How to Enhance Healthcare Applications with QA in Data Segregation Frameworks: Indiums’ Expertise

Reconsider your assumptions if you only associate quality assurance with commercial situations. As pay-for-performance and evidence-based medicine are being implemented, the assurance of quality is becoming an even more significant and noticeable aspect of healthcare.

To create policies and procedures that promote the greatest possible patient outcomes, quality assurance (QA) teams at healthcare facilities work across the system. That entails making sure that a wide range of rules, guidelines, and laws at the federal, state, and local levels are followed, as well as devising internal strategies to promote the provision of high-quality healthcare and the general wellbeing of the community the organization serves.

What is healthcare administration ecosystem?

The management and direction of healthcare organizations, such as hospitals, clinics, and other forms of healthcare institutions, are referred to as healthcare administration. To provide healthcare services to the public, a variety of various organizations and stakeholders collaborate within the healthcare administration ecosystem.

These stakeholders include the administrative employees who manage the daily operations of healthcare institutions as well as healthcare providers like doctors and nurses. The insurance industry, governmental entities, and regulatory bodies are all part of the healthcare administration ecosystem, and they all contribute to the development and smooth operation of the healthcare system.

How do organizations use healthcare administration ecosystem

The healthcare administration ecosystem is used by healthcare organizations to plan and control the provision of healthcare services. This involves overseeing the different divisions and jobs performed by a healthcare facility, including clinical care, accounting, human resources, and information technology. Healthcare administrators also make sure that the facility is meeting the needs of the community and patients, as well as all applicable laws, regulations, and standards.

Additionally, healthcare organizations can work with insurance firms, regulatory bodies, and other healthcare organizations to enhance the effectiveness and quality of care by utilizing the ecosystem for healthcare management. For instance, a hospital might collaborate with an insurance provider to create a patient payment schedule or with a regulatory body to make sure the institution complies with all relevant safety and quality standards.

Overall, the delivery of healthcare services depends heavily on the complex and interrelated healthcare administration environment. Healthcare providers can provide better care to their clients and the public at large by cooperating with one another.

What are the issues with healthcare administration ecosystem based on legacy technologies?

When healthcare companies rely on old technologies inside the healthcare administration ecosystem, several problems may occur.

One problem is that older technologies might not be able to keep up with the healthcare system’s evolving needs and rising demand. For instance, the volume of data and information produced by contemporary healthcare facilities may be too much for older systems to handle, causing bottlenecks and inefficiencies. Additionally, it may be challenging to interact with or exchange data with other businesses within the healthcare administration ecosystem if legacy technologies are incompatible with more modern systems or technology.

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The fact that outdated technologies might not be safe or in compliance with present laws and standards is another problem. Data breaches and cyberattacks are more likely as the healthcare sector grows more digital, endangering patient privacy and endangering the business. Legacy technologies might not be protected against these attacks by the proper security measures, which could result in regulatory penalties and reputational harm.

Finally, maintaining and upgrading legacy technologies can be costly because they may need specialized resources and expertise that are hard to come by. It may be difficult for the companies to invest in more cutting-edge and efficient technologies as a result of this drain on resources.

What are the needs of a modern-day healthcare administration ecosystem using QA and a data segregation framework?

Using a quality assurance (QA) programme with data segregation architecture can help meet several needs of the contemporary healthcare administration ecosystem, including the following:

A QA program can assist healthcare organizations in locating and addressing areas where patient care delivery can be improved. This could entail gathering and examining data on patient outcomes, running audits and reviews, and putting right any problems that are found. Sensitive patient data can be protected by healthcare organizations by being divided into several categories or “segments” according to the level of sensitivity. This can lessen the likelihood of data breaches and help prevent unauthorized access to sensitive information.

Healthcare organizations can comply with the requirements of numerous laws, regulations, and standards, such as the Health Insurance Portability and Accountability Act, by using both QA programmes and data segregation frameworks (HIPAA). These programmes can assist healthcare businesses in operating more effectively and cost-effectively by detecting and correcting inefficiencies and waste. 

Overall, the QA programmes and data segregation frameworks can assist contemporary healthcare administration ecosystems in providing patients with care that is higher-quality, more effective, and more cost-effective while also addressing the needs of all stakeholders in the healthcare ecosystem.

The Success Story

The client is a leading global provider of advisory solutions for health plans and a range of value-added services in the healthcare technology sector. Utilizing technology to provide solutions that ease business administration procedures, healthcare partner management, and automated medical care is the key to their services.

What were the issues with our client’s administration ecosystem?

• The client’s business-admin management portal was updated from the legacy systems, which had problems with data operations in siloed databases for distinct healthcare partners and their associated members.
• The system was upgraded with a multi-tenancy structure and segregated databases that demonstrate efficient querying and analysis.
• The Data Integrity and Security were in jeopardy during the system upgrade process and necessitated extensive Validations.

What are the business requirements?

• To confirm that the Data Segregation Framework is suitable for mapping access privileges and possible data breach escalations.
• Verify the data integrity of all aspects of the business flow, including on boarding, profiles, health plans, and the business rules that govern them.

How we did it

• To make sure there are no gaps in test coverage, a strong test strategy was defined and then carried out in accordance with the business flow.
• Developed a reliable test design requires in-depth knowledge of the Data Segregation Framework at the functional and database levels.
• In-depth business rules were included in the workflow’s on boarding process and customizations based on plan choices, including setting up benefit amounts and caps, restricting shipments, activating emergency plans, etc.
• Logical QA checks on the application of “security filters” for Partner group access. This QA criteria was fulfilled by performing user hierarchy-based tests; only the right partners and their members shall have access to information that is relevant to them.
• Information Look-up Integrity has been confirmed for the correct fetch from the data tables for all information request permutations.
• Conducted responsiveness and data-manipulation tests.

What are the results we have delivered?

• Since data segregation is a process-intensive exercise, knowing the data orchestration in and the numerous business rules in the end-to-end workflow were part of Indium’s test strategy.
• Beyond just data validations, Indium’s CoE evaluation of the entire project resulted in functional improvements that the client effectively adopted and applied.
• Demonstrated domain expertise and infused the right flavor of data security into the design of test cases.

If you are unable to find the perfect solution, we are happy to assist you in utilizing technology in your company. Contact us at (888) 207 5969 or (800) 123 1191 for more information or send an email to [email protected].