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Setting up Center of Excellence for QA in Healthcare

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April 2019
Setting-up Center of
Excellence for QA in
Healthcare
White Paper

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QA Center of Excellence (TCOE) is a model for
centralized testing platform that provides a platform
for standardizing test...

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2
1.1.2 Key Drivers
The following factors should be in place for the
success of the QA CoE:
▪ Empowered & Skilled Personne...

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Setting up Center of Excellence for QA in Healthcare

  1. 1. April 2019 Setting-up Center of Excellence for QA in Healthcare White Paper
  2. 2. QA Center of Excellence (TCOE) is a model for centralized testing platform that provides a platform for standardizing test processes and optimal utilization of resources for test purposes. It brings the infrastructure and resources together for achieving excellence in testing functions. The below diagram presents the core building blocks of a QA Centre of Excellence Framework. 1.1 Parts of Framework 1.1.1 Executive Commitments The obligations at the executive level for the success of QA CoE are: ▪ Budget –Overall investment required to setup and sustain the QA CoE (cost of resources, training, infrastructure, hardware / software licenses, audits) has to be approved ▪ Business Drivers – Clear and concise objectives should be set for the QA CoE to measure success ▪ Transparency – QA CoE will be successful only when standardized and streamlined processes are followed across various projects. Also, there should be visibility and transparency to eliminate any kind of latency that may delay testing activities ▪ Leadership Review – Continuous feedback and suggestions by stakeholders and leaders is essential for a CoE to be successful 1. HEALTHCARE QA CENTER OF EXCELLENCE (CoE) FRAMEWORK 1 QA CoE Framework
  3. 3. 2 1.1.2 Key Drivers The following factors should be in place for the success of the QA CoE: ▪ Empowered & Skilled Personnel • Shared / Flexible resource pooling across different projects • Continuous improvement and innovation • Build knowledge repository for cross skilling and training • Create a defined and structured core team with expertise in various applications ▪ Standardized Approach • Structured, business-driven testing approach (TDD / TLD & BDD) • Training and audits to ensure adherence to standards and guidelines • Tailor-made best practices and processes to achieve greater ROI • Metrics management / Dashboard reporting mechanism ▪ High-end IT Expertise • Create automated frameworks to ensure reusability • Leverage top industry tools like TFS, HPQC, QTP, Selenium, Test Complete, Ranorex etc. • Keep abreast with the latest trends in testing through continuous training and R&D ▪ Streamlined Project Management • Define KPIs / SLAs to meet organization objectives • QA resource management and planning • Apply quality management principles across all projects • Focus on PHI compliance to ensure that healthcare security is not compromised
  4. 4. 3 1.1.3 Key Performance Indicators The following KPIs should be measured to track the success of the QA CoE against set business drivers and, based on the same, improvements should be brought about to achieve the goals: ▪ Improve Test Effectiveness • Define metrics to gauge the quality of the QA deliverables • KPIs should be defined at each stage of the STLC • Test plan coverage, test creation and execution productivity, defect escapes in prod, and defect density should be measured in every release ▪ Reduce Time to Market • Have a shift left approach • Integrate testing strategies in the CI / CD pipeline • Introduce parallel batch executions • Improved project management ▪ Performance Benchmark and Compliance Review • Set up the processes for performance benchmarking • Identify KPIs that can be measured and compare with the benchmark • Setup standards for the compliance review process ▪ Conformance of Standards and Quality • Define and set the guidelines for standards to be followed • Identify areas to be measured for conformance of quality and standards • Define ways to measure the conformance of standards 1.2 Details of Core Services 1.2.1 List of Core Testing Services ▪ Manual & Automation • Smoke / BVT Testing
  5. 5. 4 • Sanity Testing • Functional Testing • Integration Testing • Database Testing • Regression Testing • User Interface Testing • Patient Safety Testing • Exploratory Testing ▪ Security ▪ Performance 1.2.1 List of Core Testing Services The following testing strategies (manual / automated) should be implemented as part of the testing process: ▪ Smoke / BVT Testing Test Objective ▪ To validate the critical functionalities of the application are working properly Technique (contd.) ▪ Create the test cases to verify that the basic functionality is working as expected ▪ Execute the test cases and ensure that the objective is satisfied Test Entry Criteria ▪ Build is deployed successfully on the test environment Test Completion Criteria ▪ All planned smokes tests have been executed ▪ No tests have failed in the smoke test execution Special Considerations ▪ Should be performed every time a build is deployed ▪ Required test data should be present to test the end-to-end functionality
  6. 6. 5 ▪ Sanity Testing ▪ Functional Testing Test Objective ▪ To validate the functionalities of specific features being tested are working as expected ▪ It is specific to the new feature being developed and tested Technique ▪ Create the test cases to verify the basic functionality of the feature is working as expected ▪ Execute the test cases and ensure that the objective is satisfied Test Entry Criteria ▪ Build is deployed successfully on the test environment Test Completion Criteria ▪ All planned tests have been executed ▪ No tests have failed in the test execution Special Considerations ▪ Should be performed every time a build is deployed ▪ Required test data should be present to test end-to-end functionality Test Objective ▪ Validate how well QA executes functions for positive, negative, and boundary conditions Technique ▪ Create the test cases to verify that the functions as specified in user stories ▪ Execute the test cases and ensure that the objective is satisfied
  7. 7. 6 ▪ Integration Testing Test Entry Criteria ▪ User story is completed by Developer and code is pushed to QA environment Test Completion Criteria ▪ All planned tests have been executed ▪ All identified defects have been addressed Special Considerations ▪ Should be performed in the QA environment before signing off the user story ▪ Required test data should be present to test the end-to- end functionality Test Objective ▪ Validate how well QA executes functions for positive, negative and boundary conditions ▪ Validate data inserted from one application is displayed in other Technique ▪ Create the test cases to verify that the functions and integration as specified in user stories ▪ Execute the test cases and ensure that the objective is satisfied Test Entry Criteria ▪ User story is completed by Developer and code is pushed to Integration environment ▪ The 3rd party systems are up and running and the connection between the systems are enabled Test Completion Criteria ▪ All planned tests have been executed ▪ All identified defects have been addressed
  8. 8. 7 ▪ Database Testing Special Considerations ▪ The testing should be performed in the Integration environment, where the environment is connected to the other 3rd party systems and data flow between the applications is setup ▪ Integration testing takes place before the release to ensure all systems are functioning well. It is also executed when the user stories / functionality depends on 3rd party systems Test Objective To validate whether the following criteria are satisfied: ▪ The database access methods function as required ▪ The integrity of the data stored in the database is maintained Technique Create scenarios to: ▪ Inspect the database to ensure that data has been populated as intended and all database events have triggered appropriately ▪ Execute the scenarios to ensure that objective is satisfied Test Entry Criteria ▪ User story is completed by developer with code and data pushed to the test environments and database Test Completion Criteria ▪ All planned tests have been executed ▪ All identified defects have been addressed Special Considerations ▪ NA
  9. 9. 8 ▪ User Interface Testing ▪ Regression Testing Test Objective To validate that the following criteria are satisfied: ▪ Navigation through the application properly reflects business functions and requirements ▪ Report objects and characteristics, such as menus, modules, filters, sizes, positions, states, and focus conform to client specified and user story Technique ▪ Create the test cases for each report to verify proper navigation and object states for each application window and object ▪ Execute the set of test case to ensure that objective is satisfied Test Entry Criteria ▪ User story is completed by Developer and code is pushed to test environment Test Completion Criteria ▪ All planned tests have been executed ▪ All identified defects have been addressed Special Considerations ▪ NA Test Objective ▪ To ensure that any functionality found working perfectly before a new release should not break post any new release Technique ▪ Identify a set of test cases that need to be performed as the first test suite (regression test suite) on any new release
  10. 10. 9 ▪ Security Testing Technique (contd.) ▪ When a new release is received by the testing team, all the test cases should be executed in the regression test suite to ensure the basic functionality in the previous release is not broken in the new release Test Entry Criteria ▪ A complete integrated build is deployed on test environment which would be released in production Test Completion Criteria ▪ All planned tests have been executed ▪ All identified defects have been addressed Special Considerations ▪ Regression testing is done before every release ▪ Only one regression cycle if no critical/high defect is found Special Consideratio ns (contd.) ▪ If critical/high defect is raised then second cycle of regression post developer fixing it Test Objective ▪ To identify security vulnerabilities in the application ▪ To validate that the application is reasonably secure from known vulnerabilities Technique ▪ Create a test plan with security test scenarios ▪ Perform automated security testing using tools ▪ Perform manual security testing to confirm vulnerabilities reported by the tools and areas not covered by the tools i.e. business logic bypass
  11. 11. 10 ▪ Performance Testing Test Entry Criteria ▪ User story is completed by developer and code is pushed to test environment ▪ Required test data should be present to test the end-to-end functionality Test Completion Criteria ▪ All planned tests have been executed ▪ All identified security vulnerabilities have been addressed Special Considerations ▪ Should be performed every time a there is a new change ▪ There should be a complete code freeze in the test environment ▪ To ensure the integrity of the test results, there should be other form of testing in the environment where security testing is conducted Test Objective ▪ To validate that the application meets the defined performance SLAs ▪ To benchmark the performance of the application under expected user load ▪ To assess the impact of architectural changes (new component added, configuration changes) on performance ▪ To evaluate the scalability of the application in terms of number of users and transactions supported
  12. 12. 11 Technique ▪ Understand the production / expected usage to design the workload and identify workflows and scenarios for performance testing ▪ Create scripts for end-to-end user workflows ▪ Execute planned tests and capture performance metrics ▪ Highlight any performance issues – in terms of response time, application / system errors and server resource usage Test Entry Criteria ▪ The workflows in scope for performance testing is functionally stable ▪ All information required to plan and design the test is provided to performance test engineer Test Completion Criteria ▪ All planned tests have been executed ▪ All issues identified have been resolved / deferred Special Considerations ▪ Should be executed if the expected load on the application will increase ▪ If product / application is rolled out in new region / to new customers ▪ If architectural changes have been made to the application ▪ If new functionalities / workflows have been added or modified
  13. 13. 12 ▪ Patient Safety Testing Patient safety is emphasized in healthcare through the prevention, reduction, reporting, and analysis of medical errors which may lead to adverse effects. Patient safety test suite is created to ensure: ▪ Data of one user doesn’t get displayed to another user on any system ▪ Data entered on all platforms (web application, iOS or Android) is stored and displayed correctly ▪ Patient related information isn’t incomplete or displayed inaccurately in the EHR to ensure correct and relevant information is available for taking clinical decisions Technique ▪ Identify critical workflows that may risk a patient’s life ▪ Identify usability test cases to be performed for certification that focus on EHR functions required by ONC ▪ Identify real life scenarios pertaining to: ▪ Data Entry – Ensure that the right fields have correct values to be selected, units of measurement are appropriate, labels are marked properly, easily interpretable, and are as per standards ▪ Authorization – The correct roles and access are set to ensure wrong access to information is not provided Test Objective ▪ To test workflows which will test usability and patient safety aspects of the application which can impact / risk the life of a patient
  14. 14. 13 Technique (contd.) ▪ Alerting – Proper alerts to be generated in case any important notification needs to be passed to the clinician, pop-ups aren’t blocked, alerts are self- explanatory and simple ▪ Interoperability – Data should flow correctly from different systems or other modules within the same system and related standards are maintained ▪ Visual display – The labels and fonts of the fields should be clearly visible for the clinicians to select appropriate values ▪ Automated settings – The automated settings should be properly validated to ensure that dates, doze, and other values are tested to be the right values Test Entry Criteria ▪ A complete integrated build is deployed on test environment which would be released in production Test Completion Criteria ▪ All planned tests have been executed ▪ All identified defects have been addressed Special Considerations ▪ Patient safety testing is done before every release on priority ▪ The release will be stopped in case any of the patient safety test cases fail ▪ Member who creates the patient safety test suite should have proper domain and product knowledge
  15. 15. 14 ▪ Exploratory Testing Test Objective ▪ The main purpose is to identify bugs (as against scripted testing which validates the application against requirements) ▪ To test the application without any specific test cases, and check if design and execution are simultaneously executed Technique ▪ Define the scope of exploratory testing and the time limit for the same (90 minutes) ▪ Note defects from previous releases and categorize them to identify areas for exploratory testing ▪ Identify use cases which imitate real-life users Technique (contd.) ▪ Test the application using any of the following techniques ▪ Freestyle exploratory testing – test the application in an ad hoc manner ▪ Scenario based testing – Testing performed is based on scenarios provided by customers or prepared by the test team ▪ Strategy based testing – Common testing techniques like Decision Table based testing, Cause-Effect graphing, and Error Guessing are combined with exploratory testing ▪ Document areas covered to understand test coverage ▪ Document defects found to enhance exploratory test plan
  16. 16. 15 Test Entry Criteria ▪ A complete integrated build is deployed on test environment which would be released in production ▪ List of defects from previous releases are provided by the production support team Test Completion Criteria ▪ Time slotted for exploratory testing is over ▪ Major areas of the application are covered as part of exploratory testing Special Considerations ▪ Success of exploratory testing depends on the knowledge of the tester with respect to the application and the domain ▪ Documentation is necessary to be done along with the testing ▪ Exploratory testing can not be automated
  17. 17. 16 1.2.3 Manual Testing Approach
  18. 18. 17 1.2.4 Automated Testing Approach
  19. 19. 18 1.2.5 Security Testing Approach
  20. 20. 19 1.2.6 Performance Testing Approach
  21. 21. 1.2.7 Key Strategy Considerations 20
  22. 22. 21 1.2.8 Test Data Management Test data management is the creation of non- production datasets that reliably mimic an organization’s actual data so that systems and applications developers can perform rigorous and valid systems tests. It helps organizations create better quality software that will perform reliably on deployment. It prevents bug fixes and rollbacks and overall creates a more cost-efficient software deployment process. It also lowers the organization’s compliance and security risks. Factors to consider for Test Data Management 1. Test Data Sources ▪ Manually create test datasets using the application workflows, e.g., patient creation, add allergies and other details for the patient, claims creation and other workflows for these claims, etc. ▪ Automate the test data creation by automating the workflow (mentioned above), which can be used repeatedly to create numerous records ▪ Back-end insertion of the test data into the DB directly by running SQL scripts or generating bulk HL7 messages / EDI files, etc. ▪ Running batch files manually to copy data from production, de-identify it and then dump into the test environment ▪ Use of tools to sync de-identified production data to the test environments ▪ Mock test data by creating stubs or using automated tools e.g.: Mountebank 2. PHI Data Masking ▪ There are various ways in which test data can be masked. Especially when dealing with PHI data, its important to mask the PII and PHI data. The following fields needs to be masked: ▪ Individual’s past, present, or future physical or mental health or condition
  23. 23. 22 ▪ Provision of health care to the individual ▪ Past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe can be used to identify the individual. ▪ Protected health information includes many common identifiers (e.g., name, address, birth date, Social Security Number) when they can be associated with the health information listed. ▪ There are various ways in which data can be masked, few of which are: ▪ Encryption – Data will be encrypted using encryption key and only someone who has the decryption key can decode the data ▪ Substitution method – Replace with other meaningful data which is like an alias to the value being masked. E.g.: Replace SSN number with a random number by using random number generators ▪ Redaction – Replace the data with a generic value. E.g. all credit card numbers can be replaced with 1111-2222-3333-4444 ▪ Date Aging – All dates can be set to a policy of dating it back by 6 months or 2 years or as applicable. E.g. DOB of males aged more than 50 should be reduced by a year 3. Test Data Cleanup ▪ Manually delete the test data entries created using the appropriate workflows. E.g.: registered patient should be discharged, entered claims should be denied or approved, etc. ▪ Run automated scripts to change the status of the test data to the required end state such that it’s not visible as active ▪ Recreate the DB schema completely (delete and create new DB schema)
  24. 24. 23 ▪ Run SQL scripts or trigger HL7 / EDI files to change the status of the test data entries 4. Test Data Backup Once the test data is created and the application is ready to be used, create a dump (backup) of the DB. Next time when the build is deployed, run the restore scripts to load the test data into the application. 5. Test Data Maintenance Test data should be refreshed periodically. The periodicity should be defined keeping in mind: ▪ If the period is too less, the testers will find it difficult to recreate their specific test data which is not created through automated scripts or bulk file uploads ▪ If the period is too high, the test data might not be accurate as per the latest functionality and testers might miss testing the real edge cases due to improper/ invalid test data ▪ Test data refresh exercise should keep in mind: ▪ Changes in existing DB schema, data constraints, rules, etc. ▪ Addition of new database tables or fields ▪ Changes in functionality ▪ Changes in DB schema or data constrains of the 3rd part systems which might impact the applications functionality
  25. 25. 24 Environment Testing Strategy Test Data Source Test Data Clean-up Test Data Maintenance Dev ▪ Unit testing ▪ In-Sprint scenario testing ▪ Manual creation ▪ Automated scripts/ SQL scripts ▪ Recreate DB schema ▪ Refreshed when there is change in DB schema, constraint, API contracts QA ▪ In-sprint testing ▪ Functional testing ▪ Automation testing ▪ Automated scripts/ SQL scripts/ Bulk HL7/ EDI files ▪ Copy, de-identify and dump from Prod database ▪ Run scripts to clear the test data i.e. change status of records ▪ Recreate the DB schema ▪ Periodic refresh (decided based on the release and changes planned) ▪ Refreshed when there is a change in DB schema, constraints, API, etc. ▪ Test Data and Environment Strategy
  26. 26. 25 Environment Testing Strategy Test Data Source Test Data Clean-up Test Data Maintenance Integration ▪ End-to-end testing ▪ Integration testing ▪ Release testing ▪ Automated scripts / SQL scripts / Bulk HL7 / EDI files ▪ Copy, de-identify and dump from Prod database ▪ Ensure connectivity and data flow between 3rd party systems ▪ Real data or mock the test data from 3rd party systems ▪ Run scripts to clear the test data i.e. change status of records ▪ Recreate the DB schema ▪ Periodic refresh (decided based on release & changes planned) ▪ Refreshed when there is a change in DB schema, constraints, API, etc. UAT ▪ User acceptance testing ▪ Integration testing ▪ Copy, de-identify and dump from Prod database ▪ Recreate the DB schema ▪ Real data should flow from 3rd party systems ▪ Refreshed every new release ▪ Periodic refresh (decided based on release & changes planned) ▪ Refreshed when there are changes in DB schema, constraints, API, etc.
  27. 27. 26 1.2.9 CoE Governance 1.2.9.1 Project Framework Client/ vendor should use a project management process that includes a formal set of tools and techniques to initiate, plan, execute, monitor, control, and close projects. It should include: ▪ A clear project framework for achieving project specific goals and business goals ▪ Emphasis on phased execution (i.e., regular and measurable progress) ▪ A systematic approach to resolving high-risk factors associated with an objective Throughout the implementation, the client team will be equipped with the correct tools and resources to assist with strategic decisions, and client/ vendor should work to identify critical use cases that will support their vision and objectives. The QA strategy should be tailored to meet the client’s preferences and accommodate varying levels of technical capabilities. A phased implementation approach is recommended, keeping in mind the following objectives for ensuring sustainable success of your initiative: ▪ Ensure rapid go-live ▪ Minimize risk and demonstrate value early ▪ Ensure effective adoption ▪ Interactively evolve the solution with user feedback ▪ Realize quick and sustained ROI 1.2.9.2 Roles and Responsibilities CitiusTech Role Key Responsibilities Healthcare QA Manager ▪ Project planning and coordination ▪ Team management and technical leadership ▪ Weekly status reporting covering progress, plan, issues and risks
  28. 28. 27 1.2.9.3 Project Lifecycle Following is a schematic representation of the Agile (SCRUM) methodology for project execution: CitiusTech Role Key Responsibilities Healthcare QA Lead ▪ Client coordination ▪ Sprint planning, backlog & retrospective ▪ Daily standup and sprint velocity Healthcare QA Engineer ▪ Create test plan & test cases for functional and non- functional requirements ▪ Test data setup & test case execution for functional, system integration & performance testing ▪ Defect tracking and re-testing Security Testing Specialist ▪ Information security and privacy requirements ▪ Security testing scenarios, test cases, test execution, test result reporting CitiusTech Role Key Responsibilities Security Testing Specialist (contd.) ▪ VAPT and support regulatory / industry certification efforts Performance Specialist ▪ Performance SLA review / discussions ▪ Performance testing scenarios, test cases, test execution, test result reporting ▪ Support certification efforts
  29. 29. 28 Project Lifecycle
  30. 30. 29 1.3 Process of Setting Up CoE
  31. 31. 30 1.3.1 Execution process for each application within CoE 1.3.1.1 Requirement Analysis Sr. No. Activity Owner & Participants Templates Tools / Technology 1 PO / BA to conduct refinement session with the QA Team before the sprint starts PO / BA / SM or Project Manager NA Meeting 2 PO to document all the user stories with acceptance criteria before the sprint starts PO NA Agile Tool 3 PO to document the Impacted areas in the User Story (in case of legacy systems) PO NA Agile Tool 4 PO to attach detailed requirement documents(mockups / wireframes) if any to the user stories PO NA Agile Tool
  32. 32. 31 1.3.1.2 Sprint Planning / Release Planning Sr. No. Activity Owner & Participants Templates* Tools / Technology 1 Only prioritized user stories with clear requirements should be selected for Sprint Planning Scrum Team NA NA 2 During planning, QA estimates (story points) should be considered QA Team / SM ▪ CT Estimation Guidelines ▪ CT Template Sprint Tracker Agile Tool, etc. 3 The team should be clear on Definition of Done for QA tasks QA Team Refer Appendix 3.1 Agile Tool, etc. 4 User story state should be correctly maintained Scrum Team Refer Appendix 3.2 Agile Tool, etc. 5 Create the QA project plan to define overall QA processes QA Lead CT PMP - QA Project Word / Excel Document, etc. 6 Form team based on requirements & estimates (skill sets, experience, etc.) Project Manager Refer Appendix 3.3 NA * Templates mentioned are created as part of SmartTest and SmartAutomation processes followed at CitiusTech. These work as accelerators which can be readily used for any project with appropriate customization.
  33. 33. 32 1.3.1.3 Test Design (Manual) Sr. No. Activity Owner & Participants Templates Tools / Technology 1 Create the Test Approach and Strategy document for the project QA Lead CT Test Approach and Strategy PowerPoint, etc. 2 Post requirements grooming session, QA team to brainstorm and create scenarios QA Team CT Template Test Scenario Excel, etc. 3 Manual Testing effort estimation QA Team CT Template Test Estimation-Manual Excel / Agile Tool, etc. 4 Review of scenarios by BAs and Dev's QA / BA / Dev CT Review Tracker Excel, etc. 5 QA Team to create test cases based on scenarios QA CT Template Test Suite TCMS – TFS, ALM, Zephyr, etc. 6 Peer and Lead review of the test cases QA CT Template Test, Case Review Checklist Excel, etc. 7 Define the KPIs and the SLAs QA Lead Refer Appendix 3.4 Excel, etc.
  34. 34. 33 1.3.1.4 Test Design (Automation) Sr. No. Activity Owner & Participants Templates Tools / Technology 1 Create the Automation Strategy Document Automation Lead CT Template Automation Strategy Document 2 Estimate automation efforts based on requirements gathered Automation Lead / Team CT Template Test Estimation- Automation Estimation Document 3 Design the automation framework for the project Automation Lead / Team Automation Testing Process and Best Practices; Automation Frameworks Automation Code in the Tool 4 Automate the test cases and create automation scripts Automation Team Create coding guidelines Sample: CT VBScript Automation Coding Guidelines Automation Scripts in the Tool 5 Track the automation status Automation Lead CT Template Automation Tracker Automation Tracker Document
  35. 35. 34 1.3.1.5 QA Environments and Build Strategy ▪ Specific user story testing for the release R1 done during sprint cycles of R1 ▪ Post the sprint testing, team gives sign off on the sprints – on CI and QA Environment ▪ Regression testing of the overall stories for the release R1 (across sprints) is pending ▪ Integrated build for the release is deployed in the Integrated Environment, which is like a Pre-Prod environment ▪ Regression testing of the release R1 is done in the sprints cycle of next release i.e. R2 along with the user stories for that release R2 ▪ After that R1 is released into production ▪ Regression testing of R2 stories is executed in the R3 release sprint cycles
  36. 36. 35 QA Environment and Build Strategy
  37. 37. 36 1.3.1.6 Test Execution (Manual) Sr. No. Activity Owner & Participants Templates Tools / Technology 1 Execute the test scenarios QA Team CT Template Test Execution Result Zephyr / TFS / QC etc. 2 Log defects for issues and failed test cases QA Team CT Template Test Defect Report Jira / TFS / QC etc. 3 Defect lifecycle – Triage the defects and assign to the developers PO / QA Team Refer Appendix 3.5 4 Sent the test execution status reports to the stakeholders QA ▪ CT Template Test Execution Result ▪ CT Template Test Status Report Jira / TFS / QC dashboards, etc. 5 Provide QA Sign-off on the final build for a sprint or a release QA CT Template QA Sign Off Word document, etc. 6 Conduct RCA of the defects escaped in production QA Team CT Template Defect Analysis Excel document, etc.
  38. 38. 37 1.3.1.6 Test Execution (Automation) Sr. No. Activity Owner & Participants Templates Tools / Technology 1 Execute the automation scripts in batches and send daily reports Automation Team ▪ CT Template Batch Detail and Summary Report ▪ CT Template Batch Summary Report Automation Tool / TCMS (Automation Anywhere, Katalon, Selenium etc.)
  39. 39. 38 1.3.2 Suggested Flow Team Structure ▪ Formal Agile team structure should be formed ▪ Roles and Responsibilities for scrum team should be defined ▪ QA members (manual + automation) to be part of the scrum team PO / BA ▪ PO should create product backlog ▪ PO signoff for user stories should be obtained before testing starts Dev ▪ Dev team should share build release notes and provide unit test results ▪ Dev team should provide impact analysis of the fixes / changes made QA ▪ Each team member should attend sprint planning meeting and create sprint backlog ▪ Test strategy and test plan should be created ▪ Estimation template should be used for user stories for sprint planning ▪ QA team should create manual test cases in the TCMS ▪ Peer review of manual cases and signoff from BA should be taken ▪ QA team should execute automated BVT (Build Verification Test) after each build ▪ Jira should be used to track Requirement traceability ▪ Smoke and regression suites should be identified ▪ QA team should identify business critical scenarios and add to regression suite ▪ Automate regression cases (API Web, Mobile) ▪ Automation and manual test execution report should be shared with the team
  40. 40. 39 2.1 Testing Effectiveness ▪ Defect Escapes • With reduced defect escapes through RCA and defect prevention, client can achieve Improved Quality Defect escape = # of Client reported defects * 100 ---------------------------------------------------------- (# of QA defects - # of QA defects rejected) + (# of Client reported defects) ▪ Test Cycle Execution Time • Reduction in the execution cycle through automation and multiple environments, client can achieve Faster time to Market • Test execution time = Total time taken to run the test cases (manual and automation) for a build or release • Test Coverage • Testing coverage will increase due to automation which will help achieve Improved Quality Test Coverage = Total no of requirements tested ---------------------------------------------------------- Total no. of requirements released 2.2 Tools ▪ Hardware/ software license usage • With optimal usage of hardware and software, client can achieve improved quality as well as Faster time to Market) • Use of software license metrics is recommended here (Named User / Role, Concurrent User / Instance, Instance, Managed Capacity, Performance, Physical Machine, Machine Compute Capacity) ▪ Environment Usage • Due to managed build deployment and testing strategy, client can achieve Improved quality as right environment will be used for the right kind of testing 2. KPIS TO ACHIEVE BUSINESS BENEFITS
  41. 41. 40 • Also multiple environments will ensure simultaneous testing being conducted and thus facilitate faster time to market • Environment usage matrix will help define which environment should be used for which testing and what stages 2.3 People ▪ Resource Skill Index • With the skill set of the resources improving through cross-skilling and documentation, the client can achieve Faster time to Market, as well as Improved Quality • Sample Skill Matrix Weight Descriptor: 1 – Needs training 2 – Currently being trained 3 – Trained & has knowledge to test independently 4 – Trained & can train others • Based on the total score, we know which module / tool / domain is least known and needs more attention from a training perspective • We can also set threshold that if the score of an area is less than that, it needs attention ▪ Resource Utilization • With proper usage of resources across projects, the client can achieve Faster time to Market • Based on the skill matrix and availability of the members, the resources can be utilized for different projects to ensure resources are leveraged optimally Team Mem Mod 1 Mod 2 Tool 1 Tool 2 Dom 1 Dom 2 Mem 1 1 3 2 3 2 3 Mem 2 4 3 2 3 3 4 Total 5 6 4 6 5 7
  42. 42. 41 3.1 Template for Tasks for User Stories The following QA tasks should be created for a User Story: ▪ Scenario brainstorming ▪ Test scenario creation ▪ Test scenario review with peers ▪ Test scenario review with BA and Dev ▪ Test case creation ▪ Test case review with peers ▪ Test case review with lead ▪ Test execution ▪ Regression testing ▪ Defect re-testing ▪ Test status reporting 3.2 Template for Tasks for User Stories The states of a user story should be either: ▪ New: The user story should be in New State when it is added in the Agile Tool ▪ ReadyForRefinements: The user story should be in this state when the Business Team / BA is clear on the requirements ▪ ReadyForSprint: In this state when the team knows the requirements and is ready for Sprint Planning ▪ ReadyForDev: The user story should be in ReadyForDev state when it is assigned to a sprint ▪ InDevelopment: The user story should be in InDevelopment state when the Developer has picked the user story for Development ▪ ReadyForIntegration: The user story should be in ReadyForIntegration state when the user story is ready for deployment on the QA environment ▪ InIntegration: The user story should be in InIntegration state when it is deployed to the QA environment and ready for the QA team to test ▪ ReadyForRelease: The user story should be in this state when the QA team has finished their testing and it is ready to be deployed to Production ▪ Closed: The user story should be in Closed state after it is deployed to Production 3. APPENDIX
  43. 43. 42 3.3 Team Structure
  44. 44. 43 3.4 KPIs Projects – Agile Methodology Metrics Name Unit of Measure Metrics Parameters Formulae Remarks Productivity Metrics Done to Said Ratio Ratio # of Story points delivered; # of Story points planned # of Story points delivered / # of Story points planned per sprint Indicator of productivity of the scrum team Sprint Velocity Story points per team # of Story points delivered # of Story points delivered This is a measure of how much functionality the team can deliver. Indicator of productivity Sprint Velocity per Person Story points per person # of Story points delivered; # of members in the team # of Story points delivered/ # of members in the team This is a measure of how much functionality the team can deliver per person per sprint. Indicator of productivity
  45. 45. 44 Projects – Agile Methodology Metrics Name Unit of Measure Metrics Parameters Formulae Remarks Productivity Metrics Manual Test Case Preparation Productivity Manual Test Cases prepared per person day # of test cases created; Total test case creation effort (# of test cases created/ Total test case creation effort in PDs) This is an indicator of test case writing productivity Automation Test Case Preparation Productivity Automation Test Cases prepared per person day # of Automation test cases created; Total test case creation effort (# of Automation test cases created/ Total Automation test case creation effort in PDs) This is an indicator of test case writing productivity Manual Test Case Execution Productivity Manual Test Cases executed per person day # of test cases executed; Total test execution effort in PDs (# of test cases executed/ total test execution effort in PDs) This is an indicator of test execution productivity Rate of Test Automation % # of Test steps to be automated; # of Test steps automated; (# of Test steps automated/ # of Test steps to be automated) *100 This is an indicator of the rate of automation of the team
  46. 46. 45 Projects – Agile Methodology Metrics Name Unit of Measure Metrics Parameters Formulae Remarks Quality Metrics Defect Density (Size in Story Point) Defects per story point # of QA defects; # of Client reported defects; # of QA defects rejected; Total size in Story point (# of QA defects + # of Client reported defects - # of QA defects rejected) / Total size in Story point This is an indicator of the quality of the deliverable. Defects per story point for a release Defect Leakage to Client % % # of QA Defects; # of QA defects rejected; # of Client reported defects; (# of Client reported defects / ((# of QA defects - # of QA defects rejected) + # of Client reported defects))*100 This is a measure of the effectiveness of test execution Manual Test Case Execution % # of test cases planned to execute; # of test cases executed (# of test cases executed/ # of test cases planned to execute )*100 This is an indicator of the test execution coverage
  47. 47. 46 Projects – Non-Agile Methodology Metrics Name Unit of Measure Metrics Parameters Formulae Remarks Productivity Metrics Delivery Commitment % # of deliveries delivered; # of deliveries planned # of deliveries delivered/# of deliveries planned per month or release An indicator of commitment to the planned deliveries Manual Test Case Preparation Productivity Manual Test Cases prepared per person day # of test cases created; Total test case creation effort (# of test cases created/ Total test case creation effort in PDs) This is an indicator of test case writing productivity Automation Test Case Preparation Productivity Automation Test Cases prepared per person day # of Automation test cases created; Total test case creation effort (# of Automation test cases created/ Total Automation test case creation effort in PDs) This is an indicator of test case writing productivity
  48. 48. 47 Projects – Non-Agile Methodology Metrics Name Unit of Measure Metrics Parameters Formulae Remarks Productivity Metrics Manual Test Case Execution Productivity Manual Test Cases executed per person day # of test cases executed; Total test execution effort in PDs (# of test cases executed/ total test execution effort in PDs) This is an indicator of test execution productivity Rate of Test Automation % # of Test steps to be automated; # of Test steps automated; (# of Test steps automated/ # of Test steps to be automated) *10 This is an indicator of the rate of automation of the team
  49. 49. 48 Projects – Non-Agile Methodology Metrics Name Unit of Measure Metrics Parameters Formulae Remarks Quality Metrics Defect Density with respect to Size in Story Point Defects per story point # of QA defects; # of Client reported defects; # of QA defects rejected; Total size in Story point (# of QA defects + # of Client reported defects - # of QA defects rejected) / Total size in Story point This is an indicator of the quality of the deliverable. Defects per story point for a release Defect Leakage to Client % % # of QA Defects; # of QA defects rejected; # of Client reported defects; (# of Client reported defects/ ((# of QA defects - # of QA defects rejected) + # of Client reported defects))*100 This is a measure of the effectiveness of test execution Manual Test Case Execution % # of test cases planned to execute; # of test cases executed (# of test cases executed/ # of test cases planned to execute )*100 This is an indicator of the test execution coverage
  50. 50. 49 3.5 Defect Lifecycle
  51. 51. 50 3.6 User Story Guidelines User stories should follow the INVEST principle ▪ Immediately Actionable • Can be delivered independently? • Free from external blockage? ▪ Negotiable • Descriptive enough to support team debate and conversation? ▪ Valuable • Delivers customer or business visible benefit? ▪ Estimable • Clear enough that team can estimate? ▪ Sized to Fit • Divided into small enough blocks to complete within Sprint? ▪ Testable • Clear acceptance criteria to know when it is “good enough?” Ways to prioritize the user story (MOSCoW) ▪ M: Must. Describes a requirement that must be satisfied in the final solution for the solution to be considered a success ▪ S: Should. Represents a high-priority item that should be included in the solution if it is possible. This is often a critical requirement but one which can be satisfied in other ways if absolutely necessary ▪ C: Could. Describes a requirement which is considered desirable but not necessary. This will be included if time and resources permit ▪ W: Won’t. Represents a requirement that stakeholders have agreed will not be implemented in a given release but may be considered in the future 3.7 Acceptance Criteria Guidelines What is an acceptance criteria? ▪ Acceptance criteria define the boundaries of a user story, and are used to confirm when a story is completed and working as intended ▪ Acceptance criteria are a set of statements, each with a clear pass / fail result, that specify both functional and non-functional requirements, and are applicable at the epic, feature, and story level
  52. 52. 51 ▪ What are Acceptance Criteria used for? • To define boundaries • To reach consensus • To serve as a basis for tests ▪ Acceptance criteria are usually initiated by Product Owner or BA but other team members can also participate in defining the acceptance criteria for each story ▪ Example for Password for a Login Module: • Must be at least 8 characters and no more than 12 • Must contain only alpha numeric • Must contain at least one digit • Must contain at least one character • Etc. (There would be more such criteria) How to write Acceptance Criteria? ▪ Rules oriented (form of a list) or Scenario oriented (form of scenarios to explain each criterion) ▪ Common form of writing Acceptance Criteria is the GWT (Give/ When/ Then) format derived from BDD framework • E.g. 1: User story for Search a Patient Given the physician is logged in the system And is on the worklist screen When the physician enters the name of the patient And clicks Search button Then the patients matching the search criteria are shown up on the Worklist • E.g. 2: User story for validating mandatory fields for case creation Given the nurse is logged in the system And is on the <case creation> screen When the nurse enters the CPT, ICD, Physician fields Then the Create Case button is enabled Given the nurse is logged in the system And is on the <case creation> screen When the nurse fails to enters any of the following – CPT or ICD or Physician fields Then the Create Case button is disabled.
  53. 53. REFERENCES 52 CONCLUSION https://www.healthcareitleaders.com/blog/10-tips-for-building-a-testing-center-of-excellence-tcoe/ http://www.datamasker.com/Data_Masking_for_HIPAA_Compliance.pdf http://tryqa.com/what-is-exploratory-testing-in-software-testing/ https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html With more focus on healthcare enterprise applications, the need for end-to-end testing of applications in quick time and focus on innovation is ever increasing. Healthcare organizations should have their testing strategies in place to test data and workflows in an error-free manner. While setting up a Healthcare QA Centre of Excellence, healthcare organizations need to ensure that best QA practices are followed, the correct tools and technologies are deployed, and highly skilled individuals are a part of the project teams. This is crucial to achieve defect free applications, and launch them with faster time to market.
  54. 54. 53 ABOUT THE AUTHOR Prithu George Assistant Vice President – Enterprise Application Proficiency, CitiusTech prithu.george@citiustech.com Prithu George comes with 15 years of experience in project delivery management with hands-on expertise in the healthcare domain that includes HL7 v2.6, EHR / EMR applications. She has worked with leading healthcare organizations to develop their automation framework, implement automation best practices as well as set up a whole healthcare QA Centre of Excellence. At CitiusTech, Prithu leads the QA Practice which involves creating, reviewing and enhancing software testing related processes for clients and in-house projects. She is certified in HL7 v2.6, CSQA, CSM and holds a Bachelor’s degree in Information Technology.
  55. 55. CitiusTech is a specialist provider of healthcare technology services and solutions to healthcare technology companies, providers, payers and life sciences organizations. With over 3,500 professionals worldwide, CitiusTech enables healthcare organizations to drive clinical value chain excellence - across integration & interoperability, data management (EDW, Big Data), performance management (BI / analytics), predictive analytics & data science and digital engagement (mobile, IoT). CitiusTech helps customers accelerate innovation in healthcare through specialized solutions, healthcare technology platforms, proficiencies and accelerators. With cutting-edge technology expertise, world-class service quality and a global resource base, CitiusTech consistently delivers best- in-class solutions and an unmatched cost advantage to healthcare organizations worldwide. For queries contact thoughtleaders@citiustech.com Copyright © CitiusTech 2018. All Rights Reserved.

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