Healthcare is becoming a data-driven sector, and mobile apps are making a notable contribution to this result. People are embracing the convenience offered by apps and wearables to track their fitness and even monitor chronic disease. A study from 2016 shows that there are 1.2  billion users, growing from 1.15 billion in 2015 and this is only on the consumer end (B2C). However, some of these digital products are not always accurate and should be used with caution. 

In addition, there is real growth in the mobile apps for hospital and clinic backends, too. These are called business to employees (B2E) apps and are subject to strict regulations since they are part of medical services offered.

Despite the impressive numbers, only a handful of mobile apps for healthcare have been tested rigorously and this is due to industry practices. Most companies don’t have the time, tools, devices or specialists to perform rigorous testing on all aspects that could influence the overall performance of an app. Although the company’s reputation is on the line when an app is released, testing takes a backseat in the list of priorities.

Challenges of developing quality healthcare apps

Testing mobile apps from different angles is a challenge since the set of tests should include a multi-dimensional approach. Mobile app testing company A1QA recommends functionality testing to ensure the app is serving its primary purpose, security testing to prevent data leakage through unauthorized access, usability testing as well as network connectivity and compatibility testing. These trials are made harder by the following factors which should be taken into consideration.

Device and platform fragmentation

There is a huge array of possible combinations of devices, operating systems, and screen sizes that increase the complexity of app testing exponentially. Some healthcare facilities follow a BYOD (bring your own device) policy, while others require development for a given configuration. If the app is intended for patient use, the range of devices increases substantially.

Not only does the app need to work on the targeted devices, but it needs to connect flawlessly with other devices as well to perform data transfers of interpretation. Just think of the average fitness band-smartphone pairing, not to mention special devices such as X-ray machines or EKGs.

Compliance requirements

Healthcare apps are very different from regular mobile applications due to the intensive regulations of the sector.  If the app is installed on a medical device, it needs to pass FDA certification and ensure it is HIPAA compliant if it carries patient information.

An app that meets HIPAA compliance standards needs to have:

1. Technical safeguards – encryption of information, implement access control for each user, including during an emergency, authentication mechanism, activity audit controls, encryption and decryption and automatic log-off.
2. Physical safeguards – storing electronic records, facility access control for those who can access servers, workstations, rules for mobile devices, hardware inventory since a lot of apps can be hacked at the hardware level.
3. Administrative safeguards – all problems related to risk assessment and risk management, and contingency planning.

Test automation

While mobile testing of commercial and entertainment apps has reached some degree of maturity, the testing of healthcare apps is still in its infancy. This can be easily observed by the number of test automation tools available for general purpose apps, compared to the lack of similar items for medical apps. Although automation is a necessity for this sector as well, there are no off the shelf options, and the senior testers must design their own code.

Dummy data for running tests is also a challenge. Most automatic tests require important quantities of data for calibration purposes. Without excerpts from real health records the app can only be tested from a logical perspective, but it might be unusable in a real-life setting and even dangerous. 

Domain and system knowledge

Another specificity of healthcare apps testing is the collaboration necessity between developers, testers, and users (health professionals). While for general purpose uses the tester can substitute the end user, here it is impossible if the app is created to be accessed by medical staff. The tester should ask the end users for feedback and include their comments in newer versions of the app.

The only way to ensure proper functioning is to walk through the code and the app together with a cross-functional team of developers, testers and subject matter experts.

Agile Development

To keep a reasonable time to market, the development should follow the agile methodology, which is hard to maintain considering all the different entities which have a say in the final product. The entire process must shift from eliminating bugs to creating a minimum viable product that can be upgraded afterward. Yet, in the case of mobile development for healthcare, even for the initial version, the standards are high because human life is involved. Any error could mean death, not just a restart of the program.

The Cloud and Big Data

More and more apps rely on cloud services and Big Data. Healthcare is the best candidate for this approach, which creates additional challenges. QA specialists must be retrained to face the problems posed by distributed networks and processing large data volumes.

With the development of the IoT and increased connectivity, this trend will grow even more. Both providers and testers should take into consideration the opportunities of collecting and using massive amounts of data in the apps, as well as the security threats posed by this expansion.

Next steps

The number of healthcare apps is growing daily, and people are becoming more accustomed to the benefits they bring. The healthcare industry is slowly catching up on adopting these tools and including them in everyday routines, slowly replacing paper records and contributing to a shared base of knowledge that can be used for further medical improvements.

Yet, the process of creating and validating top quality apps takes time, we have yet to see an app that is a pocket doctor or competent nurse. To have such an app that is also safe, secure and up-to-date with the latest discoveries is for now, a utopia.