Page Comparison

Date: February 15-16, 2018

Location: Sea Cliff Hotel, Dar es Salaam

Moderator: Christian Pfleiderer

DAY 1

A. Expectation Setting

-Mapping hospital workflows

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B. Field Trip Experiences

Group 1:

Functionalities	Observation	Challenges	Recommendation
A. Members'

...

Group 2:

Members' Enrolment

obersvation - User familiar and efficient using system
Obersvation - QR codes being used
observation - lots of paper still around
No means of confirming family/household size. Need a definition of household and how we implement it (Rwanda eg)
Is it possible to do enrollment the household to get the GIS
Linking with other systems is important
Diagnosis code should be accompanied by text. This has positives and negatives - issues of data security.
Data security is also an issue with people using personal phones at the health facilities.
didn’t get to the reporting functionality which would have been valuable
is the computer version also bilingual? App is yes don’t know about computer version

C. openIMIS Global Initiative

Timeline: From IMIS to openIMIS
Vision & Mission: Link health financing schemes into interoperable digital health systems by using open source software
Components
- Open Source
- Sustainable Community
- Interoperability
- Customizable Architecture
Open Source Sofware is free but needs to consider:
- Licensing Agreement
- Free to use as-is
- Costs for customization and implementation
- The community of practice (DHIS2, openLMIS, etc)
Governance Structure
- Developers Committee
  - Continuity: SwissTPH and SolDevelo
  - Re-architecture: BlueSquare
  - Interoperability: HISP India, etc
- Implementation Committee
  - Communication: FFW
  - Capacity: SwissTPH and EPOS
  - Community: AeHIN and Jembi
Clarifications
- openIMIS as an avenue to create an environment for solving issues
- Specific country customizations to be done by responsible payer in the system
- 2 versiosn at least in a year
- Data ownership is locally managed 2019: small releases, knowledge production, master version

D. openIMIS Regional Hub Africa: Jembi Health Systems

NGO in Africa
Started in 2009
Technical development, business analysis, implementation
Requirements definition, system architecture and design, development of software,
Implementation in countries in Africa
Managing and evaluation of projects
International open software communities
Role with openIMIS:
- Define requirements and provide technical assistance
- Technical specifications for interoperability
- Helping in implementation (matching with donors)

E1. Parallel Session: Developers Committee

Alignment with digital development
Alignment with digital investment
Embedded in sustainable development goals
From MS IMIS to openIMS
Components
- Open Source: openIMIS in an open source environment
- Local Development: IMIS in TZ, NP, CM (adapt with unique requirements)
- Modulat Transformation: From a monolithic web structure to a mode modular structure
- Slow Transition: Prioritize modules depending on country needs
- Interoperability: Data exchange among different systems anchored on openHIE framework that would allow fire data to en ESB as an itneroperability layer
- Vision: Integrated Workflows (Examples: Eligibility, Claiming)
- openIMIS Outsourcing 2019
  - Continuity: Software maintenance and support (Swiss TPH and SolDevelo)
  - Re-architecture: Modular transformation (BlueSquare)
  - Interoperability: HISP India (openIMIS and DHIS2), SwissTPH and SolDevelo (openMRS and openIMIS for claims management), Possible Health (openIMIS and Bahmni for claims management)
- Current Activities
  - Routine support and release building
  - Getting the teams on board
  - Concise weekly coordination calls
  - Need-oriented special topic calls
  - Developers workshop (February 2019 in Bonn)
    - Decide on technology options
    - Learn new technologies
    - Harmonize work plans

Q&A Session 1:

How insurance will come into the new diagram of openHIE? The new version will include openIMIS.
To have a lot of buy-in in Tanzania and other countries, there is a need for local developers for customization and development. How to ensure that they meaningfully come in (like they are paid on a regular basis)? This is where the regional and country hubs come in.
Are there local developers in Tanzania? These are contracted by another implementing partner.
To be part of openIMIS, what does it require?

E2. Parallel Session: Implementers Community

UHC is the aim - through health financing sysems
health financing processes
- resource collection
  - taxes/payroll
  - Insurance contributions
  - user fees/co-pooling
- resource pooling
- purchasing of services (holds the funds for resource pooling, we need data to design a strategic purchase -match with services needed)
  - capitation
  - budget
  - case based payment / fee for service
  - more fee for service focus the more information we need. Always need data if we want to move away from a general budget
  - how do we use openIMIS
    - registration / enrollment (also collect money)
    - verification of member
    - claim submission
    - Claims review
    - client feedback
    - reporting _ basic but growing (what are you diagnosing, getting money for etc)
    - OpenIMIS is a flexible tool that can be used for main health financing schemes: NI, tax funded national health system, community-based health fund, vouchers scheme, strategic purchasing arrangements (P4P and RBF)
  - What we do at the implementing committee? Next. Steps for OpenIMIS - globally
    - position OpenIMIS globally as digital tool for health financing and UHC (so countries don't start from scratch)
    - software development - collecting and defining new user requested features
      - formal sector enrollment
      - additional reporting and monitoring functionality
      - dashboards for management and policy decision making
      - interoperability with other systems
    - marketing and communications: new website
    - expanding the network of development and implementing partners (promote sustainability at the local level)
  - Next steps: country-level
    - bringing new countries onboard
    - COuntries: RW, MW, CAM CH
    - country assessments to gather requirements and software functionality requirements
    - expansion of network of developent and implementing partners (support possibilities for country level implementation)
    - implementation steps
      - starter kit (including costing estimates)
      - costing estimates
    - Demo on software
    - - online video, wiki guide
    - Capacity-building: alliances and strategic partnerships
  - Q&A session 1:
    - from persepctive of operators already using a system would you have to do this twice
      - different insurance providers different systems. Can look at interoperability for single form for data import
      - paralel systems currently running. It’s a policy level decision.

OpenForum Q&A:

In Chad, how can this request for change (for co-payment) at the global level can be accommodated or we have it to develop it via local projects? We'll talk about the channels being used later in the afternoon. This shall be discussed among the implementers - it's something we need to find out based on your priorities. Local implementation structure and teams are needed for local development and features. Prioritization of requests is being assessed based on discussions with the technical advisory group.
How can we be registered to openIMIS (as a local company)?
How can we be capacitated? (Communication between local and global) Self-learning via wiki platform for architecture.. also via github
For interoperability initiatives, how can we coordinate (so we don't end up doing the same thing)? Communicate with our developers.
How high is the risk if I cannot fund local developers into the redesigned and modular system? Roadmap for communication among developers to be released by the end of the month.
is there a timeline for redesign? 2 modules by end of 2019 but size of module not clear. There is a will. Will have roadmap and timeline at end of Feb 2019. Until then we will be sticking with the MS based system for implementation? Yes. It should also allow for seamless transition to modular approach
Would you know about the licensing agreement (when it will be offered for free)? At the end of feb, they would most probably know about the new architectures
Can this whole work be done offline? Enquiry part is still online.
Recommendation: Big opportunity to involve developers from pioneer countries like Tanzania (re-architecure phases, etc) . Response: Academic outreach with universities
Recommendation: Need to involve local institutions like academia as early as now. Include in their curricula activities
Comment: Local private software firms may be willing to participate in the developers' committee. Response: Universities can be entry points for capacity-building.
How can we benefit from the global initiative when the complete package is complete? We want to add open source development languages that are not dependent on Microsoft. Ideal scenarios is that the database layer exchangeable that can be run on a Microsoft server and Linode server.
Comment: Potential for openIMIS to interoperate with other systems or existing systems that are up and running (GOTOHOMIS, etc)?
Will there be a claims management demo? Rejection reports

...

Enrollment	QR codes linked to members	Still very much paper-based No waiting period No means of confirming the family size Need to connect payment system	Clarify functionalities of openIMIS Clarify that openIMIS is not an EMR Incorporate GPS information with home enrolment (outbreak mapping) Incorporate GPS information with the image of the applicant Incorporate biometrics (e.g. Cameroon) Define and operationalize a 'household' Link openIMIS with registries (e.g. social registry) Link openIMIS with other systems Broaden registration form to accommodate socio-economic data
B. Patient Identification and Service Utilization	Staff input data quickly on mobile Easy to understand Users felt comfortable	Shall allow multi-diagnosis (diagnose entry field should display not just the ICD code to prevent mistakes at entry) Shall ensure data protection (staff shall not use their personal device for accessing data)	Diagnose code should be number + text (this has w positives and negatives - issues of data security) Reference coding catalog in the backend
C. Claiming Process	Users were well-informed about the application and operate it effectively	Batch processing shall allow viewing of monthly summary by regions, by a person, by a health facility, or by a group of facilities	Review the billing system
D. Other Remarks	Bringing the service closer to the people	Computer software is not bilingual	Develop a bilingual system for computers, not just the mobile app version

Group 2

Functionalities	Observation	Challenges	Recommendation
A. Members' Enrollment	Duplication of data entry/ similar data are entered in different systems (e.g. patient registry, claims, patient record) Enrolment officer has no access to the membership database (no way to track)	Lack of trust in the technology Data privacy concern about keeping data on the phone and the security issues related to this (theft, etc) → currently, only aggregated data are reported	Show summary information after enrollment (not aggregated count) Send report/ overview of members to enrolment officer
B. Patient Identification and Service Utilization	No ID check/ household identification Patient membership verification during powercut or offline mode is a challenge (lack of data and picture in the database if without internet)	Cards don’t have photos which make it difficult for illiterate people to know which card is theirs Definition of household is loose (up to 6 people) Household renewal and identification in the whole unit	Family number attached to the individual (Ex: In Ethiopia, facility health worker can see the household unit linked to card number)
C. Claiming Process	Code list of services is difficult to memorize (list is in the app)
D. Other Remarks	Capitation Diagnosis entry (reimbursement system calculated on a number of cases but the provider still needs to add diagnosis in openIMIS) Prescription information needed but the burden of data entry is on the user and no incentive to enter full data (Should we be putting this level of effort on the provider when this data is not required for capitation payment?)		Potential to harmonize/integrate data entry

C. openIMIS Global Initiative

Timeline: From IMIS to openIMIS
Vision & Mission: Link health financing schemes into interoperable digital health systems by using open source software
Components
- Open Source
- Sustainable Community
- Interoperability
- Customizable Architecture
Open Source Sofware is free but needs to consider:
- Licensing Agreement
- Free to use as-is
- Costs for customization and implementation
- The community of practice (DHIS2, openLMIS, etc)
Governance Structure
- Developers Committee
  - Continuity: SwissTPH and SolDevelo
  - Re-architecture: BlueSquare
  - Interoperability: HISP India, Swiss TPH, SolDevelo, Possible Health
- Implementation Committee
  - Communication: FFW
  - Capacity: SwissTPH and EPOS
  - Community: AeHIN and Jembi
Clarifications
- openIMIS as an avenue to create an environment for solving issues
- Specific country customizations to be done by the responsible payer in the system
- 2 versions at least in a year
- Data ownership is locally managed
- Plans for 2019: small releases, knowledge production, development of the master version

D. openIMIS Regional Hub Africa: Jembi Health Systems

NGO in Africa
Started in 2009
Technical development, business analysis, implementation
Requirements definition, system architecture and design, development of software,
Country implementations in Africa
Managing and evaluation of projects
International open software communities
Role with openIMIS:
- Define requirements and provide technical assistance
- Technical specifications for interoperability
- Helping in implementation (matching with donors)

E1. Parallel Session: Developers Committee

Alignment with digital development
Alignment with digital investment
Embedded in sustainable development goals
From MS IMIS to openIMIS
Components
- Open Source: openIMIS in an open source environment
- Local Development: IMIS in TZ, NP, CM (adapt with unique requirements)
- Modulat Transformation: From a monolithic web structure to a mode modular structure
- Slow Transition: Prioritize modules depending on country needs
- Interoperability: Data exchange among different systems anchored on openHIE framework that would allow fire data to an ESB as an interoperability layer
- Vision: Integrated Workflows (Examples: Eligibility, Claiming)
- openIMIS Outsourcing 2019
  - Continuity: Software maintenance and support (Swiss TPH and SolDevelo)
  - Re-architecture: Modular transformation (BlueSquare)
  - Interoperability: HISP India (openIMIS and DHIS2), SwissTPH and SolDevelo (openMRS and openIMIS for claims management), Possible Health (openIMIS and Bahmni for claims management)
- Current Activities
  - Routine support and release building
  - Getting the teams on board
  - Concise weekly coordination calls
  - Need-oriented special topic calls
  - Developers workshop (February 2019 in Bonn)
    - Decide on technology options
    - Learn new technologies
    - Harmonize work plans

Q&A Session:

How insurance will come into the new diagram of openHIE?
- The new version will include openIMIS.
To have a lot of buy-in in Tanzania and other countries, there is a need for local developers for customization and development. How to ensure that they meaningfully come in (like they are paid on a regular basis)?
- This is where the regional and country hubs come in.
Are there local developers in Tanzania?
- These are contracted by another implementing partner.
To be part of openIMIS, what does it require?
- Unanswered due to time limit

E2. Parallel Session: Implementers Committee

Aim: UHC through health financing systems
Health Financing Processes
- Resource Collection
  - Taxes/payroll
  - Insurance contributions
  - User fees/co-pooling
- Resource Pooling
- Purchasing of Services (holds the funds for resource pooling, we need data to design a strategic purchase -match with services needed)
  - Capitation
  - Budget
  - Case-based payment/fee for service
How do we use openIMIS? (the more fee for service-focused, the more information we need; always need data if we want to move away from a general budget)
- Registration / enrollment (also collect money)
- Verification of member
- Claims submission
- Claims review
- Client feedback
- Reporting (what are you diagnosing, getting money for etc)
OpenIMIS is a flexible tool that can be used for many health financing schemes (NI, tax funded national health system, community-based health fund, vouchers scheme, strategic purchasing arrangements)
- - Next Steps for openIMIS (Global Level)
    - Position OpenIMIS globally as a digital tool for health financing and UHC (so countries don't start from scratch)
    - Software development - collecting and defining new user requested features
      - Formal sector enrollment
      - Additional reporting and monitoring functionality
      - Dashboards for management and policy decision making
      - Interoperability with other systems
    - Marketing and communications: new website
    - Expanding the network of development and implementing partners (promote sustainability at the local level)
  - Next Steps for openIMIS (Local Level)
    - Bringing new countries onboard
    - Current countries: RW, MW, CAM CH
    - Country assessments to gather requirements and software functionality requirements
    - Expansion of a network of developent and implementing partners (support possibilities for country-level implementation)
    - Implementation steps
      - Starter kit
      - Costing estimates
    - Demo on software
      - Online video
      - Wiki guide
    - Capacity-building: alliances and strategic partnerships

Q&A Session:

From the persepctive of operators already using a system, would you have to do this twice?
- Different insurance providers have different systems. Can look at interoperability from single form for data import
- Parallel systems currently running. It’s a policy level decision
In Chad, how can this request for change (for co-payment) at the global level can be accommodated or we have it to develop it via local projects?
- We'll talk about the channels being used later in the afternoon. This shall be discussed among the implementers - it's something we need to find out based on your priorities. Local implementation structure and teams are needed for local development and features. Prioritization of requests is being assessed based on discussions with the technical advisory group.
How can we be capacitated?
- There shall be communication between local and global implementers.
- Self-learning via wiki platform and via github for architecture.
For interoperability initiatives, how can we coordinate (so we don't end up doing the same thing)?
- Communicate with our developers.
How high is the risk if I cannot fund local developers into the redesigned and modular system?
- Roadmap for communication among developers to be released by the end of the month.
Is there a timeline for the redesign?
- Two modules by end of 2019 but the size of the modules are not yet clear.
- Roadmap and timeline by the end of Feb 2019. Until then, we will be sticking with the MS based system for implementation. It should also allow for a seamless transition to a modular approach

Would you know about the licensing agreement (when it will be offered for free)?
- At the end of February, they would most probably know about the new architectures
Can this whole work be done offline?
- Enquiry part is still online
How can we benefit from the global initiative when the complete package is complete? We want to add open source development languages that are not dependent on Microsoft.
- Ideal scenarios are that the database layer exchangeable that can be run on a Microsoft server and Linode server.
Recommendation: Big opportunity to involve developers from pioneer countries like Tanzania (re-architectural phases, etc)
- Academic outreach with universities
- Need to involve local institutions like academia as early as now (to include openIMIS in their curricular activities)
Recommendation: Local private software firms may be willing to participate in the developers' committee.
- Universities can be entry points for capacity-building.
Comment: Potential for openIMIS to interoperate with other systems or existing systems that are up and running (GOTOHOMIS, etc)
Comment: Claims management demo for rejection reports

F1. Parallel Session: Country System and Requirements in Tanzania

National Rollout
Governance	Harmonization/Business Processes	Feature Requests	Challenges
Adoption of SWAps (Sector-wide Approaches) Proposed governance structure Health Financing Technical Working Group CHF Implementers Group PORALG CHF-IMIS Technical Committee Policy on installment of payments (a question right now)	CHF is a standard product (current rollout) GIZ still at the beginning Harmonize strategy for enrolment officera Issues on mismatch of finances	Electronic payments/ mobile money Inform clients of payments + renewals Different programs give different hardware (progressive web app) Integration with facility system CHF-IMIS and NHIF integration Data points need to be aligned - client Diagnosis and other integration points between NHIF and CHF Hardware needs MOH ICT - Sotto PORALG ICT - Kitali	Unclear policy/ national direction Contribution payment Resource mapping Hardware/infrastructure (mobile phones/tablets) Coordination among DP+ national Shouldering of costs SMS costs Hardware costs Administrative costs (Forms, cards, etc) Training costs Hardware: Lack of phones for enrolment officers Capacity-building: Large number of people to train and the high cost of training

Other Issues:

Feature Requests: Payments have arrived, policies are active, app that runs on any hardware, integration with facility system, client registry might have overlapped with insurance system - integration needs to be aligned re data capture, standardization on NHIF and CHF

F2. Parallel Session: Country System and Requirements in Cameroon

Payer	BEPHA (Bamenda Ecclesiastical Province Health Assistance)	FRPS (Fonds Régionaux pour la Promotion de la Santé)
Population Group	General Population	Pregnant women Newborn up to 42 days
Provider	Accredited Facilitiies: Confessional Public Private	Accredited Facilities: Confessional Public Private
Benefits Package (services and prices)	Services are defined for outpatient and inpatient Different prices based on contract Contract-based	Medical and non-medical services Same prices for all providers Contract-based in three regions
Enrollment/Registration	Manual + openIMIS (computer-based) For 2019: Use of mobile phones	Paper-based entitlement for services (5 paper sheets - manual) Registration for the voucher Pay when register National ID/phone Schemes 10 % co-pay 90 % subsidized
Claiming	Manual + openIMIS (computer-based) For 2019: Use of mobile phones	All bills sent on paper Registry list Voucher # Date Treatment
Claims Verification	Manual For 2019: Use of mobile phones	Paper to excel Longitudinal follow-up not possible Claims rejection may be possible Admin review Accountant secretary Financial admin clerk checks excel (can ask bills) Medical officer checks bills and examination (only 2nd category selected for check) Regional office approves The total budget to be divided by family Medical review Adherence to guidelines Quality checks by medical supervisor
Digital Process (Which Parts?)	Enrolment Claims	Specification is ongoing Concept is under development (deadline end of March)
Support Needs for Next Steps	Capacity-building Equipment Material (QR code)

F3. Parallel Session: Country System and Requirements in Rwanda

Payer	RSSB (Rwanda Social Security Board) MOH	RSSB (Rwanda Social Security Board) Medical Scheme	Military Medical Scheme	Private Insurance
Population Group	Informal Sector	Formal Sector	Military Personnel	Private Organizations and Others
Provider	Public FFs PPCP (a few)	Private (mainly) Public FFs	Private (mainly) Public FFs	Private FFs
Benefits Package (services and prices)	Defined Benefit Package Uniform package Different tariffs based on the plan of the health facility level	MOH-defined Benefit Package (with flexibility)	MOH-defined Benefit Package (with flexibility)	Health plan-defined benefit package
Enrollment/Registration	3Ms (Mutuelle Membership Management Software) ePayment Enrolment Can the monolithic IMIS integrate with membership?
Claiming	Manual
Claims Verification	Manual (except the payment process)	Manual	Manual
Digital Process (Which Parts?)
Support Needs for Next Steps		Digitization of claims Automation

F4. Parallel: Country System and Requirements in Chad

Payer	Mutuelles de Sante	CNPS (Caisse Nationale de Privoyance Sociale)	CNAS (Caisse Nationale d'Assurance Sante')
Population Group	Informal Sector Communal Professional	Formal Sector Private and Public Workers	Universal
Provider	Public Providers Private Providers Faith-based
Benefits Package (services and prices)	Primary care Secondary care Tertiary care	Primary care Secondary care Tertiary care
Enrollment/Registration	On paper Excel openIMIS (test)	Paper + excel
Claiming	On paper Excel openIMIS (test)	Paper + excel
Claims Verification	Monthly verification FOSA Punctual Medical Adviser Network	Internal management information system
Digital Process (Which Parts?)	NDN (openIMIS en test)	NDN (openIMIS en test)
Support Needs for Next Steps	Capacity-building Equipment (computers, phones) Material/QR code	Institutional support Information system

Q: Is there a sustainability plan for CBHI?

A:

Q: In Cameroon and Rwanda, no enrolment features. Recommendation: Cameroon might want to customize it in their country as we are developing a master version.

A: Government want to use the aspect of this program for the future. We want to check if we can adopt openIMIS. Our problem is we have many bills and we want to extend this program in Cameroon. It's a strategic decision to make. We want to get ready on the rollout of openIMIS. To get the offline version installed and understand the functions so we can manage it on our level.

Country System and Requirements: Tanzania

...

's a strategic decision to make. We want to get ready on the rollout of openIMIS. To get the offline version installed and understand the functions so we can manage it on our level.

Q: Microsoft training - we have done video tutorials, we can create training in each region via video

...

Comment: There should be closer linkages between working groups on health client registry and openIMIS.

F5. Parallel Session: openIMIS Technical Discussion

Front (Material-ui, React & Redux, Javascript) in MS active source pages
Back (Django/Python <> Java)
University students come with Java and Python
Database (SQL server)
HL7-FHIR as data exchange standard (issue: question on database set-up or use an external one?)
Airflow for monitoring of batch processes
Migrating mobile application

F6. Parallel Session: openIMIS in the Academia

Assets
- Social protection and insurance (with courses on health financing)
- IT programming
- Research component
Gaps
- Limited tools for practical learning
- Limited real-life scenarios
- Curriculum outdated
Action Items
- Revisit curriculum to include openIMIS
- Research topics on digital health trends using openIMIS
- Ad hoc projects on openIMIS for collab collaboration between IT and social protection
- Short courses on health financing (with openIMIS as a tool)
- IT specialist to support the local openIMIS developers' team

COMMUNICATIONS CHANNELG. Communication Channels

-Data Confidentiality Onion

Confidentiality Access
- Public Communication (website) - representative deigndesign
- Team Communication (wiki) - transparent discussions
- Internal Team (forum) - restricted
- Peer to peer (eMail) - confidential
- GIZ Internal - GIZ internal systems
Communication Platforms
- Issue Queue (Jira)
- Wiki (Confluence)
- Source Code Repository (Git)
- Documentation Repository (Git)
- Etc (Refer to Uwe's list)

...

Wiki for IC
Wiki for DC
Events
Calendars
Google Groups
Google Folders

H. Reflections:

Encouraged to talk more about openIMIS and adopt it in the country
Appreciate the clarification of governance structure
Importance of communications
Broaden our systems with openIMIS
Difference between IMIS and openIMIS and the potential of timing in terms of starting implementation
Sustainability via academia
Strengthening the local capacity

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