The document outlines an introduction to the healthcare domain and the challenges faced in testing within this field, highlighting key terminology such as Medicaid, Medicare, and the significance of CPT and ICD coding systems. It emphasizes the critical need for test engineers to possess extensive domain knowledge, including safety standards and regulations (e.g., HIPAA), to ensure effective testing of healthcare software. Additionally, challenges like understanding clinical workflows and managing dependencies are discussed as essential for achieving high-quality software in healthcare.

1. Introduction To Healthcare Domain
& Testing Challenges
Pawan Kumar Yadav

2. About Me
ISTQB/ISEB – Certified Quality Analyst
Skills:Manual Testing ,Database-Testing, Desktop
Applications, Web Application testing HealthCare
Domain Testing,Mobile Application Testing
Connect me
Twitter:- https://twitter.com/pypawankumar
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Google+: https://plus.google.com/#112933361580214411600/posts
Contact me
Email:- pawany@mindfiresolutions
- pypawankumar@gmail.com
Sykype ID:-Mfsi_pawany

3. INTRODUCTION

4. BASIC FLOW OF APPS

5. 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.

6. 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.

7. 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

8. 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

9. 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

10. Challenges Faced while Testing in
Healthcare domain
●
Domain and System Knowledge
●
Clinical usage/Workflow
●
Healthcare Domain Standard
●
Cross Dependency of Software

11. 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.

12. Questions ?

13. Thank you !