Jaspar Casey - 7 July 2021
Like any modern workplace, hospitals have largely adopted software to accommodate a wide set of workflows. The emergence of — and dependence on — electronic medical records (EMR), also referred to as electronic health records (EHR), has meant that these systems are vital to the operation of the modern healthcare system.
Not only is it important to conduct rigorous tests of these EMR systems, it’s also necessary to test how they handle peak load conditions. This latter set of tests falls into performance testing, and it’s something that hospitals should not overlook.
Basics of load and performance testing
Load testing is a type of performance testing that helps assess a system’s ability to perform under heavy user loads. There are a number of benefits to load testing critical systems like EMRs or hospital websites:
- Detect errors that affect EMR functionality
- Determine how much load the hardware can handle before limits are exceeded
- Collect data for capacity and scalability planning
- Determine the adequacy of the hardware environment
More broadly, key benefits to performance testing hospital systems include:
- Determining the speed, scalability, and stability of the EMR
- Understanding the impact on user experience of the EMR’s performance
- Identifying mismatches between user expectation and actual performance
To learn more about performance and load testing, take a look at our guide.
What to look out for when load testing your EMR/EHR
With these benefits in mind, it’s important to be aware of factors that may complicate your performance testing efforts. There are a few things you should be mindful of:
Test environment vs. clinical environment
Because hospitals are so reliant on EMRs, tests are performed in a sandbox environment, rather than the production version. This means that you’ll need to account for different conditions that may be present in the real world. In addition, HIPAA regulations can create issues for those wishing to perform automated processes on live systems with real patient data.
However, if you manage to properly account for these considerations, performance testing in a representative, realistic test environment can help you prepare for real world load in the clinical environment.
Configuration of EMR/EHR
- EMR systems are designed to be robust out of the box, but configuration for the unique clinical environment of each hospital is where people tend to run into trouble.
- Configurations should be performance tested to ensure the system will stand up to adjustments over time. IT teams should be aware of potential consequences of proposed configuration changes.
Growth and scaling of the EMR
Over time, there may be a number of additions and changes to the EMR:
- More users may need access as new staff are onboarded
- Additional locations will be added if health systems acquire other hospitals or clinics
- New medical devices will be communicating with the EMR
Performance testing can help IT teams get ahead of these potential scaling issues, identifying bottlenecks ahead of time and planning adjustments to their infrastructure accordingly.
Questions that performance testing can help you answer
Performance and load testing your EMR/EHR should help you to understand some key questions:
- Under what conditions will performance start to suffer?
- If we are at peak expected load, how will the user experience (UX) be affected? Will clinicians experience a lag in the EMR? Will certain features or fields be unresponsive?
- If we overload the system, which things break and what are the consequences? Do we have a plan to restart key systems and get everything working again?
Not just for EMR
Of course, performance testing can be performed on other key systems besides the EMR. Earlier this year, a major health system in the US used Eggplant Performance to help with the vaccine rollout. They were able to replicate peak expected load conditions to test their systems and ensure that they could accommodate high volumes of traffic from those signing up for their vaccine appointment. Eggplant Performance helped the IT department make the necessary adjustments so that their infrastructure held up and end-user performance and functionality would not be compromised.