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For 10 years, up until the end of 2019, I was a Non-Executive Director in a UK National Health Service (NHS) Clinical Commissioning Group, and I gained valuable insights into how Electronic Medical Records (EMR) solutions were becoming vital to improving not only operational efficiency, but also patient outcomes and the overall patient experience. As an IT analyst at Bloor Research, I am also acutely aware of the need for effective software testing. So, I was interested to see the output of a Keysight sponsored survey with the Healthcare Information and Management Systems Society (HIMSS) into key trends and future projections for software testing in healthcare in the United States.
EMRs are at the heart of modern healthcare systems. Over a lifetime, patients will almost certainly undergo a number of medical interventions, involving primary, secondary and sometimes even specialist tertiary care across numerous different healthcare organisations. Collecting, sharing and managing patient data is very complex and also highly sensitive. There are strict regulations, like the Health Insurance Portability and Accountability Act (HIPAA), to ensure Protected Health Information (PHI) is secured, and the sources of that data are now more numerous than ever before. On top of normal medical record keeping and sharing across multiple different providers and clinicians, the Internet of Things (IoT) has resulted in huge amounts of data being collected from, at one extreme, the most sophisticated medical scanners, right down to consumer-based wearables. This has spawned a large range of new applications, all with a need to interface with EMRs.
Patient safety is a primary focus for all healthcare systems, be they largely private sector run as is the case in the United States, or largely publicly funded and run, as in the UK National Health Service. Improving patient outcomes is also a critical requirement. Given that EMRs are critical to ensuring that all patients’ medical histories are accurate and available in a timely fashion to clinicians and nursing staff, data errors, omissions and application failures can have devastating consequences for patient safety and patient outcomes. The Keysight/HIMSS survey highlighted a 2020 US research that found that EMR systems failed to detect up to 33% of drug interactions and medication errors that could injure or kill patients.
Additionally, in recent years there has been a recognition of the need to make healthcare more patient centric, putting the patient at the centre of everything and improving the overall patient experience. Incomplete EMR data can put patient safety at risk, while a lack of integration between applications, poorly designed workflows and user interfaces causes duplication and delay, and ultimately, increases anxiety and frustration for patients.
In this environment, comprehensive EMR testing from functionality and performance to integration and usability is absolutely critical. The Keysight/HIMSS survey highlights the challenges for testing that Quality Assurance (QA) leaders face. On one hand, the volume, velocity and complexity of new application developments and integration requirements has grown significantly. Yet, on the other hand the survey revealed that thirty-eight percent of providers still use manual testing approaches, where the software testing teams go through repetitive tasks from test case creation to maintenance to identify defects, and forty-four percent use a DIY approach, maintaining in-house testing solutions. Even if healthcare organisations could overcome skills shortages issues, common across many areas of IT and not just in testing, these approaches are not scalable to satisfy the rapid growth and complexity of the testing requirements they are facing.
Advances in automation, machine learning, and the development of non-invasive testing platforms, that work with new DevOps continuous integration and continuous delivery (CI/CD) pipelines in highly secured environments offer the genuine promise of being able to meet the increased demands for healthcare software testing without having to cut corners. However, the survey found that only 25% of providers were using primarily automated software testing. Interestingly 100% of healthcare executive leaders claim software quality assurance is a priority, yet just 6% of primary decision-makers in testing are confident that testing coverage is sufficient to minimize the risk to patient lives. Perhaps this reflects some cultural issues within the healthcare sector where challenging upwards can be problematic. In which case, senior executives may well have a false sense of assurance that current testing regimes are adequate. To overcome this, QA testers and IT executives need to raise their horizons a little. The survey suggested that the greatest impact of poor-quality software fell on physicians and nurses and that it has a statistically significant positive correlation with physicians’ stress and burnout. Undoubtedly physicians and nurses suffer burnout. Undoubtedly, they are annoyed and inconvenienced by EMR functionality and usability issues. But healthcare leaders will be prioritising much more significant causes of burnout than the effectiveness of software testing functions.
It’s important to realise that testing is not a goal in and of itself. Testing, as with any part of the organisation, should provide genuine business value, and must be structured with that in mind. In the case of healthcare that value lies in improving patient outcomes, patient safety and the overall patient experience. Being able to demonstrate clear links between EMR software quality and patient outcomes, and EMR software quality and automated testing solutions are critical if the projection of 75% of providers using automated software testing in five years’ time is to be realised.
To understand other key trends and issues in healthcare software testing, you should explore the comprehensive survey findings in the Vital Signs study. You will find additional helpful insights to future-proof your testing strategies.