Automated Test Generation for Medical Rules Web Services: A Case Study at the Cancer Registry of Norway

TL;DR

This study evaluates AI-based automated test generation tools for a medical rule engine at the Norwegian Cancer Registry, demonstrating their effectiveness in code and domain-specific rule coverage, with recommendations for practical use and future improvements.

Contribution

It presents an industrial case study assessing EvoMaster for testing a medical rule engine, highlighting its effectiveness and providing practical insights for applying automated testing in healthcare software.

Findings

EvoMaster achieved around 19% code line coverage.

EvoMaster's black-box tool covered 100% of aggregation rules.

Test effectiveness was consistent across 10 rule versions.

Abstract

The Cancer Registry of Norway (CRN) collects, curates, and manages data related to cancer patients in Norway, supported by an interactive, human-in-the-loop, socio-technical decision support software system. Automated software testing of this software system is inevitable; however, currently, it is limited in CRN's practice. To this end, we present an industrial case study to evaluate an AI-based system-level testing tool, i.e., EvoMaster, in terms of its effectiveness in testing CRN's software system. In particular, we focus on GURI, CRN's medical rule engine, which is a key component at the CRN. We test GURI with EvoMaster's black-box and white-box tools and study their test effectiveness regarding code coverage, errors found, and domain-specific rule coverage. The results show that all EvoMaster tools achieve a similar code coverage; i.e., around 19% line, 13% branch, and 20% method; and find a similar number of errors; i.e., 1 in GURI's code. Concerning domain-specific coverage, EvoMaster's black-box tool is the most effective in generating tests that lead to applied rules; i.e., 100% of the aggregation rules and between 12.86% and 25.81% of the validation rules; and to diverse rule execution results; i.e., 86.84% to 89.95% of the aggregation rules and 0.93% to 1.72% of the validation rules pass, and 1.70% to 3.12% of the aggregation rules and 1.58% to 3.74% of the validation rules fail. We further observe that the results are consistent across 10 versions of the rules. Based on these results, we recommend using EvoMaster's black-box tool to test GURI since it provides good results and advances the current state of practice at the CRN. Nonetheless, EvoMaster needs to be extended to employ domain-specific optimization objectives to improve test effectiveness further. Finally, we conclude with lessons learned and potential research directions, which we believe are generally applicable.