The Value of Testing a CPOE Solution
By Kimberly Spada

Organizations planning to implement a Computerized Physician Order Entry (CPOE) solution or have already implemented a CPOE application should always include testing in their work process. Testing should apply to both new installations and maintenance of other existing applications. The most significant value of testing is the identification of defects, or “bugs” in the application. Defects may include spelling errors, as well as missing orderable items. Testing also helps validate that the basic design requirements are met and functioning correctly, as well as the system’s impact on physician performance (i.e. the length of time it takes to open an order set, sign on, etc.). Obviously the goal of a CPOE implementation is to reduce time, improve workflow and gain a higher level of patient safety.

There are various levels of testing that should be considered when creating the testing plan. Evaluating each level of testing will help in determining a more accurate system activation date. It is critical to plan sufficient time to test, fix, and retest the defects that are found. The test plan should take into account what resources will be available to test during the designated timeframe. Each organization will also need to determine the level of testing their system requires and the duration, or timeframe of the testing. Listed below are some critical testing steps to help ensure correct functioning of the system:

• Unit Testing: The analyst who is developing or configuring the application will typically conduct the unit testing, as this phase requires detailed knowledge of the application. This testing usually occurs while the analyst is designing the system. Performing unit testing as the analysts configure the application helps to validate the expected results.
• Functional Testing: Designated testers typically conduct the functional testing. In some organizations, these testers are referred to as the Quality Assurance (QA) department. They review and test the system and report any defects identified during testing.
• Integration Testing: Testing combined parts of an application to determine if they function together correctly is referred to as integration testing. Testing is crucial to determine if the data successfully transfers from one system to the other.
• Regression Testing: Re-testing after fixes or modifications have been made is commonly referred to as regression testing. Regression testing must be done on a schedule after fixes have been applied in order to verify that the outcomes are now correct.
• User Acceptance Testing (UAT): This is usually the final testing. It is based on requirements of the end-user or customer. One of the approaches used includes taking the paper chart and placing those same orders in the system. This provides a test scenario where the results can be evaluated and a determination can be made if the system is functioning as designed.

As testing begins, it is imperative to not only track the defects identified, but also prioritize and determine the level of priority for each defect. You can further assign them to the appropriate analyst(s), who will be responsible to fix the defect. If a defect is defined as “critical” and must be fixed before go-live it may require evaluating its impact the activation date.

As defects are identified by the end users, it is important to distinguish a difference between those items that need to be fixed and those that are simply enhancement requests. Typically during testing, users may want to add new requirements or request new changes. Many times these changes could impact the specifications which were communicated in the original design stages. As these new enhancements are identified, it is important to document each request. This will help in determining if the items can be placed “on-hold” for a future date or if the request should be considered sooner.

During all testing phases, communication is the key to success. Maintain concise documentation, and change orders which can be used to communicate the status back to the end users and project leadership team. This helps provides assurance that all key stakeholders continue to be involved in the process. Doing so helps maintain their confidence not only in the system, but also their expectations are appropriately managed.

For more information about how VCS can help you with your CPOE solutions or testing plans please call us at 610.444.1233 or email us at vcs@getvitalized.com.