Case Study

Non-Intrusive Performance Testing & HIPAA Safeguarding of Protected Health Information


Non-Intrusive Performance Testing & HIPAA Safeguarding of Protected Health Information


A client in the Healthcare industry was experiencing performance issues with a Citrix based application. Due to the sensitive nature of protected health information in their databases, the client wanted a non-intrusive approach to generate additional load on the application servers without exposing electronic health records during the testing process.


Due to security concerns, the client could not give direct access to a terminal which accesses the application. The tester would have to assume control of an IT Engineer’s computer over a Zoom meeting. Because of this, scheduling available windows where work could be completed was an additional challenge. A representative from the client and the IT Engineer would observe the work of the tester throughout the engagement.


The client’s need for a non-intrusive method of performance testing led the Test Engineers at RTTS to choose Tevron’s CitraTest as the tool of choice for this particular scenario. CitraTest is a software testing tool that works purely on the front-end by emulating the clicks and keystrokes of a user through image recognition. Captured images can be referenced in a Visual Basic script, which the software then executes as part of the test plan. The software is well suited for both performance and functional testing.



Test Engineers prefer to work in a dedicated test environment to not risk any downtime to the user. In this instance, the client chose to have the load tests executed on the live environment. This calculated risk was deemed acceptable due to the relatively low number of virtual users we were emulating in the system. The maximum number of users on the system at any one time was 120, of which 50 were virtual users generated as part of the load test.

The system performed well during each phase of testing, beginning with 10 virtual users, and incrementing each subsequent test with an additional 10 users. After each step of the testing process was completed, RTTS Test Engineers coordinated with the client and IT Engineer to ascertain if any issues arose on the backend during the load test. CitraTest has limited methods of logging metrics due to the nature of the program. Because of this, Test Engineers rely on the client sharing relevant data to perform a detailed analysis.

Throughout the entire process, RTTS Test Engineers coordinated with the client and IT Engineer to schedule execution of each load test along with requesting analytics captured by the client on the backend. CitraTest requires some additional configuration on the machine generating the virtual users, this required a coordinated effort with the client and IT Engineer to enable the necessary changes on the backend, as the RTTS Test Engineer was unable to make the changes themselves.

Several areas of interest and potential bottlenecks were revealed by the load tests executed by RTTS Test Engineers. The client’s software is hosted on a central terminal server which users access via a remote desktop connection.

An issue with the load balancer was identified. This showed that an imbalance of users was being logged onto the same server and as a result caused the machine to run at 100% CPU usage and become low on available memory. In addition, two business transactions were identified to have higher than expected 90th percentile response times while under high levels of load.


Load tests executed by RTTS Test Engineers revealed key points where the client could take action to improve the performance of their software solution. Reconfiguration of the load balancer resulted in a more balanced spread of users across servers and provided an overall better user experience. Pinpointing the two problematic transactions as potential bottlenecks allowed the client to have their software engineers make the modifications necessary to alleviate the issue.

About RTTS:

RTTS is the premier pure-play QA & Testing organization that specializes in Test Automation. Headquartered in New York, RTTS has had 1,000+ successful engagements at over 700 corporations since 1996.

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