Healthcare Information Exchange Software Testing

Healthcare Information Exchange Software Testing AFour Technologies May 20, 2009 AFour Technologies 2009 1

Healthcare Background With increasing healthcare costs and looming Medicare bankruptcy, President George Bush issued an executive order for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care with the goal that most Americans will have an EHR by 2014. In July 2004 the United States Department of Health and Human Services released their vision of how America s healthcare system could be rebuilt during the next decade. That vision is in the process of maturing and the lead in this effort is the Office of the National Coordinator for Health Information Technology May 20, 2009 AFour Technologies 2009 2

RHIO / HIE Regional Health Information Organizations (RHIOs) are key to the US National Health Information Network (NHIN). [1] The Office for the National Coordinator has contracted with the National Alliance for Health Information Technology to lead workgroups of national experts in defining key terms including RHIO and to solicit public comments. The effort began in late 2007 and has submitted their final definition for public comment in May 2008 Definition of a RHIO - "A health information organization [HIO] that brings together health care stakeholders within a defined geographic area and governs health information exchange [HIE] among them for the purpose of improving health and care in that community. Health information exchange (HIE) is "The electronic movement of health-related information among organizations according to nationally recognized standards". The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care. HIEs also provide the infrastructure for secondary use of clinical data for purposes such as public health, clinical, biomedical, and consumer health informatics research as well as institution and provider quality assessment and improvement. May 20, 2009 AFour Technologies 2009 3

Key Terms EHR Electronic Health Record Comprises of HIE Systems and EMRs EMR Electronic Medical Record Patient information in the electronic formats Systems managing electronic medical records HL7 Health Level 7 Protocol High level protocol defined by hl7 organization (www.hl7.org) accredited by ANSI Identifies HIE standards MPI Master Person Index (Also referred as master patient index) Store Demographic Information of Patients Intelligent grouping of patient information from various EHRs Retrieval of patient information based on query parameters EMPI (Enterprise master person index) MPI is also referred as EMPI May 20, 2009 AFour Technologies 2009 4

Initiatives HIMSS (www.himss.org) Healthcare Information Management and System Society in collaboration with ANSI have come up with HITSP to achieve vision of implementation of interoperable electronic health records (EHR) by 2014 HITSP (www.hitsp.org) - Health Information Technology Standards Panel is formed with public and private industry collaboration and is active in coming up with standards related to HER (Electronic Records System) and HIE (Health Information Exchange Systems). HITSP implements standards of HL7 IHE (www.ihe.net) - IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical need in support of optimal patient care. Some key profiles from IHE are PIX, PDQ, XDS.b, CT, ATNA CCHIT (www.cchit.org) Center Commission for Health Information Technology is a non profit organization recognized by Department of Health and Human Services (HHS). CCHIT provides certifications for various modules of EHR. Yearly certification programs are offered by CCHIT. ARRA 2011 - is a preliminary certification for EHR by CCHIT and accredited by HHS (health and human services) May 20, 2009 AFour Technologies 2009 5

Initiatives HL7 (www.hl7.org) is an open forum who is accredited by ANSI. HL7 defines specifications for the Health Information Exchange (HIE) protocols. Latest version of 2.5.1 is recommended for implementation. DICOM - The DICOM 3.0 standard evolved from versions 1.0 (1985) and 2.0 (1988) of a standard developed by the American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA). This standard deals with the way binary data exchanged across systems (e.g. digital images) HITECH - On February 17, 2009 a $787 Billion, the American Recovery and Reinvestment Act of 2009 aka the Stimulus Bill, was signed into law by the federal government. Included in this law is $22 Billion and $19.2 Billion of that is intended to be used to increase the use of Electronic Health Records (EHR) by physicians and hospitals; this portion of the bill is called, the Health Information Technology for Economic and Clinical Health Act, or HITECH Act. The government firmly believes in the benefits of using electronic health records and is ready to invest federal resources to proliferate its use. Title XIII in Division A, pages 112 through 165 and Title IV in Division B, pages 353 through 398, cover the HITECH portion of this economic recovery act. May 20, 2009 AFour Technologies 2009 6

EHR Accreditations IHE Connectathon IHE (www.ihe.net) organization conducts yearly evaluation events (usually in the month of January / February) called Connectathon IHE proposes various HIE specifications and publishes the specifications based on feedback from open forum These specifications are called profiles (e.g.) Patient Information Cross Sharing (PIX) Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS.b) Audit Trail and Node Authentication (ATNA) Consistent Time (CT) CCHIT Certification CCHIT provides certification to EHR systems (e.g.) Comprehensive Certification - CCHIT Certified 2011 Preliminary Certification - Preliminary ARRA 2011 May 20, 2009 AFour Technologies 2009 7

Client Case Study HIE Testing The client is a start up organization with range of products catering to healthcare IT. Flagship product is a middleware application for HIE services. Head office and business center at Seattle USA and ODC at Bangalore India. Engineering team size is 30 with 22 Developers and 8 Test Engineers May 20, 2009 AFour Technologies 2009 8

Case Study HIE Testing Product The product provides following key services Connecting healthcare applications node (e.g. hospital systems, labs, PHRs) Storing demographic information of patients Allowing patients to view and update their demographic information Allowing patients to view and update their clinical information (e.g. problems, allergies, medications) Managing consents of information disclosure of patients Integration with various EMRs (using HL7 2.3.1 and 2.5 versions) Providing demographic information of patients upon requests to various EHRs Publishing updates to the patient information to all associated nodes Intelligent automated grouping of patients based on the demographic information Admin assisted grouping of patient information Integration with known systems such as Microsoft HealthVault Integration with Cerner Health Information System May 20, 2009 AFour Technologies 2009 9

Business Challenge Case Study HIE Testing Client is a start up organization QA activities were more subjective QA learnt product functionality after code complete with knowledge transfer from developers QA largely doing unit testing with very little test coverage No process to certify major releases No process to certify hot fixes No test automation process No performance testing process Product documentation not updated API documentation not frozen before API changes May 20, 2009 AFour Technologies 2009 10

Case Study HIE Testing Technologies Microsoft Windows based technologies Windows 2003 Server, Windows 2008 Server.Net 2.0 and 3.5 SQL Server 2005, 2008 ASP.Net Web Services SSL UI is mix of web and Windows forms. Test Tools Mantis, Testlink, SOAPUI May 20, 2009 AFour Technologies 2009 11

Case Study HIE Testing Proposed Solution Client approached AFour in order to help the client establish QA organization and testing processes Engagement is phased in multiple initiatives May 20, 2009 AFour Technologies 2009 12

Case Study HIE Testing Initiative 1 Pilot to address immediate quality issues Included test automation Included test strategy for consequent phases Initiative 2 IHE Compliance Testing Testing of PIX profile (Used Mesa Tools) Testing of PDQ profile (Used Mesa Tools) Testing of XDS.b profile (Used Mesa Tools) Testing of ATNA profile (This is taken out of mandatory IHE compliance) Testing of CT profile (This is verified with required configurations) Initiative 3 Managed test execution of a core product component Test Case Documentation Managed Test Case Execution Certified Test Release May 20, 2009 AFour Technologies 2009 13

Case Study HIE Testing Initiative 3 introduced Tools and Processes Introduced open source Defect Management System Mantis Introduced open source Test Management System Testlink Defined processes to manage defects and test cases Initiative 4 Managed test execution of entire product (all components) Test Case Documentation Managed Test Case Execution Certified Test Release May 20, 2009 AFour Technologies 2009 14

Case Study HIE Testing Initiative 5 Test Automation API Automation (Web Services Automation) UI Automation (using internal test automation tools / open source tools) Initiative 6 Performance Testing / Stress Testing Setup Performance Lab Identify Performance Goals Identify Performance Bottlenecks and verify fixes to the bottlenecks Publish Performance Benchmarks May 20, 2009 AFour Technologies 2009 15

Business Impact Case Study HIE Testing Reduced number of test cases to organized 3000 test cases from 10000 test cases Setup defined period of 3 weeks for one test pass execution against undefined test pass execution period (spanning for 6 weeks) Reduced number of post release issues to less than 10 times May 20, 2009 AFour Technologies 2009 16

Case Study HIE Testing Future Initiatives API Documentation, Security Testing, Product Documentation QA Organization Team works in the mixed mode. Team works at client premises and AFour premises Test lead from AFour heads the team Test lead reports to head of engineering / top management at USA. No reporting to engineering team at India COE from AFour premises provide solutions to the issues faced by QA team at client premises May 20, 2009 AFour Technologies 2009 17

Case Study HIE Testing Gains for AFour Team Used SOAP UI for functional and performance testing Worked on Web service testing Worked on functional, performance testing of middleware testing Mastered using MESA tools for IHE compliance testing of PIX, PDQ and XDS.b profiles Learnt about HL7 messages for various triggers such as ADT, ORM, ORU, PPR, PDQ, PIX, MDM, etc. Developed tools for HL7 version compatibility testing May 20, 2009 AFour Technologies 2009 18

Approach Organized QA with Multiple Initiatives Initiative 1 Defining Effective Regression Pass for the Product Initiative 2 Migration of Older Defect Management System to New System Initiative 3 Prepared QA Strategy for Next 6 Months Initiative 4 Proposed Changes in Engineering Processes to Isolate P.S. and Core Engineering Activities May 20, 2009 AFour Technologies 2009 19

Approach Organized QA with Multiple Initiatives Initiative 1 Defining Effective Regression Pass for the Product Initiative 2 Migration of Older Defect Management System to New System Initiative 3 Prepared QA Strategy for Next 6 Months Initiative 4 Proposed Changes in Engineering Processes to Isolate P.S. and Core Engineering Activities May 20, 2009 AFour Technologies 2009 20

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Thank You! May 20, 2009 AFour Technologies 2009 24