Introduction To Healthcare Domain & Testing Challenges

Pawan Kumar Yadav

About MeISTQB/ISEB – Certified Quality Analyst

Skills:- Manual Testing ,Database-Testing, Desktop Applications, Web Application testing HealthCare Domain Testing,Mobile Application Testing

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INTRODUCTION

BASIC FLOW OF APPS

Health Care Basic Terminology● Medicaid:-Medicaid is a joint federal and state program that helps

low-income individuals and families pay for the costs associated with medical care

Medicare:-A federal health insurance program for people 65 and older and some people who are permanently disabled

Claim:-A request to your health plan to pay a bill for a health care service (Usually your provider files the claim. You can file a claim yourself if you paid for the service up-front.)

Provider:-A professional person, medical group, clinic, lab, hospital, or other health facility licensed by the state to provide health care services Prior Approval/Prior Authorization:-The process of getting approval from your health plan or medical group before you get services.

Continue......● Co-payment:- A form of medical cost sharing in a health

insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insurer is responsible for the rest of the reimbursement.

♦ There may be separate co payments for different services.

♦ Some plans require that a deductible first be met for some specific services before a co payment applies.

Deductible: - A fixed dollar amount during the benefit period - usually a year - that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both per individual and family deductibles.

♦ Some plans may have separate deductibles for specific services. For example, a plan may have a hospitalization deductible per admission.

♦ Deductibles may differ if services are received from an approved provider or if received from providers not on the approved list.

Continue......● Current Procedural Terminology(CPT):-The Current

Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association(AMA) through the CPT Editorial Panel. The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.

● International Classification of Diseases(ICD):-International Classification of Diseases (also known by the abbreviation ICD) is the United Nations-sponsored World Health Organization’s "standard diagnostic tool for epidemiology, health management and clinical purposes

Continue......● National Provider Identifier(NPI):-A National Provider

Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the unique provider identification number (UPIN) as the required identifier for Medicare services, and is used by other payers, including commercial healthcare insurers

● Health Insurance Portability and Accountability Act(HIPAA):- HIPAA is a set of rules and regulations which hospitals, doctors, healthcare providers, and health plans must follow in order to provide their services. The Health Insurance Portability and Accountability Act of 1996 was enacted by the United States Congress and signed by President Bill Clinton in 1996

Continue......● Centers for Medicare and Medicaid Services:-The

Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards

Challenges Faced while Testing in Healthcare domain

● Domain and System Knowledge● Clinical usage/Workflow● Healthcare Domain Standard● Cross Dependency of Software

Precautions ● Safety and Hazards:- Healthcare software’s are designed

around safety and hazard requirements Inadequate testing for safety and hazards will have a fatal impact on the product, end user and patient. Test engineers must have a good understanding & knowledge in identifying the safety and hazard tests and its impact.

● Domain and System Knowledge:-Lack of domain and system knowledge will result in inadequacy of testing. Test engineers with testing knowledge will not only suffice testing the product as a whole but also must know the complete functionality, clinical usage scenarios, workflows, environment, standards used, configurations, regulations, interoperability, domain tools etc

● HealthCare Domain Standards:-Insufficient knowledge of domain standards will result in poor quality of testing. Test engineers must be trained and well equipped with standards ( HIPAA, HL7 etc..) while testing the product for interoperability, connectivity and security aspects.

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Questions ?

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