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.
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.
Basic Terminology of Health
Care System
·
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
Testing of Providers system
Sample Test Scenarios and
Test cases for providers (doctor/hospital) system:
Test Scenario
|
Test Cases
|
1.
Access to providers system
|
·
Provider system should let us enter,
edit and save provider's data
|
2.
Positive flow system testing
|
·
It includes scenarios to enter
different types of provider, change providers details, save and inquire them
|
3.
Negative flow system testing
|
·
Allows to save a provider information
with incomplete data, contract's effective date, entering details about
existing providers in the system
|
4.
System integration testing
|
·
Validate the feed to members system,
finance system, claim system, and provider portal. Also, validate if the changes
from provider portal are entered into the respective provider's record
|
5.
Positive flow providers portal
testing
|
·
Login and view providers details,
claim status, and member details
·
Make change request to change the
name, address, phone number, etc.
|
6.
Negative flow providers portal
testing
|
·
View the member details with an
invalid ID
·
Login with invalid credentials
|
7.
Positive flow Broker portal testing
|
·
Login and view details about broker
and commission payment
·
Make request to change the name,
address, phone number, etc.
|
8.
Negative flow Broker portal testing
|
·
It should include scenarios to login
with invalid credentials
|
Testing of Broker System
Sample Test Scenarios and
Test cases for Broker System:
Sr#
|
Test Scenario
|
Test Cases
|
1)
|
Broker
System
|
·
It should be capable of edit, enter
and save broker data
·
Broker commission calculation based
on the premium payment details from member system
|
2)
|
Positive
Flow System Testing
|
·
Enter, save and edit brokers record
for different types of broker
·
For active brokers calculate the
commission by creating feed file with the respective record for members with
different plan
|
3)
|
Negative
flow System Testing
|
·
Enter a broker record with incomplete
data and save for different types of broker
·
By creating the feed file with the respective
record for members with different plan calculate the commission for the
terminated broker
·
By creating the feed file with the
respective record for members with different plan calculate the commission
for the invalid broker
|
4)
|
System
Testing
|
·
To downstream system such as finance
system, broker portal and member system validate the feeds
·
Validate if the changes from broker
portal are incorporated in the respective broker record
|
Testing of Member System
Sample Test Scenarios and
Test cases for Member (Patient) System:
Sr#
|
Test Scenario
|
Test Cases
|
1)
|
Member system
|
·
Enroll, reinstate and terminate a
member
·
Remove and add a dependent
·
Generate premium bill
·
Process premium payments
|
2)
|
Positive Flow System Testing
|
·
With current, past and future effective
dates enroll different types of members
·
Inquire and change members
·
Produce premium bill for an active
member for following month
·
Terminate an active member with past,
current and future termination dates greater than effective date
·
Re-enroll a terminated member with
current, past and future effective dates
·
Reinstate a terminated number
|
3)
|
Negative flow system testing
|
·
With insufficient data enroll a
member
·
For a terminated member produce a
premium bill for following month
|
4)
|
System Integration Testing
|
·
Validate the feed to downstream
systems such as provider portal, broker portal, finance system and claim
system
·
Validate if the alterations from
member portal are incorporated in the respective member record
·
Process the payment of premium bill
generated with feed from members portal that has details of payment made
|
Testing of Claims System
Sample Test Scenarios and
Test cases for Claims System:
Sr#
|
Test Scenarios
|
Test Cases
|
1)
|
Claim System
|
·
Claims in health-care should edit,
enter and process claims for member as well as dependent
·
For invalid claims, it should throw
errors when incorrect data is entered
|
2)
|
Positive Flow System Testing
|
·
It should include the scenario to
edit, enter and process claims for member as well as dependent
|
3)
|
Negative Flow System Testing
|
·
It should validate and enter a claim
with invalid procedure code and diagnosis code
·
Validate and enter a claim with
inactive provider ID
·
Validate and enter a claim with
terminated member
|
4)
|
System Integration
|
·
It should include scenario to
validate the feed to downstream systems such as provider and finance portal
|
Testing of Finance System
Sample Test Scenarios and
Test cases for Finance System
Sr#
|
Test Scenarios
|
Test Cases
|
1)
|
Finance System
|
·
Enroll, reinstate and terminate a
member
|
2)
|
Positive flow system testing
|
·
It should check whether correct
account number or address is chosen for the respective member, provider or
broker for the payment
|
3)
|
Negative flow system testing
|
·
Verify whether payment is done for
invalid member, provider or broker ID by creating respective record in the
feed
·
Verify whether payment is done for
invalid amount for the member, provider or broker by creating respective
records in the feed
|
Testing for regulatory
compliance
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:
Sr#
|
Test Scenarios
|
Test Cases
|
1)
|
User's Authentication
|
·
Using verification method to ensure
that correct users get login and deny to others
|
2)
|
Information Disclosure
|
·
Authorizing access to information is
based on user's role and patient limitation
|
3)
|
Data Transfer
|
·
At all transfer points ensure that
data is encrypted
|
4)
|
Audit Trail
|
·
All transactions and all attempts to
access data with a proper set of audit trail information are recorded
|
5)
|
Sanity Testing related to regulatory
body
|
·
Perform sanity testing and verify the
encryption of the data is done in particular areas like EPHI ( Electronic
Protected Health Information)
|
Performance testing of
Healthcare Application
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.
Other Testing Types for
Healthcare Application
·
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
Healthcare Application
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.
Healthcare device Testing
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.
Useful tips for Healthcare
Testing
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.
