Electronic Health Records: Testing Strategies

The rapid technological evolution and the adoption of information systems such as Electronic Health Records (EHR) have made it possible for professionals and organizations to access and store large amounts of data. EHR systems have also enabled simpler communication and data integration in many organizations. Testing is a critical process that should be applied before implementing a Change from the old EHR (Cerner) to a new EHR (Epic). Without adequate testing, technical issues cause frustration to the users and system analysts. These issues may also result in additional organizational expenses. Testing is a vital process in project development that ensures that a given system meets users’ requirements and functions as designed.

Evaluation of Various Testing Methodologies

Every testing methodology has a unique test strategy, objectives, and deliverables. An efficient project and system management lifecycle should result in a fully-functional system ready for implementation (Ahmad et al., 2019). Both functional and non functional testing techniques should be applied to validate reliability, usability, performance, and software actions. The most common testing methodologies include performance testing, system testing, unit testing, and integration testing.

Unit testing is the basic testing component performed within a given application. Unit testing analyzes the inner workings of an application to satisfy whether the design is functioning as expected (Garcia-Dia, 2019). Unit testing is the first step of testing that is conducted when a system change is applied to a system. This test can be applied to EHR in nursing items, laboratories, pharmacies and other ancillary features (Garcia-Dia, 2019). On the other hand, functional testing focuses on the result of system processing and can be created based on user requirements or organizational goals. One of the main reasons for doing functional tests is to verify whether the user input matches the output and that the data displayed can inform effective decision-making. For instance, the testing technique can be applied in EHR to prevent medical errors by flagging allergy alerts. Integration testing helps to identify any possible interfacing errors that may result from unit testing. In EHR systems, integration testing tests all the modules together to identify any faults present in the build.

Performance testing and system testing are applied to EHR systems to verify that the system meets the minimum user requirements. Performance testing can also verify that the system response times of specific transactions are within the acceptable limits defined in the system requirements (Anwar & Kar, 2019). System testing can help to identify errors and bugs in the entire system. System testing is carried out through integration of the hardware and software components. Subjecting an EHR system to performance and system testing would help analyze workflow, data flow, interphase messaging, and connectivity.

Developing a Testing Scenario

Effective system testing requires coordination among system owners in understanding the clinical scenario, reviewing test scripts, and relating how system users will be interacting with the patients. By creating and building test scenarios in advance, the number of failed test scripts and a smooth testing process can be ensured (Aghajani et al., 2019). Test scenarios are a collective set of test cases that cover the end-to-end functionality of software applications. Creating test scenarios ensures complete coverage and helps identify the real use of the system and the most important end-to-end transactions. Clinical scenarios that can be staged include setting up laboratory orders on future dates and the preadmission of surgery patients.

Test scenarios can be created in five key steps. Namely: reading requirements, predicting end usage, determining scenarios, creating traceability matrix, and final review of the created scenarios. The two first steps are focused on determining the testing requirements. It is vital to read requirement documents like FRS, SRS, and BRS of the system under test. It is also vital to refer to manuals, books, and use cases of the application to be tested (Aghajani et al., 2019). The tester should determine system objectives and figure out possible actions of users. The next two steps will entail listing possible scenarios, and creating a traceability matrix to ascertain that each corresponding requirement is assigned a test scenario. In the last step, the created scenarios will be reviewed by the supervisor and key stakeholders.

Test Items and Test Conditions

Test items are the individual components to be tested while test conditions are specifications that a tester must adhere to. A test item can be verified by one or more test cases. A test condition is a collection of restrictions that might include features such as functions, transactions, and structural aspects.

Documentation of Test Results

Test documentation is a vital software development process that helps the testing team to determine needed testing efforts, test coverage, track resources, and make meaningful progress. The test documenting process can be done before or during the software testing process. Common testing documents include a test plan, a test policy, a defect report, and a test summary report. The quality assurance team should be involved in the initial project phases to ensure the parallel creation of the test document (Aghajani et al., 2019). Test documents should be prepared in standard templates such as MS Excel sheets and Microsoft Word documents and stored in a centralized location that is accessible to every team member. Test documentation should be updated when required, and version control policies should be implemented to manage and track the changes to the document.

References

Aghajani, E., Nagy, C., Vega-Márquez, O. L., Linares-Vásquez, M., Moreno, L., Bavota, G., & Lanza, M. (2019, May). Software documentation issues unveiled. In 2019 IEEE/ACM 41st International Conference on Software Engineering (ICSE) (pp. 1199-1210). IEEE.

Ahmad, T., Iqbal, J., Ashraf, A., Truscan, D., & Porres, I. (2019). Model-based testing using UML activity diagrams: A systematic mapping study. Computer Science Review, 33, 98-112.

Anwar, N., & Kar, S. (2019). Review paper on various software testing techniques & strategies. Global Journal of Computer Science and Technology.

Garcia-Dia, M. J. (Ed.). (2019). Project Management in Nursing Informatics. Springer Publishing Company.