig costs of healthcare, miimize waste, ehace quality of care, ad improve the overall health outcomes. With this iitiative they also hoped to reduce the healthcare costs to the federal govermet by a estimated $12 billio over 10 years. However, idividual doctors, cliicias, ad hospitals would oly receive the bous dollars icetive if they demostrated a Meaigful of EHRs. What is Meaigful? 'Meaigful ' refers to the deploymet of EHRs, as per the guidelies established by the Federal Govermet, withi a healthcare orgaizatio. The successful certificatio of Meaigful decides whether a orgaizatio is eligible for fiacial icetives either from the Medicare or the Medicaid EHR Icetive Program. The efficiet utilizatio of EHRs is moitored through stadards for Meaigful set by the Ceters for Medicare ad Medicaid Services (CMS). CMS has laid out a three-stage pla for providers to comply with Meaigful criteria by A reward ad pealty mechaism that recogizes compliace ad timeliess while pealizig defaulters will also be eabled. Some of the commo goals, which the providers must esure for a compliat EHR are: Structure the data to efficietly capture a patiet's cliical data Esure cliical data ca be shared electroically Esure predictive aalytics for accurate decisio makig Steps to Achieve Meaigful : A Testig Perspective Physicias eed to take greater resposibility ad esure that the EHRs are upgraded, so that iformatio maagemet ca drastically improve the quality of care. Followig are some of the steps that ca be take to achieve Meaigful :

2 Momet of Ivolvemet of QA Team Certify for Meaigful Steps for achievig Meaigful Creatio of Test Pla Eterprise Roll Out Beta Testig Ivolvemet of the QA Team: The QA resources must be ivolved early i the systems developmet life cycle (SDLC) phase, i order to uderstad the chages that are required for the existig EHR. They eed to aalyze the gap, alog with the product vedor ad subject matter experts (SMEs), to fialize the testable requiremets. Durig the requiremet's freezig phase, they must esure the modificatio of the EHR to allow easy ad secured access for all ed users (icludig patiets). These cosideratios will also be icluded as a part of the Test Strategy. I additio it is imperative to documet ad verify these requiremets throughout the up gradatio. Creatio of the Test Pla: Oce the requiremets are fialized, the QA resources must create a well-laid out Test Pla. This will ecompass both i ad out-of-scope services, QA implemetatio strategy, patiet usage simplificatio mechaism, assumptios ad exit criteria. The Test Pla should be drafted based o the uderstadig of the chages that are beig impacted ad to desig test cases accurately for detectig defects. This should also clearly state the data migratio eeds ad the right test strategies (either a big-bag migratio, or a staged migratio) to be deployed. A clear cotigecy pla should also be embedded as a part of this Test Pla, to avoid ay mishaps durig the implemetatio process. A accurate effort will be calculated to determie the duratio of the testig activities ad to arrive at the headcout required for accomplishig the testig tasks. Beta Testig: The testers ad developers must work i collaboratio to provide a tailored EHR system. By pursuig a commo objective ad beig spurred o by domai kowledge, they ca fulfill the objectives of Meaigful. Oce the EHR is ready, with all the ecessary chages, it must be released o a smaller scale for a short period of time to check for defects. The daily tasks ad duties, completio time of the work, ad a few model patiet visit etries should be aalyzed ad documeted. Eterprise Roll Out: The results obtaied from the Beta testig stage must be carefully aalyzed, ad the deviatios should be oted. The reasos for these deviatios should be aalyzed to prepare a proper mitigatio strategy that alleviates the problem. The EHR should be suitably modified before beig released to the eterprise-level audiece. Oce the customized EHR is implemeted, a traiig pla should be created to educate the cliical staff practice with real patiet data. This traiig will familiarize the cliical staff with the upgraded EHR ad help to avoid cofusio due to chages i the workflow. Certify for Meaigful : The testers must esure that the modified EHR is both free of errors ad thoroughly compliat. If the provider is able to demostrate Meaigful, the CMS is expected to make paymets withi six weeks of successful attestatio. There eeds to be more emphasis o cotiuous evaluatio of the upgraded EHR to improve utility ad esure sustaiability of the healthcare system 2

3 Testig ad Meaigful : A Smart Way to Esure Compliace It is critical to test the modified EHR to esure Meaigful compliace. Verifyig ad validatig the chages ad demostratig the appropriate usage depeds primarily o testig (ad more testig). Right Testig Resources Right Sized Testig Testig for Meaigful Kowledge Maagemet Right Testig Approach Improvemets through Adaptive Assurace Figure 2. Testig for Meaigful Some of the testig best practices which ca assure Meaigful of a EHR system are as follows: 1) Experieced testig resources: Appropriately skilled testig resources who possess domai kowledge ad a thorough uderstadig of the workflow withi the tailored EHR should be deployed. These testig experts ca detect defects ad documet them for future referece. 2) Idetificatio of right-sized testig for EHR Meaigful : There ca be may ew modules i the customized EHR that eed to be tested i a orgaized maer ad sequeced for effectiveess. A qualified tester esures that sufficiet testig is carried out across the system. Give below are the testig types which are expected to be performed for a EHR Upgrade testig. Iteral Readiess Testig verifies whether a idividual system module (for example, patiet admissio, patiet iformatio updates, provider referral, ad medical writig) is workig efficietly. Cofirmatio Testig verifies the completeess of busiess process flows betwee the EHR system ad exteral systems to esure if they are workig as expected. The focus of this testig is to check whether the EHR system (as a seder) is able to trasmit the HL7 message to the exteral systems appropriately ad vice versa. A fial ed-to-ed testig should be doe coverig the busiess flow, icludig all iteral ad exteral systems, to esure that the EHR is ready for Meaigful. This will also iclude the Data Migratio testig as well. If the iterfaces are ot ready the Stub Testig ca be doe. Usability Tests ca also be coducted to esure there is o visual clutter ad complex scree flows. 3) Right testig approach: To pla, execute, ad certify the various types of testig required for esurig Meaigful compliace, a defied Etry-Task-Validatio-Exit (ETVX) model with striget quality gates ca be eforced. This ETVX model evisages co-ordiatio ad cotrol betwee various stakeholders across all the phases i a testig process, amely, Busiess, Developmet Teams ad the Testig Team. The first step of this testig exercise is to develop a test pla which details the ecessary etry-exit criteria with complete traceability to the requiremets. The test desig, executio ad sig off must be exercised as per the test pla documet ad ay deviatios are to be oted after each release. A separate ad a dedicated test eviromet must be made available durig subsequet releases ad must be maitaied accordigly. 3

4 4) Kowledge maagemet: A kowledge base of all that has bee doe durig this upgrade exercise, icludig the applicatio documetatio, test case repository, impacted workflow defiitios to traiig kits should be created. This will help i maitaiig the EHR for sustaied periods of time ad could be hady if traiig eeds to be imparted to ew associates i the future. Additioally, a separate 'kow-error database' ca be created to idetify the 'Hot Spots' for a IT applicatio (defects that ca arise) ad to take appropriate steps to address the future testig scearios. 5) Cotiuous improvemets through adaptive assurace: Feedback ca be take from the go-live to esure ay errors which creep up i real time be avoided i the immediate release. This could iclude performig a root-cause aalysis of the productio icidets ad itroducig a revised test pla, test data, ad test case to elimiate the errors which occur durig productio. Coclusio Successful implemetatio of a EHR through Meaigful is possible oly whe physicias alog with the right set of test professioals are completely committed to the task. Although several issues might creep up durig the trasitio to the modified EHR system, a successful trasitio is possible if it ecompasses the right set of people, processes, goverace, ad techology. Oly the will the healthcare idustry experiece a major trasformatio, with EHR becomig the medium for trasmittig medical iformatio for all curret ad future use. With the successful implemetatio of EHR, through effective QA practices, the healthcare providers ca cotribute to revolutioizig healthcare services through affordable care, lower rates of error, greater admiistrative efficiecies, ad improved accessibility. About the Author Deepak Subramaia Deepak has bee workig with Tata Cosultacy Services (TCS) sice 2011 i the Assurace Healthcare Uit, providig a umber of Quality Assurace (QA) solutios for customers. He has also bee istrumetal i wiig large deals for the Assurace Healthcare Services, wiig ew logos ad creatig domai offerigs. 4

5 About TCS' Assurace Services Uit With oe of the most comprehesive portfolios of idepedet test capabilities o offer, TCS addresses both busiess ad quality challeges for its global cliets. We empower orgaizatios across domais to optimize overheads, realize first mover advatage ad improve customer satisfactio. TCS offers assurace services across the testig value cycle, icludig test cosultig ad advisory, test services implemetatio, ad maaged services for test eviromet ad test data maagemet. We cotiually redefie testig ad QA paradigms to help our cliets stay ahead of the curve. Our library of domai-based reusable busiess fuctios ad prove egagemet model fouded o the twi pillars of product ad process quality eable us to deliver certaity to our cliets. Over 27,000 testig cosultats, strategic alliaces ad parterships with key product vedors, more tha 65 dedicated test ceters of excellece ad our iovatio labs power our tailormade solutios, testig assets ad accelerators. With specialized test eviromets ad labs, TCS drives the delivery of assurace i a o-disruptive, agile, ad automated maer, makig the etire developmet lifecycle more efficiet. Cotact For more iformatio about TCS Assurace Services Uit, visit: About Tata Cosultacy Services Ltd (TCS) Tata Cosultacy Services is a IT services, cosultig ad busiess solutios orgaizatio that delivers real results to global busiess, esurig a level of certaity o other firm ca match. TCS offers a cosultig-led, itegrated portfolio of IT ad IT-eabled ifrastructure, egieerig TM ad assurace services. This is delivered through its uique Global Network Delivery Model, recogized as the bechmark of excellece i software developmet. A part of the Tata Group, Idia s largest idustrial coglomerate, TCS has a global footprit ad is listed o the Natioal Stock Exchage ad Bombay Stock Exchage i Idia. For more iformatio, visit us at IT Services Busiess Solutios Cosultig All cotet / iformatio preset here is the exclusive property of Tata Cosultacy Services Limited (TCS). The cotet / iformatio cotaied here is correct at the time of publishig. No material from here may be copied, modified, reproduced, republished, uploaded, trasmitted, posted or distributed i ay form without prior writte permissio from TCS. Uauthorized use of the cotet / iformatio appearig here may violate copyright, trademark ad other applicable laws, ad could result i crimial or civil pealties. Copyright 2014 Tata Cosultacy Services Limited TCS Desig Services I M I 12 I 14

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