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In this episode of TWIHT, Vik and Jimmy continue the series about testing and test automation in healthcare, specifically EMR and health systems test automation.
We start out with the difference between web test automation that we discussed in the last episode versus EMR and health systems test automation. Vik explains that the biggest difference would be that web applications may or may not have patient health information however EMR and all hospital systems all have patient health information (PHI). So the impact of system errors with EMR and hospitals systems (PACS, Pharmacy, Laboratory, Cardiology, ambulatory, etc). is way higher as it could lead to critical adverse events.
Vik explains that with EMR and other hospital systems, changes are being made in those systems based on the feedback from clinical staff for workflows and then there are also application updates that are also happening continuously.
Vik then explains the traditional approach for testing of changes in healthcare organization. In most cases it is a manual testing. He explains the traditional manual approach in detail using an example. But it is definitely a challenge because all the staff members involved in this testing already have competing deadlines and testing of the EMR and other hospital changes becomes secondary.
Jimmy shares a testing story from video game industry and  Vik mentions Apple's Mythic Quest show and how there are only 2 testers for a very complex video game. Just shows that testing is not always a priority.
But the impact of software issues in a video game versus EMR or other hospital systems is very different. It is actually a life or death difference in hospital systems. 
Jimmy and Vik then discuss what can be done better for testing in healthcare. Vik indicates that to cover all the testing required for continuous changes happening in hospital systems, on average, it will probably take about 50,000 hours to cover all the testing required. And if we average out the hourly rate of staff members to $50/hour, that means it will take $2.5 million dollars per year to do all testing using manual testing.
The way around this is to use the right technologies to automate the testing. Vik indicates that depending on whether the system is web or desktop, selenium or appium framework can be used for test automation scripts. The other thing to consider is that there are lots of different devices used in a hospital environment i.e. desktop, laptops, tablets, and mobile devices. This is where using a real device cloud in automated testing to ensure the system works as intended on all devices is very important.
Vik explains the process used by test team at Tido Inc. for test automation. Initially once assessment is done to capture all the different workflows and downstream systems used, the team then develops test scripts. They also use integration framework since all the information to downstream systems going through the interfaces can be used to cross check information between EMR and downstream systems.
Once the test scripts are developed they can be run continuously or on-demand for

Tido Inc.
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Vik Patel - LinkedIn
Tido Inc. - Website
Tido Inc. - LinkedIn