Compliance Confirmation Testing for Healthcare Applications

Today’s era is of ever-growing technological advancements and digitization and the whole world is being techno-savvy. Everyone across the globe seeks excellent medical care facilities in real-time. The most important factor today lies in providing the healthcare information anywhere and anytime for all healthcare industry associates, i.e. Doctors, patients, TPA/administrators, medical staff, etc.

According to the healthcare innovation group, the healthcare IT industry is expected to reach $280.25 billion by the year 2021, and not only this unprecedented growth in terms of money involved but also at the annual growth rate of 15.9% is going to overshadow all other industries as well. As a result, we would notice the market for Healthcare software, including electronic health records (EHR), healthcare’s CRM and mobile apps for the medical staff and patients, will also continue to grow.

There co-exists another significant part of it which is known as the healthcare insurance sector without which the healthcare industry is incomplete. An insurance company must ensure that it adheres to the requirements of related regulations, standards, laws and policies. Organizations may suffer the loss of reputation due to Non-compliance and may result in revenue loss regardless of their size (small, medium or large). Therefore, compliance testing is a necessary and mandatory step. While achieving compliance could be a challenging process, but with the right kind of systems and customized data management policies, it could be managed easily.

Overview

Customers prefer simpler and quicker ways to apply for insurance or to make requests for their claims processing. To adjust and accommodate the emerging trends in the insurance business, insurance applications need to be developed. Once the application is developed, the foremost important task required to be performed is the “Compliance Testing” which is the backbone of all the insurance applications.

Compliance testing is performed to validate and maintain the software that adheres to the standards set by the regulatory bodies throughout the life of the software during its usage, i.e. In healthcare, Health Insurance Portability and Accountability Act (HIPAA) includes an administrative simplification section, which adheres to protecting the information assets of patients. Similar is the case with the Food and Drug Administration (FDA) which is widely used in the pharmaceutical industries. In India, Insurance Regulatory and Development Authority, (IRDA) has its health insurance standards, 3rd party settlements and related aspects. It has got its own set of regulations that should be followed by the healthcare providers.

Similarly, we have HL7 which are sets of standards required for the exchange, integration, and retrieval of the electronic health information, ensuring that the global medical data interoperability is in place and along with it also provides the possibility to access and use the relevant health data very securely.

Why Compliance Testing Is Needed?

Whenever software deals with medical devices, medical software, healthcare applications, these devices or applications must pass mandatory compliance testing for the respective regulatory bodies. Otherwise, these cannot be installed or integrated with other systems available in the healthcare industry thus making it mandatory to perform the compliance testing.

During earlier days, compliance testing was performed manually and took a lot of time. So, we needed to automate it, or we can also use some accelerators to perform the testing in a faster way. At JK Tech, we have the accelerators available which helps us conduct the compliance testing in a faster way. In addition, we also have a dedicated compliance testing team to carry out the testing proactively and find the integration or compliance-related issues at the earlier stage of the testing lifecycle.

While the modifications to compliance rules maybe not so frequent, however, over a period when the new products are being introduced, they must be subjected to compliance testing. Hence, the continued workload of regression testing on the application will occur, because a change once incorporated into the existing insurance application software due to the introduction of new products, it must be able to handle all the pre-existing situations that touch upon before the introduction of the newly added product(s).

It is also important to ensure primarily that there are no ripple effects and the software's existing functionality is not disturbed elsewhere. Based upon the compliance, it may apply retrospectively or prospectively and in case it is applied retrospectively the tester should be able to test all the previous old valid records without any issues. This is where the major emphasis should be on complete application testing, i.e. end to end workflow is important to be tested along with the compliance regulations testing. More than anything else, nowadays in healthcare testing, a healthcare application vendor/user is looking for readily reusable test cases/configurable assets rather than starting everything from scratch and the majority of customers look for the existing automated test cases, with the latest technology being used to generate the test data.

Nowadays, the most preferable way being used is, automatically or through synthetic test data generation. Testing methodology and reporting are other two key areas to be focused on while testing the insurance applications and in the current market the healthcare testing has matured so much that a lot of automation is available as of today. There are various applications with automated strategies, even where the test case generation is also automated and not just merely through scripting.

Across industries, we observe that all applications which are being used by the end-users are multi-channeled. E.g. Banking or digital payment application is available for end-users on multiple channels/devices, (i.e. Availability through multiple channels).

Therefore, having the latest insurance services, the related software is of no use, unless it works or behaves in a way that makes it easier to be used by all the concerned stakeholders. Ease of use of an application on a mobile device or a tab makes it more user-friendly, i.e. as an end-user a patient should be able to file an insurance claim, not only while being in the hospital but also while being an outpatient as well. When an application that is already available on a laptop/desktop is made accessible on a mobile device or a tab, the portability makes the application acceptable and hence having multi-channel delivery makes it more beneficial for the end-users.

Another major question that arises is, whether one single application is going to be used by different users or it could be altogether different applications integrated through protocols and APIs. Thus, whatever the situation may be, the integration between the healthcare and insurance applications should work seamlessly. Now that the insurance applications have come up to such a stage, that they will have a configurable mechanism, whether it is HIPPA compliant or catering to any other compliance, we notice that the insurance application software is the same but through a configurable mechanism it becomes easier to cater the needs of different customers.

All that is required as an application user is that the whole application is working properly and there is no field failure and to ensure that the logical business flows and data logging comply with the applicable regulations and the laid down protocols used in healthcare services. The automation in the insurance sector has evolved so much that only requires to drag and drop the test conditions/scenarios on the screen and the test cases are generated internally through pre-existing models and further, the test data is being picked up automatically which makes it a data-driven test suite, which is reusable and easily maintainable.

Organization’s Perspective

To be a persistent leader in insurance application testing in the IT sector, customers related to the worldwide insurance sector need to be provided with outstanding testing services. Here are the reasons which make companies stand apart from other competitors:

• Companies having great experience in testing can easily handle insurance applications for customers worldwide.
• Existing configurable test suites and data extraction mechanism which tester performs, i.e. automatically as well as through Synthetic test data generation technique.
• Expertise on testing the multi-channeled insurance applications across various mobile devices/tabs on multiple OS platforms to make it more user-friendly.
• Companies should have a specialized team for managing the testing of various insurance compliances used worldwide like, HIPPA, FDA, IRDA and HL7 standards.
• Another bigger asset which companies heavily rely upon is the highly automated regression test suites for compliance testing with configurable artifacts. This again helps their customers save a lot of time and money, thus reducing the overall time of delivery as well.
• The Test automation framework had helped multiple leading insurance companies to achieve a 75% reduction in the overall test execution time.