healthcare information exchange software testing...rhio / hie regional health information...
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May 20, 2009 AFour Technologies © 2009 1
Healthcare Information Exchange
Software Testing
AFour Technologies
May 20, 2009 AFour Technologies © 2009 2
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
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RHIO / HIERegional 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.
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Key TermsEHR – 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
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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)
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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.
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EHR AccreditationsIHE 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
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Case Study – HIE Testing
Client
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
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Case Study – HIE TestingProduct – 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
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Case Study – HIE Testing
Business Challenge
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
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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
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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
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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 TestingTesting 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
componentTest Case Documentation
Managed Test Case Execution
Certified Test Release
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Case Study – HIE Testing
Initiative 3 – introduced Tools and ProcessesIntroduced 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
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Case Study – HIE Testing
Initiative 5 – Test AutomationAPI Automation (Web Services Automation)
UI Automation (using internal test automation tools / open source tools)
Initiative 6 – Performance Testing / Stress TestingSetup Performance Lab
Identify Performance Goals
Identify Performance Bottlenecks and verify fixes to the bottlenecks
Publish Performance Benchmarks
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Case Study – HIE Testing
Business ImpactReduced 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
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Case Study – HIE TestingFuture 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
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Case Study – HIE Testing
Gains for AFour TeamUsed 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
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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
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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
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Thank You!