This page presents the analysis of AI algorithm’s input data model. First, we analyse the openIMIS data structure and fields representing the information used by the Medical Officer to adjudicate a claim. Second, we look at the openIMIS-FHIR mapping and extract the required FHIR resources to feed the AI algorithm during the learning, development and test processes. Because the openIMIS FHIR module do not map all openIMIS fields to FHIR resources, we are limited by the current FHIR-openIMIS R4 mapping.

Claim adjudication - openIMIS entities and fields

Based on the openIMIS claim adjudication process, we are interested to identify the entities/tables and their fields that are used by the Medical Officers to review and categorise the items and services present in a claim.

openIMIS Claim Review Web Page

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