evolve or die: healthcare it testing | qasymphony webinar

Evolve or Die:Healthcare IT Testing

August 30th, 2016

Michael Cooper – Healthcare IT LeadersKevin Dunne - QASymphony

Join the conversation – use the hashtag #HITTesting on Twitter

Guest Speaker: Michael Cooper, Chief Quality Officer• Mike Cooper is an acknowledged global thought leader in QA and

Testing, Michael does QA and Testing Consulting and Advisory work at leading corporations worldwide. Michael was previously the software QA and Testing evangelist for HP Software. Prior to that, he was Sr. Director for IT Quality Assurance at T-Mobile USA, where he led a group of 500+ QAT professionals. He holds an MBA from Georgia State University and a BA from the University of Florida.

OUR PRESENTERS

https://www.linkedin.com/in/qacooper

@QACooper


Guest Speaker: Kevin Dunne, VP Strategy and Business Development• Kevin Dunne is the VP of Strategy and Business Development at

QASymphony, ensuring their continued commitment to innovation and delivering tools to create better software. With a deep interest in the emerging trends in software development and testing, Kevin is dedicated to collaborating with thought leaders in this space. Kevin comes to QASymphony from Deloitte, where he managed testing on large government and Fortune 500 engagements.



• The Big Picture• Modernization of Technology across Healthcare IT Value Chain• Evolving role of Healthcare Testing

– Modern Healthcare Testing Techniques• Security, Compliance and Government Regulatory Mandates • Real world applications and examples• Importance of interoperability• Q&A

AGENDA


THE BIG PICTURE


HEALTHCARE IT VALUE CHAIN


KEY DRIVERS FOR CHANGE

• Upgrades & new releases

• Maintenance• Integrations• Mobility• Cloud and SaaS

Technology

• Revenue / Cost initiatives

• Quality initiatives• Changes in

business process• M & A activity• External business

relationships

Business

• State and Federal • International • Industry standards

and practices• Compliance and

audits• Penalties and

remediation

Regulatory


EVOLVING HEALTHCARE TECHNOLOGY TO TEST


Good Quality (the cost you see)QA & Test Best PracticesInternal & External Test Resources

Poor Quality (hidden costs)Data / Security BreachesUnder Billing or Improper BillingGovernment Fines & PenaltiesPatient DissatisfactionCustomer Churn or LossSuboptimal Business OutcomesLitigationProvider DissatisfactionHarm to BrandSoftware Fix/Issue Remediation…and more!

Total Cost of Quality

Poor Quality80% of true cost

QA and Testing Impact• Failure to achieve compliance can result in

millions of dollars of impact• Requires testing of several systems

resulting in a spike in testing needs• Must test any system which stores,

processes, sends, receives, or reports diagnosis code information.

Guidance• Good opportunity to document key end-

to- end business process test cases• Test automation

COMPLIANCE TESTING


QA and Testing Impact• Agile teams often have limited

documentation• The role of the tester is often unclear on

Agile projects• Agile sprints have short time lines 2-4

weeksGuidance• Testers should be considered a part of the

Scrum/Sprint Team• Testing tasks should be reflected in the

backlog• Agile/Scrum training is recommended• Automation and performance testing are

essential in Agile projects

AGILE DEVELOPMENT AND TESTING

46% of organizations are using Agile development methodologiesSource: Forrester Research


• Moving towards Agile Testing (TDD/ATDD/BDD) also demand a more complete testing strategy focused on more than just UI testing:

BUILDING A COMPLETE TESTING STRATEGY

UI Tests

Integration Tests

Unit

Tests

UI Tests

Integration Tests

Unit Tests


EXPLORATORY TESTING – PROS & CONS

-Reduce time spent writing tests-Find new bugs by testing new paths-Increase speed of execution-Increase tester morale & engagement

-Increased level of skill required-Risk of failing to test a critical path-Potential increase in test plan scope-Risk of backfilling if last tester leaves


SESSION BASED TEST MANAGEMENT

Introducing exploratory testing within a framework will greatly increase the odds of success, and will reduce fear and uncertainty among the practitioners as well as executives.

Session Based Test Management is a popular framework for this, as it tracks all the important data on testing:

More info on SBTM: http://www.satisfice.com/articles/sbtm.pdf

• Session charter (includes a mission statement, and areas to be tested)

• Testers involved Date and time executed• Task breakdown• Data files• Test notes• Issues • Bugs


http://www.satisfice.com/articles/sbtm.pdf

http://www.satisfice.com/articles/sbtm.pdf

A HYBRID APPROACH

ExploratoryManual ScriptedAutomated

Charge TestingEnrollmentData SetupRegressionSmoke Testing

Critical Path ScenariosSecurity

UsabilityNew Feature TestingUser Acceptance TestingRole Based Testing

Integration API Testing


QA and Testing Impact• QA teams have new apps to test• Data migration, Big Data testing projects

require specialized skills

Guidance• Consider parallel system testing during

migration• Test role-based work-flows in production• Performance testing from the cloud• Consider service virtualization for SaaS

testing of third party services

CLOUD, SAAS AND BIG DATA

By 2018, 80% of healthcare data will pass through the cloud at some point in its lifetime, as providers seek to leverage cloud …for data collection, aggregation, analytics and decision-makingSource: IDC


LEADING EHR’S SUPPORT THE CLOUD

Company System Cloud Hosting?

1 Cerner Corporation Cerner PowerChart Ambulatory EHR Yes

2 Epic Systems Corporation EpicCare Ambulatory - Core EMR Yes

3 Allscripts Allscripts Professional™ EHR" Yes

4 NextGen Healthcare Information Systems Inc*

NextGen Ambulatory EHR Yes

5 athenahealth athenaClinicals Yes

*As of 2013 http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/top100ehrs/top-100-ehr-companies-part-1-4


http://www.cerner.com/solutions/cerner_services/hosting_services/

http://www.epic.com/Services

http://www.allscripts.com/market-solutions/physician-community-practices/services

https://www.nextgen.com/Managed-Cloud-Services




http://www.athenahealth.com/knowledge-hub/ehr/cloud-based

OTHER TOOLS AVAILABLE IN THE CLOUD

Tool Category Value Representative Vendors

Test Case ManagementCentralize and store test cases, report on test progress and coverage

qTest

Collaboration Centralize requirements and planning documents Confluence

Communication Chat and share relevant issues with teams in real time HipChat, Slack

Test Environment Leverage cloud resources to build test environments AWS, SauceLabs

Test Data Management Define, Subset, and Mask data from production for testing Informatica, Delphix

Defect ManagementSubmit, monitor, and track defects and issues found in test & production systems

JIRA, ServiceNow


QA and Testing Impact• Application level security is an aspect

of quality• Cross-site scripting and sql-injection are

common hacker techniques

Guidance• Explore test automation tools available

to identify security vulnerabilities• Be aware of false positives• Focus on the OWASP Top 10

SECURITY TESTING

By 2015, 50% of healthcare organizations will have experienced 1 to 5 cyberattacks in the last 12 months with 1 out of 3 attacks deemed successful Source: IDC


https://www.owasp.org/index.php/OWASP_Top_Ten_Cheat_Sheet

THE GREAT PII DEBATE

Source: https://www.healthit.gov/policy-researchers-implementers/faqs/what-information-will-be-sent-providers-test-ehr


QA and Testing Impact• Testers with specialist skills are can be difficult

to find• Specialist may come at premium rates

Guidance• Provider your organizations hiring managers

with specific screening criteria• Benchmark specialist salaries and, talent-wise,

be wary of the low end • Some specialties will require training and/or

certification (e.g. Epic)

TEST SPECIALIZATION

In 2015, new development projects will exceed maintenance projects. Testing for new development (including SMAC) requires specialist skills.Source: 2014-15 World Quality Report -Capgemini, HP, Sogeti


• Mix of Certified Epic Professionals and experience HIT Testers

• 1460+ Epic Test Cases– 8-10 test steps on average across multiple modules

• Epic Modules: ADT, ADT Prelude, Ambulatory, Anesthesia, Aria, ASAP (ED), Cadence, Clarity Reports, ClinDoc, Cupid, Dietary, Downstream Interfaces, HIM, Home Health Clinical, Home Health Hospice, Home Health Billing, Hospital Billing Claims, Interfaces, iSite, Lab, My Chart, Optime, Orders, Physical Outpatient Thera, PowerScribe, Professional Billing, Professional Billing Claims, Radiant, Stork, Willow Inpatient, Willow Ambulatory

• 120+ other applications to be tested including such: as Apache Outcomes, Aria, Cloverleaf, Health Touch, Midas, eScription,Nurse Call, Patient Call Manager, Perinatal, ResponderNet, SMS, Teletracking, RALS, Softlab, Pyxis, Perinatal….

EXAMPLE: EHR TESTING ENGAGEMENT


INTEROPERABILITY STILL BELOW 50%

Source: http://dashboard.healthit.gov/evaluations/faca/HITJC_%20Data_Update_on_Interoperability_2016-07-27.pdf


MANY EXTERNAL BARRIERS TO ADOPTION

Source: http://avalere-health-production.s3.amazonaws.com/uploads/1460384367_201604_Pew.jpg


INTEROPERABILITY WILL RULE…SOON

Source: https://pbs.twimg.com/media/CZ0fozGWQAA_rcT.png


HEAT MAP – SAMPLE PAYER CLIENT ASSESSMENT


QA and Testing Impact• May need to test Multiple Device/OS

combinations (IOS, Android, Windows)• Performance may vary depending on

network conditions (3G, 4G, LTE)

Guidance• Testing with emulators is insufficient

consider using real devices on a private or public mobile device cloud

• Don’t forget about performance testing• Use of network virtualization and

service virtualization can improve accuracy of testing

MOBILE TESTING

By 2015, mobile app projects will outnumber PC projects 4 to 1 Source: Gartner

65% of consumer transactions with healthcare organizations will be mobile by 2018Source: IDC


• Leverage Healthcare domain expertise in Testing• Meet critical regulatory requirements• Improve application quality and usability• Reduce security risks• Capitalize on macro trends around healthcare technology

(i.e. big data, mobile, interoperability, agile)• Troubleshoot and remediate business, functional and

performance defects

SUMMARY BENEFITS


Robust test management platform purpose-built to help agile teams centralize, organize and accelerate software testing

ABOUT QASYMPHONY

• Clients include large health systems, hospitals, payers and life sciences companies, including Scripps Health, Catholic Health Initiatives, Philips Health, Excellus BCBS and Shire

• Offer staffing and advisory QA and Testing solutions.• Deep database of certified QA Analysts, software

testers, test automation specialists, performance and load testers with EMR and healthcare-specific test experience

• Fastest-growing IT staffing company in U.S.*• Learn more at www.healthcareitleaders.com

ABOUT HEALTHCARE IT LEADERS

* 2016 Staffing Industry Analysts, Fastest Growing Staffing Companies


http://www.healthcareitleaders.com/

Thank you
