Introduction
Layout of this document
◌ Present a Test Strategy based on the project called “Targeted health dialogue” within Region Skåne. Base the strategy on project description & implementation plan.
This is written with first a section going thru the scope and highlighting facts from the document “Program for eHealth and Digitalization in Region Skåne”. Secondly a section with the same from the document: “Targeted health dialogue”. And third section is a possible Test Strategy for the project “Targeted health Dialogue”.
◌ Select one of the topics and explain your thoughts on: How your Test Strategy and the project “Targeted health dialogues” relate to the vision for “Program for eHealth and Digitalization in Region Skåne”
After each section in the Test Strategy there is a section called: In Perspective of “Program for eHealth and Digitalization in Region Skåne”. There is my thoughts how my Test Strategy and the project “Targeted health dialogue” relates to the vision for “Program for eHealth and Digitalization in Region Skåne”.
Scope – Program for eHealth & Digitalizing in Region Skåne
What? Product overview:
Region Skåne´s ambition is to be the leading region to develop, offer and to use digital e-services within their health care system. The development of eHealth will contribute to new solutions and work routines that is needed to be able to offer the citizens an available, reliable and quality assured healthcare.
The purpose is a modern, continuous learning organization and a cohesive digital healthcare environment.
To succeed a clear and committed leadership is required, a leadership that provide mandates and means, clear priorities, well-defined responsibilities and realistic expectations. In addition, decisions are needed that, in accordance with “eHealth strategy for Region Skåne”, consistent supports the paradigm shift to a patient-centered and health-promoting approach and a digitized care environment. In this way, understanding and an increase are ensured willingness to change both internally and externally.
Why? Goals of testing:
Focus groups
There are four main groups:
- Patients, relatives, and residents.
- Research, development, and innovation
- Health and social care
- Authorities, other county councils and municipalities.
Patients, relatives, and residents
The main goal is to present an attractive and available supply of healthcare services. Priority, development, and creation will be made with the citizens as the main focus.
Research, development, and innovation
eHealth is identified to strongly contribute to innovation and regional growth
Health and social care
A Cohesive Digital Care Environment creates conditions for innovation and continuous business development over time. With help of cohesive and user-friendly solutions the information can be presented and transferred in a reliable and more efficient way and ensure coordinated efforts to the individual. Healthcare employees are also key players in the development of new ones working methods and eHealth solutions to ensure anchoring and user-friendliness in what is introduced.
Authorities, other county councils and municipalities.
The goal is for Region Skåne to take an active and leading role in future development and actively participate in various networks around future care on the local arena, but also in that which concerns the whole of Sweden digital healthcare environment.
Strategic Focus Areas
The strategic areas are divided into six main groups:
- A. Implementation and development of national e-services
- B. Development of care processes, adjustments within the healthcare system
- C. Employeeship and leadership
- D. Innovation and process support for development and implementation
- E. Guiding and management
- F. Create technical prerequisites
A. Implementation and development of national e-services
1177 Healthcare guide is the portal for the national e-services. The concept includes a website for information about illness, healthcare, and contact information to caregivers. It also includes several other e-services.
Some services are included in a core supply and are managed centrally. Others are based on active work from respective care unit. New guidelines will be implemented. This requires a structured work that guarantee equal treatment in the healthcare.
B. Development of care processes, adjustments within the healthcare system
It is a development agreement that entail commitment to create new work routines a common solution over the authority’s responsibility areas. This creates new requirements on portable solutions and eHealth. The prioritized areas are
- Healthcare at home
- Support for patients with chronic illness
- Prevention and initiatives for better health
- Remote healthcare
C. Employeeship and leadership
To succeed it requires support and long-term commitment from leaders at all management levels, and a work environment that prioritize openness for changes in work routines, this means to include the healthcare employees in the development process. This will require extensive investment in competence development and knowledge of various systems.
D. Innovation and process support for development and implementation
The healthcare´s own processes must evolve, and eHealth become an obvious part of the work process. It also requires a process that ensure that all projects follow the strategic guidelines to create real value for the users and the society.
E. Guiding and management
To use the full development potential a clear target vision is required and a long-term commitment on all levels of management.
F. Create technical prerequisites
With the help of close and user-friendly solutions information can be presented and securely be transferred more effective. There are three priority areas:
- Cohesive digital healthcare information system
- Coordinated technological platforms
- Integrated platforms for remote healthcare services.
Scope – Targeted Health Dialogue
What? Product Overview:
The dialogues are conducted to prevent diabetes and cardiovascular diseases.
All citizens within the age group are invited. Invitation is done thru an information brochure and phone call.
If the citizen accepts the invitation a new invitation is activated on their 1177 account under the “Targeted Health Dialogue” service.
In the site they answer questions thru a form questionnaire, the form can be answered in different sessions.
The service supports both web and mobile platforms.
The caretaker (called call moderator) has their own admin view. The admin view shows an overview of the participants, sorted by age, age groups, and call statues.
Test results from physical examinations is added manually by moderator.
The answers and test results are analyzed and added to a health diagram. The health diagram is divided in different risk factors and counts in to four levels.
The release will be done gradually based upon age group and healthcare center. The release is done in three-week interval sprints.
Why? What to test:
- The citizen can log in with the services provided by 1177, i.e. BankID, Freja e-ID Plus, Foreign e-ID or Telia e-ID
- Citizens should be able to use a mobile and/or computer with the browsers: Chrome, Safari, Edge or Firefox browsers to respond to the health call. Up to three versions backward are supported by the browser. If we look at the statistics, Apple, Samsung, and Xiaomi are the three mobile manufacturers with the largest market share in Europe 2020.
- The patient’s health call, before it is sent to the healthcare provider, is available on an external web, security is important so no unauthorized can access to the information (answers or patient data). This may apply, for example, if the patient answers questions on a public computer.
- The moderator logs in with SITHS-card (an authentication method where you insert a card into the computer and identify yourself with a code)
- The moderator should only see the patients connected to the health center where the moderator works.
- The moderator will almost exclusively use Edge, but it is possible to use Safari, Chrome and Firefox. Up to three versions backward are supported by the browser. Safari is unlikely to be used by the moderators.
- The moderator’s view in the web support should only be accessible via Regions Skåne’s network. Since the health calls contain patient data, security is important so that no unauthorized (external or internal) can access the information.
- The health curve should be possible to print so that the patient can bring it home with them.
So, we have something like this for citizens
And something like this for call moderator:
Test Strategy
Quality Risk Analysis & Test Strategy
- ● What should be the priority?
- ● Business Risk – Organizational
- – Within the organization
- ◌ Lack of knowledge
- ◌ Reluctance for new work approach
- ◌ Project schedule
- ◌ Conflicting stakeholders
- ◌ Education within organization
- ◌ GDPR
- – Within the organization
○ In Perspective of “Program for eHealth and Digitalization in Region Skåne”:
It is mentioned that their ambition is to be the leading region to develop, offer and use digital e-services. And stated that to succeed a clear and committed leadership is required. Therefor it is of importance to include the organization and management in the risk analysis. To succeed the employees needs to be positive, have knowledge and agree to the changes that comes with the project.
- Testing Risk – Project Level
- Six categories:
◌ Login- – Third-party e-ID – Security, Functionality, Performance
- – Authorization and Authentication – Security, Reliability
- – Usability – Accessibility
- ◌ Forms
- – Survey´s – Usability, Functionality, Reliability
- – Results – Functionality, Usability
- ◌ Overview
- – Print – Functionality, Supportability
- ◌ Moderator
- – Admin view – Security, Functionality, Usability
- ◌ System
- – OS, Browser – Reliability, Compatibility
- – Version handling – Compatibility, Reliability
- ◌ Test Environment, Tools
- – Functionality, Reliability, Performance
- Measurement
- Risk class, Severity: ◼◼◼◼
Perspective from:
- – Probability:
- ◌ Effect
- ◌ Cause
- ◌ Likelihood
Quality risk matrix, on a high-level perspective. The more detailed matrix is in my opinion more team-based. At least with an Agile mindset to not control the teams way of working in detail. This gives the information on what is considered important and from there the team can set up their sprint planning and tasks.
From that we get something like this:
I tried to recreate this table here but can´t get it to look proper and be accessible, I apologize for that and will give it a try again later.
○ In Perspective of “Program for eHealth and Digitalization in Region Skåne”:
To present an attractive and available supply of healthcare services it is of importance to make sure all areas is secure, functions and is accessible for all users.
Acceptance Criteria
- The citizen can log in with the services provided by 1177, i.e. BankID, Freja e-ID Plus, Foreign e-ID or Telia e-ID
- Citizens should be able to use a mobile and/or computer with the browsers: Chrome, Safari, Egde or Firefox browsers to respond to the health call. Up to three versions backward are supported by the browser. If we look at the statistics, Apple, Samsung and Xiaomi are the three mobile manufacturers with the largest market share in Europe 2020.
- The patient’s health call, before it is sent to the healthcare provider, is available on an external web, security is important so no unauthorized can access to the information (answers or patient data). This may apply, for example, if the patient answers questions on a public computer.
- The moderator logs in with SITHS-card (an authentication method where you insert a card into the computer and identify yourself with a code)
- The moderator should only see the patients connected to the health centre where the moderator works.
- The moderator will almost exclusively use Edge, but it is possible to use Safari, Chrome and Firefox. Up to three versions backward are supported by the browser. Safari is unlikely to be used by the moderators.
- The moderator’s view in the web support should only be accessible via Regions Skåne’s network. Since the health calls contain patient data, security is important so that no unauthorized (external or internal) can access the information.
- The health curve should be possible to print so that the patient can bring it home with them.
- Public sector websites must meet WCAG accessibility standards.
○ In Perspective of “Program for eHealth and Digitalization in Region Skåne”:
The requirements are written to meet the vision for best user experience, product reliability of the specific eHealth service. This is also included in the program vision. Can´t tell if they would meet all quality criteria for usage of the full system and other services included.
Quality Measures
- ● Preventive
- -Definition of Done
- -Training & Education
- -Documentation & Communication
- -Acceptance Criteria
- -Root Cause Analysis
- ● Static/Detective
- -Definition of Ready
- -External Code Analysis
- -Code Review
- -Quality Risk Analysis
- ● Dynamic/Detective
- -Monitoring
- -Performance Test
- -Security Test
- -Usability Test
- -Accessibility Test
- -Exploratory Test
○ In Perspective of “Program for eHealth and Digitalization in Region Skåne”:
These quality measures are based upon the quality risk analysis and the acceptance criteria. The coverage of the products functional and non-functional requirements should be covered. It includes employees, management, and developer team (all roles included).
Reviewing
- ● Informal Reviewing
- – Code Review
- ◌ Pull request
- – Threat Modelling
- ◌ Security Testing
- – Code Review
- ● Formal Reviewing
- – Artifacts
- – Success Factors
- ◌ Verify that all necessary requirements are met
- ◌ Critical success factors are measured by: Sprint planning, test cases included. Delivery on time.
- ● Static Analysis
- – Basic Checks
Test Design
- ● Test Intensity Table
- – High Value
- – Medium Value
- – Low Value
- ● Test Script
- – Automation
- ◌ Unit test
- ◌ Integration test
- ◌ Regression test
- – Automation
- ● User Testing
- – Usability
- – Accessibility
- ◌ WCAG standard
- ● Experience-based
- – Checklists
- ◌ Requirement, Definition of done
- – Exploratory Testing
- – Heuristics
- – Checklists
- ● Risk-based
- – Based upon risk level matrix.
- – Related to requirements
- – Scenario testing with highest impact
- – Security Testing
- ◌ Penetration test, Posture Assessment
○ In Perspective of “Program for eHealth and Digitalization in Region Skåne”:
Here user testing is included, as patients, relatives and residents is in the focus group.
Usability and accessibility testing done by user testing will give direct feedback and help with improvements. Risk-based testing approach secure the sensitive data and secure the transfer of data outside of the healthcare centers intranet. With some services being managed by respective care unit the risk-based testing detects problems within the systems. The vision is a national eHealth system and will include data from several different healthcare units.
Test Data Management
- ● Needed for: System, user acceptance tests and Performance, availability tests.
– Security classified access – Only specific management access. - – Handled according to GDPR and other confidential requirements.
- – Anonymized test data – Up to date, accurate pattern for database
- – API – endpoints, full call access
- – Test environmental data
- – Production environmental data
- – Kept up to date for Continuous testing
- – Test data, logs, bug reports, results – clear description where data is to be stored
○ In Perspective of “Program for eHealth and Digitalization in Region Skåne”:
The strategic focus area, create technical prerequisites includes integrated platforms for remote healthcare services, cohesive digital healthcare information system and coordinated technological platforms. Therefor we need to make sure to use as close to real data as possible, but with large amount of confidential data it is of highly importance to make sure it is used securely. And to have a routine for test, monitoring results makes it easier to secure the files, for the right person to handle and detect faults.
Test Automation
- ● Continuous Testing
- ● Defect Prevention
- ● Unit Test
- ● Component Test
- ● System Test
- – Automate as much as possible
- – Hybrid Framework Automation
- ● Performance test
- – Load test
- – Spike test
- – Stress test
- – Disaster recovering
- ● Accessibility test
- ● Security test
- ◌ Select test based upon: Repeatability, Risks, Lifecycle
○ In Perspective of “Program for eHealth and Digitalization in Region Skåne”:
To be meet the vision of innovation and modern organization more modern development approach is needed. We leave the waterfall behind, hopefully takes a short walk in the too waterfall-hybrid model, with the goal of DevOps, Continuous Integration, Continuous Testing. Automate what we can for better performance and monitoring. (yes, yes, all automation is not the solution, we need a good mixture).
Test Execution
- ● Include steps to:
– Execute- – Build
- – Generate reports
- ● Implicit Test
- – Observability
- ● Explicit Test
- – Specified Outcome
- – Automated tests
○ In Perspective of “Program for eHealth and Digitalization in Region Skåne”:
Test execution is made continuously, reports and monitoring are possible early in the
development process. This makes it possible to find problems early and hopefully before the users gets too bad of an experience or a security breach comes up.
Investigate & Assess outcome
● Passes
● Failed
All outcomes can be traced thru:
● Monitoring
● Logging
○ In Perspective of “Program for eHealth and Digitalization in Region Skåne”:
Guiding and management mention to have a clear target vision and a long-term commitment is required on all levels of management. With monitoring and log data we have documented data to analyze for improvements.