Healthcare Software Testing

Healthcare Software Testing AFour Technologies Pvt. Ltd. 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 EMR Testing The client is a start up organization with range of products catering to healthcare IT. Flagship product is an ambulatory EMR application Client has base at USA and ODC at Nasik India. Engineering team size is 50 with 40 Developers and 10 Test Engineers May 20, 2009 AFour Technologies 2009 8

Case Study EMR Testing Product The product in this case is Ambulatory EMR. Product provides following key services Patient Registration Patient Check-in / Check-out Appointment Management Manage Encounters Problems, Allergies, Medication (ICD-9, CPT codes integration) Integration with other EMRs and HIEs (through HL7 2.5 protocol) Integration with Surescripts Faxing of medical summary document Scanning of medical summary document ACL (Access Control List) May 20, 2009 AFour Technologies 2009 9

Case Study EMR Testing Technologies Client uses Microsoft technologies Windows XP, Vista, Windows 7 Windows Server 2003, Windows Server 2008.Net 2.0 SQL Server 2005, SQL Server 2008 ASP.Net Web Services.Net Windows Forms Visual Studio 2005 Test Tools Bugzilla, QTP 10.0 May 20, 2009 AFour Technologies 2009 10

Case Study EMR Testing Business Challenge Rapid growth in the client base, resulted in more enhancements Product has many third party components. Random upgrades of the components raise compatibility issues Client had unorganized QA processes Ineffective use of defect management tools Lack of managed test management No test automation processes Lack of planned and certified release May 20, 2009 AFour Technologies 2009 11

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

Case Study EMR Testing Initiative 1 Establish Test Design Process Established Process for Test Design activities Ensured good coverage and prioritization for the product features Included test strategy for consequent phases Initiative 2 Establish Defect Management Process Earlier, issues of the products were reported separately by different groups (e.g. operations, Dev and QA) on different systems (e.g. Salesforce.com, Bugzilla and in house task tracking system) Identified Bugzilla as a single tracking system of defects engineering team (delivery team) and established process of mapping operations defects to Bugzilla. This process provided one stop report to entire organization of the product quality health. The process also removed subjectivity of product release call. May 20, 2009 AFour Technologies 2009 13

Case Study EMR Testing Initiative 3 Establish Test Management Process Test Case Documentation Managed Test Case Execution Certified Test Release (based on statistical reports) Initiative 4 Test Planning Pushed for managed test life cycle for the releases Test planning identified objective of release, scope of release, test coverage, test schedule, risks It compelled managed release cycle for engineering team Proactive notifications for schedule variance and effort variance removed last minute surprises to operations team and sales team Initiative 5 Test Automation Helped client in identifying test automation tool Evaluated multiple tools (RFT, QTP) and chose QTP as test automation tool Developed test automation framework Automated regression test suit for core product test cases May 20, 2009 AFour Technologies 2009 14

Case Study EMR Testing Initiative 6 CCHIT Compliance Understood scope of CCHIT Compliance Assisted client in CCHIT Compliance Testing Chose CCHIT 2009 Certification for Ambulatory EMR for certification Completed part testing according to CCHIT 2009 standards CCHIT 2009 internal certification activity was halted due to announcement of new certifications (CCHIT 2011 Comprehensive and ARRA 2011 Preliminary) Awaiting scope of CCHIT certifications to be finalized to reconvene the internal certification activity May 20, 2009 AFour Technologies 2009 15

Business Impact Case Study EMR Testing Provided planned and certified release for business team to plan demos and presentation schedule Reduced number of post release defects to less than 10 times Automated core business cases and reduced time of core test execution to less than 8 times May 20, 2009 AFour Technologies 2009 16

Case Study EMR Testing Future Initiatives Automation of more test cases Migration to TFS Performance Testing Periodic Internal Certifications QA Organization Team works in the mixed mode. Team works at client premises Test lead from AFour heads the team Test lead reports to head of engineering. 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 EMR Testing Gains for AFour Team Participated in CCHIT precertification testing for 2009 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