Using automated testing solutions during EHR implementation

Given that many EHR implementations can be highly complex and with small margins for error, practices often fail to consider the importance of the testing process to ensure an EHR will be functional and safe for clinical users, administrative staff, and patients. As referenced in a recent Journal of the American Medical Informatics Association article, testing should be conducted on “upgraded and newly developed or implemented EHRs, or features and modules thereof should be thoroughly tested for both technical issues like system crashes or unexpected results and user-centric issues like problems with usability or workflow.” The importance of testing has also been emphasized by ONC’s Safety Assurance Factors for EHR Resilience (SAFER) guidelines which state that pre-implementation and ongoing testing of EHRs as a key safety practice.

Manual and automated software testing

As the name implies, manual tests are executed manually by a human who executes different scenarios to test software performance. On the other hand, automated testing relies on the use of electronic tools, scripts, and software. Besides the obvious differences between the two methods, the latter method of testing is more cost intensive and requires more human resources and planning, yet, it does yield a higher volume of can yield a greater frequency of tests and can cover more scenarios. Whereas manual testing costs less, since it relies on human testing, the quantity of tests that can be run is limited.

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Given the fact that automated testing requires greater resources, it may not be feasible for smaller practices to employ this testing method, however practices that can budget for automated testing, can benefit from the fact that automated testing provides practices the ability to reduce implementation time by mitigating the risk of unanticipated technical issues arising during the go-live period and can reduce the risk of problems that can hamper user productivity such as usability or workflow issues.

Examples of automated testing

Any number of automated tests can be run on an EHR to determine if it is functioning as it should. The type of tests that should be run depending on the application and context. Some of the more common methods of automated testing include:  

Performance testing

Performance testing generally refers to tests that check how the system behaves and performs. For example, an automated performance test would examine an EHR’s speed and reliability, among others under normal operating conditions which can be simulated through automated testing scripts and software.

Load testing

Load testing refers to an automated test that simulates how software, application, or website will behave during normal and high usage. For example, an EHR may be tested to determine if a large number of concurrent users will cause performance issues with a system.

Repeated execution testing

Repeated execution testing involves repeatedly executing a task to determine if the software or system will perform up to performance standards and also perform reliably. Therefore, a certain EHR feature or function would be tested repeatedly to gather data to test whether the feature or function performs in a consistent manner.

Interoperability testing

Given the importance of interoperability to the general mission of providing care, automated testing of a system’s interoperability is vital to making certain an EHR will function properly and is able to consistently and properly share data with other EHRs and medical devices.

In summary, automated testing should be considered as a recommended practice, for ensuring an EHR is functional and also as a measure for practices to reduce the risk of costly problems software-related problems arising in the future. 

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Jeff Green

About the author…

Jeff Green, MPH, JD works as a freelance writer and consultant in the Healthcare information Technology Space.

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Jeff Green

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