A Guide to Testing Electronic Health Record Systems

What is the Value of an EHR System?

An Electronic Health Record system (EHR) helps stakeholders in the healthcare sector manage patients’ health records.  Today’s world revolves around digital information and technology. The electronic health record is a natural extension of what we have come to expect in healthcare technology.  A few benefits of an EHR are improved patient care coordination and outcomes, empowered patients,  cost savings, and improved efficiency. However, convenient access to data is only the most basic benefit of EHR technology.  To ensure that the EHR software brings value for healthcare providers, it must get validated and tested.

Patient access is important as it has shown that when patients have access to their personal health records, they will take an active role in managing their healthcare on a day-to-day basis. Today’s patient portals provide lab results, drug information, and historical data while also extending a convenient way to schedule appointments, refill prescriptions, and communicate electronically.

However, before healthcare practices implement an EHR, there should be adequate testing in a production environment to ensure safety, performance, and accuracy.

Today’s Healthcare Crisis

With the COVID-19 pandemic crippling the global economy as well as disrupting practically each and every aspect of our lives, we are forced to modify and adjust to a new way of life. As the global workforce starts offering their services remotely under the lockdown situation, the healthcare & life sciences professionals are battling at the frontline. The increasing number of corona-affected patients has resulted in hospitals restrategizing their care delivery models, with most of the healthcare systems canceling or deferring elective procedures. Amid the outbreak, as it is essential to maintain the social distancing, remote care delivery systems like telemedicine platforms and Electronic Health Record (EHR) systems are critical in attending to non-coronavirus patients. By leveraging telehealth and EHR platforms, healthcare providers can attend to critical patients without exposing them to the possibility of contracting the fatal virus.

Why Do EHR systems Need to be Tested?

The Electronic Health Record (EHR) system is an important cog in the wheel of healthcare management. It needs to be safe and quickly accessible (if possible, remotely) to ensure better monitoring and management of patients’ health. Since the record system may have interfaces with other hardware and software suites, it should be tested in the production environment for better efficacy. However, in many cases, the healthcare software testing specialists limit testing to a test environment, which should be avoided. This is because a production environment can have myriad variables and situations that cannot be mimicked in a test environment.

If the EHR systems are not tested for such variables or situations, there might be gaps left unchecked, which might come to haunt users later. Hence, effective EHR system testing can only be ensured if the testing process integrates the production environment comprising patients. The healthcare software testing should incorporate elements like the release of upgrades, downstream personnel, documentation, and test patients.

The stakeholders understand the benefits of EHR in terms of quality and safety. However, there have been reports of the system malfunctioning or generating erroneous data leading to healthcare management compromise. Also, their usage by the end-users namely, doctors, nurses, and other healthcare staff leaves a lot to be desired. It has been noticed that usability issues can render the very use of such systems infructuous. This calls for testing EHR systems where usability issues should be flagged and fixed and pre-empt patients from coming in harm’s way. Test experts usually rely on creating a virtual test environment mirroring the real environment wherein they conduct a series of healthcare application testing. It is not always the case that testing in a production environment shall yield the best results. For example, without getting access to real patients or creating laboratory results on such patients, it will not make the healthcare QA testing effective. But one cannot take away the advantages of testing in a production environment. Let us find out the reasons.

Why Test Healthcare Services in Production?

The multistep software testing process tests system crashes or user-centric ones like lack of usability or problems with the workflow. At the final stages, once the EHR system goes live, regression testing should be conducted to validate the software’s functioning as expected. Also, the regression healthcare QA testing would ensure any new software changes do not create any issues. Carrying out such testing in a production environment would ensure the safety and performance of the EHR. In many cases, organizations taking the route of using testing environments argue that their environments are foolproof and accurately mirror the various aspects of a real production environment. Several studies have shown that some errors are found only in the real production environment, as evident by the end-user report. Such errors are often found quite late after the system is put into actual use.

Further, depending on the user reports to identify issues later can lead to delays and a bad user experience. Here, bad user-experience can be life-threatening as incorrect reports derived from EHR can lead to potentially dangerous consequences. To avoid such situations, conducting controlled healthcare domain testing

can identify hidden glitches or issues quickly. Further, there can be a huge difference between testing and production environments, with many components present in real systems that cannot be mimicked. In a production environment, the EHR software suite interfaces with lots of third-party hardware and software, creating their own sets of issues in terms of response time and end-to-end functionality. So, testing in a production environment gives testers the ability to validate the entire EHR’s functioning, including its interfacing with other devices, modules, and applications.

Reporting

To ensure that test patients’ data do not contaminate the quality, financial reports, and productivity, they should be excluded from the reports and data extracts. They should be flagged in databases and excluded from productivity and quality measurements. Test patients should be named distinctly to avoid any confusion with real patients. Besides, their records should appear different than real patients, say in terms of color-coding. This ensures the end-users (doctors, nurses, and healthcare workers) do not confuse test patients with real patients.

Conclusion

Healthcare software testing for EHRs should be conducted in a production environment as much as possible to ensure their safety, usability, and responsiveness. Organizations pursuing policies of conducting testing in a test environment should reconsider their approaches for better results. As a lot depends on these remote healthcare-enabling software solutions, the industry cannot afford to lag in its service delivery capabilities.  A robust software application can help patients obtain critical care while sitting at their homes and prevent the unnecessary panic that may get induced if the general population is unable to access basic healthcare services.