Testing Healthcare Applications: How To Test Healthcare Software

Healthcare software is very popular and important because it helps both healthcare professionals and patients at the same time. Healthcare IT systems are becoming more capable and more complex by the minute, and software development in the healthcare market is already impacting healthcare quality and availability worldwide.

However, the complexity of such software systems imposes certain conditions on the development and testing software for healthcare providers. Healthcare testing is critical for pretty much every healthcare field. As a company that provides technical support to a few industry-leading healthcare software companies, we are no strangers to quality assurance practices for custom medical software specifically, so here is a quick guide on testing medical software.

What Users Expect From Healthcare Software

Medical requirements change rapidly in order to adapt to the most recent discoveries in science, which is a good thing, of course. However, this means the more advanced healthcare becomes, the higher the users’ expectations from the software get. In the days when everything is highly dependent on technology, medical device software development companies have no other choice but to meet the highest of standards. This is well reflected in custom healthcare software development: if a team wants its digital product to be useful, it has to fully correspond to the following requirements:

Reliability

Unreliable software that doesn’t perform as you expect it is always annoying, to say the least. But when it comes to the industry that deals with matters of life and death on a daily basis, the responsibility gets to a whole new level. Medical applications have to deliver error-free performance regardless of the workload or content-heavy databases. This can be achieved only through the quality-first approach to healthcare software testing and development.

Compatibility

There are three main components of any healthcare system: human factor, hardware, and software. All of these have to work in lockstep with each other in order to keep patient care effective. This explains why healthcare entities often prefer to work with a custom healthcare software development company rather than buy an off-the-shelf solution. Custom development allows practitioners to achieve a program specifically tailored to their operations instead of some average systems for average hospitals as imagined by software providers.

Ease of Use (aka UI/UX)

Medical software design defines how easy it will be to use the final product, and with healthcare applications, high usability is crucial. This is because the target audience of such software is extremely diverse: from busy personnel working at hospitals to patients using apps to control their conditions, track medicine consumption, schedule appointments, etc. Not all of them have a high level of computer skills nor have the time and/or the willingness to learn how to use some sophisticated-looking programs. To avoid possible troubles, the UI/UX design of medical applications has to be clear, concise, and intuitive. 

Privacy and Security

One of the primary aims of healthcare software systems is to collect and store patient data. Such records are considered sensitive information so no wonder people are concerned about keeping it confidential. Data storage solutions remain one of the complex components of healthcare applications. Oftentimes, developers go for data encryption technologies like Blockchain to make the information stored less prone to attacks.

Rich Integrations

Whether we are talking about healthcare software for professional or personal use, it won’t find user appreciation without useful integrations. APIs allow developers to expand the feature set of their product without building from scratch thereby saving resources and time to market. In regards to medical software development, you can find a ton of APIs designed for patients, doctors, and even scientists who contribute to the healthcare industry through studies and research (like GluVue by Stanford University).

Regulatory & Conformance Compliance

Healthcare services cannot be distributed without abidance by the corresponding regulatory acts and laws, like HIPAA in the United States or NHS White Paper in the United Kingdom. This especially applies to CRM systems for healthcare institutions and SaaS medical solutions. Also, healthcare software has to correspond to high industry standards and provide content that aligns with the most recent scientific discoveries and condition protocols.

Unreliable software that doesn’t perform as expected is annoying, to say the least. But when it comes to the industry that deals with matters of life and death on a daily basis, the responsibility gets to a whole new level.

Weaknesses to Focus on in Healthcare Software Testing

When it comes to testing, healthcare solutions stand out for many reasons because they are vastly different from most other software types. This is why, in addition to the usual focus areas of software testing, there are also potential weaknesses and vulnerabilities the team should focus on.

Usability Issues

When developing healthcare solutions, product owners often go the path of ensuring robust functionality and rich integrations, while usability becomes treated as an afterthought. This is a mistake in most cases because, as technically complex and innovative as healthcare apps are, they still need to be user-centric. This is why UI/UX checks should be among the first things to do on a healthcare software testing project.

The team must have a usability evaluation plan that includes things like how easy the app is to use for a regular user, how many steps and how much time it takes to perform the necessary action, and how enjoyable the user experience is to an average person.

Unstable App Performance

Faulty performance of a healthcare application is not something that should be taken lightly: the fact that it can spoil the user experience and cause users to abandon the app is important, but what’s even more important is the service interruptions that can be irritating, dangerous, or downright fatal in some cases.

When testing the performance of an application, it’s crucial for the team to remember that numerous factors impact the way the app works, from the number of simultaneous users and/or requests and the specifics of the devices used to access the solution to the user’s location and internet speed and quality. This is why a healthcare software testing plan should account for the biggest number of possible scenarios, no matter how unlikely.

Failure to Comply With HIPAA Requirements

Healthcare software is a highly regulated industry, for good reason. Various authorities have specific requirements for healthcare applications, and the application should comply with each one before being released into the market. The most important one of healthcare software regulations is HIPAA, and HIPAA compliance testing is one of the most integral components of creating healthcare applications.

HIPAA is a set of regulations concerning five areas of healthcare applications: security, privacy, enforcement, breach notification, and omnibus. Failure to comply with HIPAA can result in a variety of negative consequences, from reputation losses to million-dollar fines. HIPAA compliance testing is the most effective way to make sure that the intricate HIPAA requirements don’t stand in the way of your product.

Lack of Compatibility With Medical Software

Healthcare software does not exist in a vacuum. A typical healthcare app is integrated with several other products, which can include EHR (Electronic Health Records), HMS (Hospital Management Systems), and MPMS (Medical Practice Management Software). This is why a modern healthcare app is expected to be compatible with a wide range of different systems, and it’s always going to hurt the app’s market position when it’s not.

Interoperability being one of the key requirements for healthcare systems, it’s still not easy to achieve it. Things can get even more challenging, considering how many hospitals and healthcare facilities out there still operate legacy systems. However, users are not going to be more forgiving of incompatible software just because you’re dealing with legacy software, which makes compatibility testing so important.

Lack of Compatibility With Hardware

Medical software runs on hardware, and it’s one thing when the hardware in question is a commonplace Windows laptop or Android smartphone. The trickiest part is that the list of possible devices doesn’t stop there and can actually get pretty exotic-looking as it goes on. Healthcare institutions use an incredible variety of devices in their day-to-day operations, and testing all possible hardware and software combinations is, undoubtedly, a daunting task.

Moreover, healthcare app developers also need to take into account the growing popularity of wearable devices: in 2023, 506.6 million of those devices were shipped, and by the end of 2024, that number is expected to reach 559.7 million. When users expect full compatibility of the app with their wearable, which includes fast and stable connectivity and accurate data exchange, but are not getting it, their trust in the software product will gradually wane.

Common Testing Types in Healthcare Domain Testing

Testing is the only way to ensure that the healthcare application works as required. Having outlined the user expectations from healthcare software development services, you can see there are a lot of aspects to check when working on such projects. That is why the quality assurance for medical software is usually a multi-level activity that tests an app from different angles. Below are the key types of software testing for healthcare applications.

Load & Smoke Testing

Load and smoke testing refer to the basic software testing techniques: put the developed component under some level of load (in the case of smoke testing ― under the minimal one) and document the results. Smoke testing is used at the earlier stages of development to check how a program reacts to low pressure. The actual load testing takes place later and uses more realistic or even overstated levels of workload on the product.

Data Security Testing

Data security testing ensures the timely discovery of weaknesses in the application’s codebase. Data security testing becomes even more crucial for healthcare solutions, which deal with sensitive healthcare information on a daily basis. If this step isn’t taken seriously, it may result in data losses, unauthorized users, hacker attacks, and other accidents that might discredit the application. Security QA is usually performed as a penetration test, a sort of staged attack on the app’s digital system. Other than checking the hack-proof quality of software, data security testing can also exploit it in many different ways to come up with scenarios that would help to repel an attack when needed.

Compatibility Testing

A healthcare application is expected to work smoothly on every platform and with various types of software. And it’s worth noting that the number of possible hardware and software combinations can be staggering. This is why healthcare testing helps ensure that the software is equipped to work equally well on every platform, and that’s what device testing is all about. Compatibility testing checks how a program interacts with the ecosystem it is supposed to run on, including hardware, network, operating systems, and browsers. To check an application for compatibility, QA engineers try it on all devices, with all versions of operating systems, and in all browsers that were initially picked during the project planning stage.

Integration Testing

Integration testing studies how different modules of a software system integrate with each other. Depending on the technique QA engineers choose to run integration tests ― top-down, bottom-up, functional incremental testing, sandwich testing, or big-bang one ― it can be done at different stages of development. Also, during this step, all the software modules are tested both independently and as a whole. Integration testing helps ensure that a healthcare application displays steady performance even with new units being added to the original structure.

Usability Testing

This type of testing reveals how usable and ergonomic the medical software design of a particular application is. In order to make it more effective, QA teams might run UX/UI testing twice. First time, during the design phase, to reveal the unclear steps in the interface prototype, and the second time after the product’s beta version is developed. With the finalized product version, testers usually work with a focus group to get real-life feedback. 

Regression Testing

Continuous testing of healthcare applications must also check whether the latest testing efforts did not negatively affect the solution. Regression testing helps achieve clarity and confidence in the testing process. This type of testing is responsible for verifying the correct operation of the solution after a recent update, which happens regularly at any healthcare organization. There are plenty of testing tools to help with regression testing, and it’s one of the types of QA that do well with manual testing but can truly benefit from testing automation.

Localization Testing

Localization testing is essential for solutions aiming for international reach and applies to products that are aimed to be used in different regions. Since healthcare regulations can vary greatly from country (state, province, etc.) to country, this should be reflected in the application’s local version as well. This includes such aspects of the application language, integrations widely used in the region, and even marketing strategy.

Compliance Testing

Compliance testing is something that should always be included in the test plan for testing healthcare applications. This type of testing aims at making sure that the application complies with the local government regulations, which can differ greatly from region to region. If you intend to build healthcare software to be used globally, use compliance testing to ensure that you are not breaking any local laws simply due to not knowing them. For example, in the US, all healthcare applications need to be HIPAA-compliant, which means that in the US, healthcare testing requires HIPAA to be taken into account, among other things.

Automated Healthcare QA: Why and How to Automate Healthcare IT Testing

Test automation has long been one of the most vital developments in the software testing industry. Ever since QA teams started automating testing, they have been noticing a stark difference in both the process and the outcome of testing. Naturally, a task as resource-intensive as QA testing in healthcare is also a perfect fit for automation, helping solve a number of challenges and bringing additional benefits to the product stakeholders:

• Higher test coverage. Automation helps you dramatically increase test coverage, allowing you to include test cases that would often be skipped due to the lack of resources for manual testing. This helps you test more scenarios, even ones that seem unlikely at the moment.
• Faster time to market. Automating the testing process delivers results faster, which allows you to test earlier in the SDLC, detect and correct issues at a higher rate, and time your releases better to beat your competition in the market.
• Better interoperability and cross-platform compatibility. Medical software is usually designed to operate on a myriad of platforms and work together with a myriad more of medical software and hardware products, and automation helps account for more possible combinations than manual testing.
• Higher ROI of testing.  Automated testing is often associated with an elevated need for resource investment, and it’s true in the early stages of automation where the team needs to set up the entire process. However, the longer automation continues, the higher the ROI of testing is going to be.
• Increased quality of products. The benefits of automated testing are too numerous to list them all in one article. But, at the end of the day, we test software to create more functional, stable, secure, and usable products, and that’s exactly what automation helps achieve.

Right now is the perfect time to invest in automated healthcare QA: despite the level of innovation that has always been present in healthcare software, the industry is still falling behind on the automation trend. Only 15% of healthcare software providers embrace automated testing, which means that whoever starts automating right now will get the upper hand, releasing better-quality software at a faster rate.

Key Challenges in Healthcare App Testing

The latest healthcare developments make it clear that the healthcare industry is growing at a brisk rate. Timely and all-encompassing healthcare software testing helps make sure that you, as a product owner, don’t stay behind the rapidly developing industry. And part of that is being fully aware of the healthcare software testing process, including its challenges and limitations. Here are the issues you can face when healthcare testing is conducted.

User-Friendliness

One of the specific challenges of healthcare domain testing includes the fact that healthcare applications are designed for a wide category of users, including patients of older age who may not necessarily be tech-savvy. This means that the team responsible for healthcare IT testing must test the product from different perspectives, meaning even the most improbable test case may turn out to be essential for the success of the whole operation.

Interoperability

In healthcare software and medical device software testing, there were times when interoperability was merely a best practice, not a requirement. During these times, desktop application testing was the main QA activity in healthcare. Then teams gradually started doing healthcare mobile app testing along with desktop testing. However, things changed the most when medical applications became available on a wider range of platforms. These days, interoperability is essential for QA testing in healthcare. What makes the interoperability aspect particularly challenging is that the range of devices in healthcare testing isn’t just limited to desktop computers and mobile devices, as both hospitals and patients use a myriad of heavy equipment, sensors, wearables, and other electronics for data transfer, which means that the test cases for healthcare application testing must account for all potential combinations.

Security

Patients use medical applications to communicate with their healthcare providers about the most sensitive subjects, so there is no room for error when it comes to the security of the solution. For the testing team, it means not only evaluating every aspect of the solution to ensure its absolute security, but also keeping sensitive information safe in the process. Many QA teams and companies now use non-invasive testing techniques, which involve testing without gaining access to private information within the application or sensitive parts of the code base.

Regulatory Compliance

Healthcare software is not exactly unique when it comes to regulatory compliance: there are both industry-specific regulations — for example, for banking and financial products — and general regulations that all software products have to adhere to, such as GDPR in Europe. However, healthcare apps are definitely unique when it comes to the sheer number and complexity of regulations they need to comply with. We’ve already mentioned HIPAA, which is the main regulatory requirement for healthcare products in the US.

Still, the list doesn’t stop there. There is also HL7 (Health Level 7), which regulates the process of exchanging medical data between different healthcare systems, FHIR (Fast Healthcare Interoperability Resources), which dictates the appropriate data formats and APIs to be used with electronic health records, XDS (Cross-Enterprise Document Sharing) and XDS-I, its healthcare-specific extension for sharing medical images.

Plus, there are international regulations as well: there is PIPEDA (Personal Information Protection and Electronic Documents Act) in Canada, the Privacy Act 1988 in Australia, the European Commission – Directorate-General for Health and Food Safety in the European Union, Health Data Law 2019 in UAE, and so on. Depending on where you intend to make your product available globally, you may need to test your software against dozens of different regulations. This is where a reliable testing partner, experienced specifically in healthcare compliance testing, can come in handy.

Working With a Vendor for Healthcare QA: Key Insights

Healthcare software quality assurance is such a complex, time-consuming, and labor-intensive task that only the biggest companies with the largest staff can afford to keep their testing operations in-house. Everyone else has to go for an alternative method of testing their software, and outsourcing software testing in healthcare is currently the most popular solution.

Needless to say, you cannot just randomly pick a QA vendor and entrust them with something as significant to your business reputation as testing a healthcare software product. The vendor for this task needs to be picked very carefully: most importantly, they need to have relevant experience in healthcare IT testing and a thorough understanding of what needs to be done. A portfolio of relevant cases will tell you a lot about it, as will the content the vendor publishes regarding healthcare software solutions.

Vendor Management: How to Make the Most of Your Cooperation

Choosing the best possible vendor for your healthcare QA project is only half the battle. The other half is building the collaborative process to ensure maximum benefits to your company. Here are some tips for managing the project like a pro:

• Invest time in contract negotiation. One of the best ways to ensure the success of an outsourced testing project is to allocate time to negotiating the right contract for your needs. When it comes to healthcare projects, it’s important to include provisions regarding HIPAA compliance and extra security measures to protect sensitive patient information in addition to the usual provisions like team roles and responsibilities, project scope, deliverables, timelines, and costs.
• Introduce project management and communication tools. A vital benefit of working with an outsourcing partner is that you get to call all the shots, and that includes using your preferred project management and communication solutions. Have the vendor adjust to your communication needs, not the other way around. You can not only choose the tools you want to use, but also set the communication schedule, the preferable format for reports, the work schedules, the milestones, and so on.
• Create a culture of continuous improvement. Healthcare testing projects are usually designed to last for months, if not years, since there is so much to test. This is why, as the application progresses, your vendor’s approach needs to do the same. To achieve this, you’ll need to introduce performance metrics and feedback mechanisms to regularly evaluate your vendor’s work and communicate your findings to them. Point out the strengths and weaknesses of the vendor in a specified period of time to create a continuous improvement process that will ultimately benefit every participant.
• Don’t let technical debt build up. Technical debt is perfectly normal on a software testing project. However, it does become a problem when there is too much of it. A reliable vendor will always notice, encouraging you to take steps to eliminate it. A vendor who lacks integrity or technical proficiency will let the debt grow, which can result in a string of problems down the line, including the product shutting down, temporarily or permanently, due to the accumulated issues. Attitude towards technical debt is a good way to evaluate a QA vendor in general.
• Enforce strict documentation practices. Documentation is a vital component of a software testing project, and is even more important for healthcare IT testing. Documentation is useful both throughout the duration of the project and afterwards, or when you decide to employ another vendor for the next phase of the project. This is why you need to request the vendor to create and maintain detailed documentation. Moreover, a good QA vendor will actually study your existing documentation first, notifying you of any gaps and assisting you in filling those gaps.

Tips and Best Practices for Healthcare Application Testing

Testing products in the healthcare domain is often a challenging task because of how much is at stake and how different healthcare apps are from other types of software. Still, the testing phase is integral for releasing high-quality applications, and here are a few practices and best tips for achieving even more with your testing project.

1. Get a Thorough Understanding of the Healthcare System

Before you take any active steps to test your healthcare product, it’s vital to ensure that you know exactly what that entails and what the healthcare software industry currently needs. You need to know what kinds of apps are out there, how they work on their own and when integrated with each other, what users — healthcare providers and regular people — are looking for in a five-star application, and what kind of laws and regulations govern healthcare apps in your chosen location. It’s also crucial to make that research not a one-and-done occasion, but consciously make an effort to stay on top of new trends and developments.

2. Cooperate With Healthcare Providers

Software testers will do an excellent job of ensuring the spotless technical state of the application, using their expertise in QA to scrutinize every possible technical aspect of the product. However, no one has more insights about the functional and usability sides of the application than the people the app is actually intended for. Creating close collaborations between healthcare providers and testers, and including healthcare professionals in the testing process, delivers stronger results and helps create products the target audience wants to use.

3. Get Testers Involved Early

There are currently different approaches regarding where to start testing in the software development lifecycle. Some teams follow the Waterfall model and begin testing only after the product development is completed. Others follow Agile practices and the shift-left approach, moving testing to the earlier stages of the SDLC. An approach that has proven to be even more effective, however, is involving the testing team already at the requirement elicitation stage. The team will confirm that the requirements are consistent and testable, kicking off the quality assurance process and overseeing the creation of a stable, flaw-free product.

4. Use Mock Data in Healthcare Testing

Performing software testing on a completed or nearly completed product typically requires large sets of data to test different scenarios and use cases. Many teams use real patient data to make the testing process more realistic, but the truth is that using real data can jeopardize the integrity and security of sensitive patient information in case there are undetected gaps in the product’s security. Using mock data in the corresponding format gives just as much insight into how the application works without putting patient safety at risk.

5. Measure Testing Effectiveness With KPIs

We all know the general goal of testing: to create high-quality, functional products with great usability, solid performance, and unparalleled security. But how exactly do you evaluate the success of the testing process before you can get any feedback from actual users or assess your market positions? The good news is that you can use a set of testing KPIs at all stages of the QA process to know if it’s going well and what needs to be changed to improve it. Common healthcare domain testing KPIs include:

• Total number of test cases created, updated, and executed
• Average number of test cases created, updated, and executed over a certain period of time
• Requirements coverage
• Defects found and rejected
• Defects leaked
• Ratio of reopened issues to resolved issues
• Time and money spent on testing over a certain period of time

Final Thoughts

We are not here to tell you that testing medical software is more important than testing activities with other types of software. At the same time, the cost of failure for a medical application is significantly higher than that of most other products. If you’re not willing to take that risk, testing early and testing in full is the only way to keep critical issues at bay, improving the usability and security of the product, and giving it a significant advantage in the increasingly competitive market.

Medical software testing might seem overly complex, but the complexity of the healthcare domain testing comes from the fact that the healthcare software testing team has more responsibility behind this process is even higher compared to other projects. The described above steps and techniques aimed at polishing a medical application to the point the release of it would be valuable for the industry, useful for clinicians, and relieving for patients. Our background with medical and healthcare applications taught us to never settle for less than an A to Z tested application before the release, as well as ongoing improvement and post-launch support, so you can safely entrust us with your healthcare software testing project and expect a stellar result.