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openIMIS Claim Review Web Page
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openIMIS Database Tables
Diagram
The following database diagram displays openIMIS tables and their relations. The analysis is centered on Claim and identifies other entities in relation to a Claim and used in the adjudication process.
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FHIR Resources Definition
From all the fields that the Medical Officers are using when reviewing claims, we mainly need to identify entities in relation to the Claim. From some entities (Diagnosis, HF), we might not require more than the identification fields.
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FHIR R4 Resource (AI algorithm input data model) | openIMIS Database tables Tables (mapped entities) | Notes |
|---|---|---|
tblClaim | ||
ClaimResponse → Condition | tblClaim → tblICDCodes | Main and Secondary Diagnosis |
ClaimResponse → HealthcareService | tblClaim → tblHF | |
ClaimResponse → Patient | tblClaim → tblInsurees | Name is not considered |
ClaimResponse → ActivityDefinition | tblClaim →tblClaimServices → tblServices | |
ClaimResponse → Medication | tblClaim →tblClaimItems→ tblItems | |
ClaimResponse → Practitioner | tblClaim → tblClaimAdmin | Only the identifier is considered |
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