Before we begin testing, let's quickly understand the healthcare industry.
The entire health care system is weaved with each other by the single body that is hospital or provider (doctor).
While the other entities include-
- Insurance company: Medicare, Medicaid, BCBS, etc.
- Patient/Consumers: Patient Enrolled
- Regulatory Authority: HIPAA, OASIS assessment, HCFA 1500 and UB92, etc.
- Health-care and Life-Science solution Vendors
Healthcare Business Process
Most health-care organization have adapted software program to process the smooth functioning of the system. This software system gives all the information in a single document for each entity dealing with this.
Interconnecting this whole system to a single web application is a huge task and making it work effectively is even a bigger task. Rigorous testing of this health application is compulsory, and it has to go through various testing phases.
In this tutorial, we will learn,
- Basic Terminology of Health Care System
- Testing of Providers system
- Testing of Broker System
- Testing of Member System
- Testing of Claims System
- Testing of Finance System
- Testing under regulatory compliance
- Performance testing of Healthcare Application
- Other Testing Types for Healthcare Application
- Testing Challenges in Healtcare Application
- Healthcare device Testing
- Useful tips for Healthcare Testing
- Provider: A health care professional (doctor), medical group, clinic, lab, hospital, etc. licensed by health care services
- Claim: A request to your health insurance company to pay a bill for health care service
- Broker: An insurance professional, who negotiates, procures insurance on behalf of insured or prospective insured
- Finance: Insurance bodies that pay for medical expenses, it could be government (Medicare or Medicaid) or commercial (BCBS)
- Medicare: A federal health insurance program for senior citizen and permanently disabled people
- Medicaid: A joint and state program that helps low-income families and individuals pay for the cost associated with medical care
- CPT code: A current procedural terminology code is a medical code set to describe medical, surgical and diagnostic services
- HIPAA: It is a set of rules and regulations which doctors, hospitals, healthcare providers and health plan must follow in order to provide their services
Sample Test Scenarios and Test cases for providers (doctor/hospital) system:
Sample Test Scenarios and Test cases for Broker System:
Positive Flow System Testing
Negative flow System Testing
Sample Test Scenarios and Test cases for Member (Patient) System:
|Test Scenario||Test Cases|
|2)||Positive Flow System Testing|
|3)||Negative flow System Testing|
|4)||System Integration Testing|
Sample Test Scenarios and Test cases for Claims System:
|2)||Positive Flow System Testing|
|3)||Negative Flow System Testing|
Sample Test Scenarios and Test cases for Finance System
|2)||Positive flow system testing|
|3)||Negative flow system testing|
Protecting patient sensitive data and health information is an utmost priority for health regulatory bodies. The testing should be done in compliance of such regulatory bodies.
Sample Test Scenarios and Test cases for Regulatory Compliance:
|5)||Sanity Testing related to regulatory body|
Before preparing test scenarios certain requirement of the system should be considered. For example, health-care providers (Doctors/Hospitals) provide care 24/7, so the patient check-in software needs to be available at all times. Also, it needs to communicate with insurance companies to validate policy information, send claims and receive remittances. Here, the architecture should define the different components of the system, the protocol to communicate with insurance companies, and how to deploy the system so that it complies 24/7.
As a tester, you need to ensure that the healthcare software system meets the desired load/performance benchmark.
- Functional Testing: Testing healthcare application against functional capabilities
- Conformance Testing: Conformance test Healthcare security requisites and industry frameworks
- Platform Testing: Testing of applications on Mobile platform and applications testing for cross-browser compatibility
- Interoperability Testing: Testing conformance to interoperability standards ( Eg; DICOM, HL7, CCD/CDA)
Testing challenges in testing healthcare application are no different than other web application testing.
- Requires expertise in testing, and usually it is high in cost
- Requires interoperability, compliance, regulatory, security, safety testing besides regular testing techniques (Non-Functional, Functional and Integration testing)
- Testing should be done keeping in mind the safety and regulatory standards- as any error can cause direct effect on patient's life
- Testing team needs to be well aware of the various functionalities, clinical usage, and the environment the software will be used for
- Health-care product should comply with various standards like FDA, ISO and CMMI before it can be used
- Cross dependency of software- testers need to ensure that any changes in one component or layer should not lead to side effect on the other.
While health-care device software is not the direct concern of patient, they also require a rigorous testing like other software testing. For example, X-ray machines that are controlled by software programs should be tested well because any testing error in software can lead to a serious effect on the patient.
FDA (Food and Drug Administration) has guidelines for mobile and web applications for medical devices. While testing medical devices the proper functional Test Plan along with pass and fail criteria is also the part of FDA guidelines. When test plan is executed, the results are collected and reported to FDA. This process ensures that the device meets the standard of the regulatory bodies.
While testing software, you can consider some important tips for the testing healthcare system.
- Dates are important and needs to be accurate
- While designing test cases consider various parameters like different types of plan, brokers, members, commission, etc.
- Complete knowledge of the domain is required