The last few years have been quite transformative for the healthcare industry. Medical diagnosis and patient records, which were once maintained on paper, have shifted almost entirely to the digital realm.
The software systems manage end-to-end patient journeys, starting from collecting health records and appointments with professionals to monitoring health conditions, recovery, and patient discharge.
Naturally, a system that manages such critical information must be tested thoroughly. Even a minor flaw, like a mismatched patient data or delayed test results, can lead to misdiagnosis and compromise patient safety.
This blog guides you through the entire process of healthcare domain testing, including its challenges, solutions, and the best practices to follow. Let’s get started.
What Is Healthcare Domain Testing?
Healthcare domain testing is the process of assessing healthcare software systems such as patient apps, clinical devices, and electronic health records (EHRs) to verify if they’re functioning correctly.
What this means is, these systems must be able to maintain accurate patient data and meet legal and safety standards. The aim here is to check the different aspects like functionality, data management, billing processes, and security to ensure the software is reliable and capable of enhancing patient care.
Since these software systems handle critical health information, understanding the healthcare workflows and regulations is essential before you start testing.
Healthcare Business Entities and Process
Healthcare systems work in a structured manner involving multiple entities. Let’s take a look.
1. Healthcare Domain Entities
Domain entities are the main units that engage with one another in a complex network. They are:
a. Providers
They are institutions or professionals who offer healthcare services; entities in this category include hospitals, doctors, nurses, and labs
b. Patients
Individuals who receive healthcare services
c. Payers
Health insurance providers and government programs that finance healthcare services
d. Brokers
Intermediaries between patients and payers: they could be licensed professionals who assist patients with claims or renewals
Healthcare Business Process
A business process is the entire healthcare workflow involving multiple steps to ensure quality health services:
a. Patient application
This is the step where data is generated. A patient submits the personal details, health records, and insurance information through apps, portals, websites, or physical forms.
b. Patient registration
Patient details are collected and registered in the healthcare system to create a medical record.
c. Scheduling appointment
Scheduling systems check availability of providers and schedule appointments with the patient as per their preference.
d. Treatment delivery
The patient receives treatment as required, and every action that takes place during treatment delivery is recorded in the healthcare systems.
e. Claims and billing
During the billing process, the provider creates invoices, generates claims, and submits them to the insurance payer.
Why Is Healthcare Domain Testing Important?
Software systems in the healthcare domain are considered life-critical because they directly or indirectly handle multiple aspects of patient safety.
Consider the example of a blood pressure monitoring system. If the system incorrectly shows that a patient has high blood pressure, the doctor might prescribe medication, which isn’t even necessary. This, in turn, can have a negative impact on the patient’s health.
Healthcare domain software testing ensures the systems function responsibly and don’t compromise patient health.
Moreover, healthcare professionals and patients who use these systems might not have a technical background. So, it’s essential to make sure systems are easy to use to avoid any delay in treatment.
Testing Types for Healthcare Domain
1. Functionality testing
This testing ensures that all the features and functions of a healthcare software system work as specified in the requirements. The test examines the end-to-end processes, including diagnostics, alerts, and scheduling, to ensure the system works as intended without any glitch.
Testers, rather than focusing on the internal code, mimic real user behavior to check how the workflows function.
2. Data and accuracy
Data is the most critical component in healthcare systems. Any mismatch or missing information can lead to misinterpretation and even wrong diagnosis.
Accuracy testing ensures that patients’ medical records are up to date, no duplicates are recorded, and data collected from various software systems are standardized through code sets and date formats.
3. Security testing
Healthcare software systems handle large volumes of sensitive patient data, and hence, protecting it is highly critical.
In 2024, HIPAA Journal reported 14 healthcare data breaches involving more than 1 million healthcare records, affecting 237,986,282 U.S. residents. This accounts for around 69.97% of the nation’s population.
Therefore, Security testing is essential to check how well the systems safeguard this data from cyber attacks.
The test assesses encryption methods, login and authentication workflows, network connections, and data transfers and storage via penetration testing, security code reviews, and vulnerability scanning.
4. Compliance testing
Healthcare systems operate under strict policies and regulations outlined by bodies like HIPAA, GDPR, and FDA. You must test the systems to ensure they comply with the standards before releasing them. It’ll help you keep a log of how patient details are used, who accessed them, and any potential evidence of data tampering.
5. Device integration testing
Healthcare systems are often integrated with devices like monitors and wearables to check the patient’s conditions. And any incorrect readings or alerts can compromise patient safety. Device integration testing allows you to assess whether data transfers between the devices are seamless.
Testers typically perform these tests on simulators or target hardware to uncover issues related to data flow, task scheduling issues or memory constraints that might lead the device to malfunction.
Health Care Domain Testing Workflow
Software testing in the healthcare domain typically includes five modules, which are member system, provider system, broker system, claims system, and finance system.
Let’s understand what the main functionalities of each of the modules are and what should integrate testing evaluate.
Testing of member system
| Category | Description |
|---|---|
| Main Functionality | Register or terminate members (patients), update and validate member details, and retrieve member details correctly |
| Other Functional Flows | Generate and process payment receipts, view past payments, and re-enroll the members |
| Integration Testing | Ensure service integration with downstream systems such as claims, finance, and other dependent systems; updates in the member record should automatically reflect in these systems |
Testing of provider system
| Category | Description |
|---|---|
| Main Functionality | Add, modify, and delete provider, and register or delete provider types as and when required |
| Other Functional Flows | Authenticate providers before allowing access to details, view members attached to a provider, and show broker details |
| Integration Testing | Integration between broker system, claim system, and finance system should work as intended, and any modification should automatically reflect on the dependent systems |
Testing of broker system
| Category | Description |
|---|---|
| Main Functionality | Add, modify, and delete any broker data, and calculate broker commissions as per health insurance premium payment |
| Other Functional Flows | Allow brokers to save and retrieve their records, and view the members associated with a broker |
| Integration Testing | Ensure broker data is updated in all inter-dependent systems like the provider portal, finance system, and member system |
Testing of claims system
| Category | Description |
|---|---|
| Main Functionality | Add and modify claims for members and their dependents, view and process claims, and verify if claim-related information is correct |
| Other Functional Flows | Offer the option to upload documents in different formats, send alerts or notifications to members regarding claim status, and reject claims in case the insured limit exceeds |
| Integration Testing | Check if the claim information flows correctly to the downstream systems such as provider and finance systems |
Testing of finance system
| Category | Description |
|---|---|
| Main Functionality | Process payments initiated by the insurance claim system, and verify data such as account number, member details, and broker and provider details |
| Other Functional Flows | Send notification in case the payment fails and offer to re-initiate the payment |
| Integration Testing | Ensure two-way integration with claims system, provider system, and broker system |
Healthcare Domain Sample Test Cases
| Function | Sample Test Cases |
|---|---|
| User Authentication | Verify users are authenticated before accessing the system |
| Patient Registration | Verify that patients can be registered in the system, and their medical and personal details can be stored correctly |
| Electronic Health Record (EHR) | Verify the EHR system functions accurately, and patient data can be stored and retrieved |
| Clinical Workflows | Verify that the system supports patient admission, discharge, and transfer |
| Appointment Scheduling | Verify that appointments can be scheduled and rescheduled in the system |
| Lab Results Management | Verify that the system supports ordering, tracking, and reporting of lab results |
| Regulatory Compliance | Verify that the system complies with healthcare regulatory requirements such as HIPAA and GDPR |
| Accessibility | Verify that the system is accessible to users with disabilities and complies with standards like WCAG 2.1 |
| Radiology Image Management | Verify that the system supports viewing, storing, and retrieving radiology images |
Challenges of Healthcare Domain Testing and Its Solutions
1. Interoperability across standards
Healthcare systems rely on protocols like FHIR, HL7v2, and DICOM to share information. Although these protocols exist, the adoption and implementation are inconsistent. As a result, even minor variations in schema or format can cause compatibility issues and break workflows.
To overcome this challenge, you can implement schema checkups and conformance profiles to make sure the data structures used by healthcare systems are consistent.
Create golden message suites and use them as repeatable test cases while testing a new system or upgrades to identify issues early. Validate medical codes such as SNOMED CT, LOINC, and RxNorm to ensure the meaning of data is uniform across all systems.
2. Safe test data and PHI privacy
Software systems in healthcare handle confidential data like patient names, insurance details, and health records, all of which fall under protected health information (PHI).
For healthcare domain testing, you need realistic datasets to examine the software systems. But using real patient data isn’t practical and might raise privacy concerns. You can generate synthetic data that mirrors real-world scenarios and complexities without revealing actual patient data.
Use de-identification to mask sensitive information like the names, IDs, addresses, and financial records, and keep only the attributes essential for testing. Make sure the anonymized data is valid for end-to-end scenarios by running regular automated checks.
3. Performance under load
Healthcare systems, whether it’s EHRs, appointment portals, or billing platforms might face high numbers of concurrent users, especially during clinic hours, telehealth sessions, and health report releases. This can cause downtime, ultimately affecting the workflow and delay in patient care.
Run capacity tests by simulating real concurrency scenarios, network conditions, and device mixes. Set up a failover mechanism to ensure a backup system instantly takes over in case the main system fails.
Enable read-only modes to allow users to view critical health information even under heavy loads. Line up incoming requests under stress through message queue handling.
4. Legacy systems and integrations
Many healthcare institutions still use legacy systems like old EHRs, radiological information systems (RIS), and picture archiving and communication systems (PACS). These systems might not be compatible with modern software testing environments.
You can use service virtualization to simulate external systems and get realistic responses. Perform contract testing to verify that data between integration points of the systems is shared accurately. Maintaining standardized data and versioned mocks keeps the testing process consistent.
Best Practices for Healthcare Domain Testing
1. Maintain a risk register
A risk register helps you keep a log of potential risks throughout the software development and testing cycle. You can identify the privacy, safety, and financial risks early so you know which areas to test deeper to ensure better coverage.
2. Ensure requirements traceability
Clearly map the requirements with test cases, defects, and compliance regulations. Link the test execution results back to the original requirements, and make sure every change in the requirements is updated in the test case. This will help you keep the audits simple and ensure no critical compliance rule is missed.
3. Include role-based tests
Simulate how nurses, doctors, lab staff, patients, and admins interact with healthcare systems. This will help you test if the processes involving multiple roles in the healthcare domain are functioning correctly. Role-based testing confirms clinical journey, including permission and handoffs work smoothly.
For example, if a doctor uploads the prescription link into the e-prescribing system, the pharmacy should be able to receive it and provide medicine to the patient. Role-based testing helps you ensure this entire process is seamless.
Simplify Healthcare Domain Testing with TestGrid
TestGrid is an AI-powered end-to-end testing platform that optimizes healthcare domain testing, ensuring the software systems are scalable, secure, and adhere to regulatory standards. The features include:
Performance testing: Assess performance of the healthcare systems under peak loads and across devices with varying network conditions, responsiveness, and battery life.
Cross-browser testing: Run automated tests across 1000+ browsers, devices, and operating systems to ensure your healthcare systems are compatible
Real-device testing: Test websites, portals, and mobile apps on cloud by simulating real user behavior
This blog is originally published at Testgrid
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