# Infosys Whitepaper 
Title: Modernizing enterprise systems in healthcare 
Author: Infosys Limited 
Format: PDF 1.7 

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 WHITE PAPER MODERNIZING ENTERPRISE SYSTEMS  IN HEALTHCARE An end-to-end testing approach for greater  predictability and quality Abstract As digital technologies, smart wearables and remote monitoring  capabilities penetrate healthcare, traditional healthcare companies  are unable to keep up with end-user expectations. Under pressure  to adopt rapid transformation, these organizations are looking  for robust and end-to-end testing procedures. This paper explains  various end-to-end testing approaches within the four main  modernization techniques for healthcare companies. The analysis  presented here acts as a guideline for healthcare leaders to make  strategic and informed decisions on how to modernize their systems  based on the needs of their end-users.  

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 Introduction Sustainability in healthcare is a looming  challenge, particularly as the fusion of  disruptive innovations such as digitization,  Internet-of-Things and smart wearables  enable remote and real-time health  tracking, diagnosis and management.  To succeed in such an environment,  healthcare organizations rely heavily on IT.  Thus, using the latest end-to-end testing  approaches becomes essential to:  •  Ensure that all applications operate  as a single entity with multi-module  interactions  •  Maintain performance/non-functional  scenarios within the desired limit •  Identify bottlenecks and dependencies  ahead of time so that the business can  take appropriate actions  Testing challenges in  healthcare modernization Business transformation in healthcare  is complex because of the challenges in  maintaining integrity between different  types of customer needs and health- related plans. Modernizing healthcare  software applications mandates enabling  multi-directional flow of information across  multiple systems, which can complicate  the entire healthcare workflow application.  Further, failures or errors in systems outside  the enterprise environment can adversely  affect the performance of applications with  which they are integrated.  To address such challenges, it is important  to determine the right method and types  of end-to-end testing. This will optimize  application performance by testing it  across all layers from the front-end to the  back-end along with its interfaces and  endpoints.<|endoftext|>Typically, most healthcare organizations  use multi-tier structures with multiple  end-users, making end-to-end testing  very complex. Launching a new product in  such a multi-directional business scenario  requires extensive user testing. Thus, to  enable end-to-end (E2E) testing, health  insurance companies must first understand  what customers expect from their  healthcare providers and identify how they  can meet these expectations in shorter  timelines.<|endoftext|>Fig 1: A typical multi-tier healthcare business Customer  Profle Cloud Member Rule Firewall Web server Service Rule Oracle Big Data Web service Find  Doctor  Hospital Claim  Web   Page Payment  Application Provider  Web Page Business Team XML XML XML XML XML SOA XML SOAPUI Pictorial Diagram of Multi-tier  Healthcare Business API Call Database Update SOA Call Service Call Consumers External Document © 2018 Infosys Limited 

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 Infosys solution  End-to-end testing approaches for different modernization techniques Infosys leverages four modernization techniques to help healthcare organizations enable end-to-end testing. These techniques are: 1. Re-engineering technique Use-case: Best-suited in cases where  companies need to digitize healthcare  product marketing to different constituents  of a state through online retail.  This modernization technique is useful  when venturing into new markets or when  retiring obsolete technologies due to  high maintenance costs. It leverages the  following end-to-end testing approaches: •  Simulation testing: User-centric  interaction testing is performed  based on different behavior events  like usability testing, cross browser  compatibility and mobile testing •  Compliance testing: This testing is  needed for security protocols and  financial boundary testing as per  mandates defined by state and central  governments •  Blend testing: This combines functional  and structural testing into a single  approach and is essential for any  healthcare digitization transformation  strategy Universal automation: This  is a new approach that automates  the acceptance of changed features  in applications through browser  recognition, payment gateways, etc.<|endoftext|>•  Risk-based testing: This focuses on  testing a few components or critical  defects that are identified as high-risk  functions, have significant complexity in  business operations and can impact key  features  •  Continuous automation testing:  Based on continuous integration and  continuous delivery, this testing is  for real as well as virtual features that  are proposed for projects in minor  transition •  Recognition accuracy testing: This tests  non-textual data like images, pictorial  figures, feelings, fingerprinting, etc.,  using a virtual augmented framework  Benefits – This testing approach provides  higher returns on investment by nearly 80- 90% in short spans within 5-7 iterations. It  also improves co-ordination, accuracy and  reusability of data in ensuing runs, thus  providing a robust and reusable testing  option through cutting-edge technology.<|endoftext|>Risks – Diversified technology exposure  is critical to support such big bang  transformation and limited technical  knowledge may result in uncovering fewer  quality issues. Further, rebuilding the  enterprise framework can be costly.<|endoftext|>2. Replacing or Retiring  technique Use case: Best-suited when one needs to  remove contract and legal documentation  from healthcare insurance and hospitals to  a separate online portal.<|endoftext|>This modernization technique is used  when there is a need for more control and  accuracy. Migratory functions are clustered  as units and can be renovated easily  without disturbing other applications.  Here, end-to-end testing focuses on  components that undergo gradual  replacement or are retired as described  below: •  Plug-and-play testing: This is usually  executed when testing teams employ  different types of tools for automation  scripting or when different types of  technologies are involved in testing •  Web service-based testing: This  is a mechanism or medium of  communication by which two or more  applications exchange data, irrespective  of the underlying architecture and  technology •  Neutrality testing: This is typically used  when the existing platform is replaced  with a new one without altering the  final business outcomes or end-user  experiences  •  Parallel testing: This analyzes several  applications or sub-elements of one  application simultaneously and in the  same instance using agile or waterfall  models in order to reduce test time •  Assembly testing: This reveals precise  interactions among modules as per user  requirements. It is used when functions    are grouped into a logical entity and  alliances are needed •  Usability testing: Usability testing  covers learnability, memorability,  adeptness, and customer satisfaction  indices to determine how easy to use  the application is for end-users  Benefits – This modernization approach  provides more structure and control to  end-to-end testing with15-20% effort  reduction. It ensures effective application  testing with the option of reverting to  native state on-demand when needed.  Further, it requires only 5-7% effort for  automation changes during build.  Risks – Project overrun can occur without  proper supervision. Additionally, it requires  repeated testing of the same regression  suite even for small deployments.  External Document © 2018 Infosys Limited 

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 3. Re-fronting technique Use case: Best-suited when adding  encryption logic protocol is required for  sensitive claim-related information passing  through a web service.<|endoftext|>This approach is used when end-users  want to use the same data efficiently  and quickly without investing in  expensive infrastructure set-up. It covers  virtualization, non-functional testing and  regression testing as described below: •  Virtualization testing: This simulates  multiple users to check the performance  of the new technology while it interacts  with existing applications •  Non-functional testing: Certain features  like technology compatibility, platform  integrity, exception handling, help  analysis, impact exploration, and  application availability falls under the  purview of non-functional testing •  Regression testing: Regression re-run  approach is used when there is a slight  change in functionality but the overall  system behavior has not changed Benefits – This approach simplifies  localized defect resolution. Here, end- to-end testing is more stable as changes  are limited and specific. Further, the cost  of running E2E test cases is lower as the  regression suite can be easily automated.<|endoftext|>Risks – Frequent patch changes can lower  productivity and increase maintenance  cost. Further, repeated testing of the same  emergency bug fix can reduce long-term  RoI.  4.Re-platforming technique Use case: Best-suited when upgrading  billing/payments databases to recent 