Quality Engineering Trends in Healthcare

Related Topics: Healthcare, QA & Testing

by Shrisha Jinukala –

Most of the consumers utilize retail services such as Amazon, Walmart or online banking to place an online order through mobile or laptop or Alexa (IoT devices) and pick their delivery from curbside or delivered same day to their doorstep. Patients and physicians are also consumers who want information at their fingertips by using their phones and faster internet connections.

Also, COVID-19 the global pandemic has impacted all industries in varying fashion with unprecedented impact on Healthcare industry. Even though many frontline workers and hospitals stepped in to save lives there are still several gaps in healthcare systems to provide anywhere, anytime digital health experience to their own hospital staff, patients and even after the pandemic ends healthcare industry will strive without addressing the growing digital needs.

So, hospitals and health systems need a strategy to re-engineer their own digital transformation making healthcare more manageable, accessible, and simple to use and we’re seeing a shift towards “value-based health,” through better outcomes, quality for patients as well as service provider’s and reduced costs. In the end, the patient is going to be far more connected to the physicians and technology is driving towards this.

Very soon we can imagine a world in which “It is all one-stop shop where patients can go online similar to Amazon, buy services for either talking to doctor or just fill their prescriptions, have medications sent to them and get a reminder about future appointments.” And a physician can use clinical speech recognition similar to Alexa and simply say: “Get my next patient details” and “Send prescription to patient’s pharmacy”

For those of us in health technology, it’s time to re-imagine healthcare technology as a connected network using agile, mobile, IoT, robots and continuous deployment business models. In 2020, we’ll have to apply them in new ways and resolve new challenges, with the goal of helping to drive desired outcomes for all stakeholders in the healthcare ecosystem.

All of this has increased stress on the IT departments of healthcare providers, who are already faced with constant issues of software upgrades, newer technologies, database management, server maintenance, network issues and much more where they are focused more on systems.

And one small mistake or any error in software/connected system will result in cost of a life as technology by itself isn’t the problem but technical errors are and to make end to end technology work flawless; adapt to new technologies without impacting existing flow, healthcare companies should emphasize software quality as their primary goal. Also, ever-changing requirements and addition of newer technologies has turned harder for traditional QA team to cope up with quality and testing of frequently released software builds that are deployed every two weeks in an agile delivery. That meant changing its software testing approach from “One Size Fits All “– manual– Quality Assurance (QA), functional testing and non-functional testing such as performance and security to a more proactive Quality Engineering (QE) process that integrates continuous software testing with DevOps by leveraging continuous automation.

Let’s discuss on how to re-engineer Quality services to support latest digital health from both the Patient and the Provider’s perspectives:

Patient view:

Telehealth Services

– “My Son is suffering with mild cough and can I talk to doctor without visiting?”

This is possible through telehealth services and although this technology is not new, adoption has been relatively slower. It has now turned most essential due to current crisis of social distancing where healthcare providers can provide virtual care and allow physicians and nurses to view and talk to patients via email, phone and video-chatting.

On April 2, 2020, the FCC announced that it will provide the COVID-19 Telehealth Program, which will grant $200M Congress-appropriated funding to eligible healthcare providers. In order to support growing telehealth, IT industry will have to identify, develop and deploy various services to securely connect patient with physician. Telehealth services equipped with AI enabled chat bot functionalities are going to improve quality care for all patients and will truly act as retail- like healthcare services and extend even after social distancing ends.

Re-engineering software testing is most crucial for telehealth market compared to all other applications as lives are dependent on apps and one mistake can cost patient life or create life-term disability.

Quality Engineering should focus on:

  • Identify systematic faults – Identify errors in specifications and requirements that can remain undetected and create failures in future
  • Data availability across multiple platforms (desktop, web, mobile and API) via interoperability testing
  • Usability and acceptance – Focus on how “user-friendly” apps can be designed considering amount user is spending on services and turn it to more consumer–friendly and customer-centric
  • Usability by people with disability like hearing, color blinded, old age via Accessibility testing
  • Incorporate QA Ops for faster releases
  • Utilize smart automation frameworks where scripts can self-heal with software changes
  • Strict vigilance on testing of products via FDA regulations

Remote Health Monitoring

– “How can everyday devices help in monitoring my health and alerting for accidents”

Wearables and health apps are going to play a big part in healthcare services that communicate vital, real-time information and analyze patient’s data in real-time. Whether it is to monitor sleep patterns or monitor heart rate and chronic conditions like diabetes or blood sugar, patients can monitor their health through Remote health monitoring with easy-to-use devices enabled by Bluetooth technology equipped with IoT (Internet of things). Doctors also are in good position to understand what’s happening with patients and offer timely cure.

But as systems are interacting real-time and all devices use latest technologies and has minimal guidance for any developer or tester, so re-engineering software testing takes greater emphasis.

Quality Engineering should focus on:

  • 24/7 services availability – Fault failure testing through automation services
  • Testing in production to incorporate real time experience and run analysis on production logs through AI automation tools to detect failure patterns
  • Validate communication through various operating systems
  • Monitor delays in connecting to device
  • Scalability and device stability
  • QA team to be trained to adapt to new technology such as voice recognition, IoT so on

Blockchain and the promise of better electronic health records

– “Physician is sued for malpractices as the doctor paid a programmer to modify the source code”

Data added to a blockchain can be shared in near real-time across a group of permissioned individuals and/or institutions. This shareable record becomes the single source of truth for a patient’s (or thing’s) history, carried by the patient as a digital record, regardless of location.

Again, as this is new technology, testing also has to be engineered to serve the purpose.

Quality Engineering should focus on:

  • Data management, data governance and data quality
  • Data sensitivity due to nature of patient records and government mandates

Healthcare Provider’s View:

Stay informed and being aware and prepared

– “How can I prepare for COVID-19 at work”

Every healthcare worker is required to know the emergency of any outbreaks and always communicated about current critical situations, so that they can be more prepared. A new era of Communication apps, contact tracing, pre-screening and rules to follow for self-isolation of affected persons came into picture due to COVID-19. Not just in emergency, but to remain in touch with team members there are several team member apps designed to be handy anytime, anywhere through mobile or other portable devices like iPad.

Quality Engineering should focus on:

  • Continuous testing for faster delivery with continuous automation
  • User engagement and ease-of-use
  • Live Testing through Canary deployment to monitor how app behaves in real-time
  • Integrated applications that work within network and outside network

Automate routine tasks through RPA (Robotic process automation)

– “How can I reduce my hours I spend in routine and repetitive documentation?”

Healthcare workers have tasks to do and are often repetitive. By offering clear information and automating parts of the routine tasks that healthcare workers need to do can ultimately cut costs and benefit users.

Quality Engineering should focus on:

  • Business user process rather than system process which can accelerate time to value
  • Create scheduled, batch jobs similar to production
  • Create easy to use jobs for any business user to trigger tests at later stage
  • Data sensitivity due to nature of patient records and government mandates

Mobile Device Management

– “How can I view patient records on my phone?” or “How can I process claims request of a patient which can be done though computer?”

As Healthcare workers are more mobile visiting patients within healthcare facility or outside through Telehealth, they expect to utilize their phones as a means to perform their day-to-day activities similar to using their laptop or desktop. But with over 60 billion mobile users and several mobile connections, security is a major concern which is addressed by Mobile Device Management.
Quality Engineering should focus on:

  • Network security and device security in order to adhere to strict policies of protecting patient privacy (HIPAA, HITECH)
  • For Bring-your-own-device (BYOD) – validate work and personal use are independent and there is no Data Leakage
  • Verify that policies, settings, updates can be pushed anytime with minimal setup and faster deployment
  • Identify strategy to test based on several software upgrades, security patches
  • Random faults – due to system deteriorating over time
  • Monitor outdated devices are retired and decommissioned and how lost devices can be tracked

Predictive analysis through Big Data and AI

– Consider current scenario of social distancing where big data is able to analyze patient location, proximity, travel history, people entered or left effected area and gain actionable insights on further lock down.

Big data is not just used to store massive amounts of data, but it helps to identify patterns to create short-term and long terms solution or cure through predictive analysis. AI has already been applied to use cases in healthcare to lower costs and improve diagnosis and help doctors take speedy decisions.

Quality Engineering should focus on:

  • Data transformation, Data accuracy, Data integrity and Data centralization
  • Risk compliance
  • Scalability
  • Unprocessed and processed data samples
  • Synchronous and asynchronous processes
  • Utilize automation tools that support continuous automation and monitoring to identify real-time behaviors
  • Train testers as SDET’s to learn all newer technologies

Quality should be balanced with Human Touch

Healthcare is only one major area where human psychology is still very critical, and patients should not feel as if they are in a factory setting with various online tools and lack essential emotional and human support. We cannot digitize every activity without determining quality/impact on actual consumer. But consumers are smart enough to choose where they need to actually visit a doctor versus browsing through data versus virtually connect to a Doctor. And, with Quality engineering we can bridge the gap by re-engineering system – centric approach to consumer- centric approach and give both patients and healthcare workers a seamless experience of digital care.

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