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nameoi_healthinsurancesoln_schemeanalysis

Defining your business requirements through consultation with key stakeholders is an important step to ensuring that the technology solution will meet those needs. It is critical to document and gain consensus on what the priority needs are. These requirements will be used to guide the process of evaluating possible solutions and inform the decision as to “adopt, adapt or develop”.

Business Requirements are high-level descriptions of what the health financing sector requires in terms of a digital solution and information in order to meet the needs of the beneficiaries and fulfil its mandate.

User requirements are clearly articulated statements of what a digital system must be able to do in order to satisfy the needs of users and beneficiaries. These should be derived from business requirements. They should be defined in two clear categories, functional and non-functional. Functional requirements describe the required behaviour and functions of the system. Non-functional requirements describe specific criteria that can be used to judge the operation of a system e.g. performance, security, availability as well as additional considerations such as data migration requirements, and requirements to integrate or interoperate with other systems.

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Read more here: Scheme Analysis

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Business Process Modelling

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  • Use a business process modelling tool and the Business Process Modelling Guide to develop a visual model of your processes flow

  • (free business process modelling tools are available to download e.g. Bizagi https://www.bizagi.com/).

  • For each of the business processes modelled, document additional information for each step as shown in the Business Process Modelling Guide.

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The User Personas Template­ can be used to identify key characteristics of the user and describing them in such a way allows a better understanding of their wants, needs and common frustrations so that these can be addressed effectively. Using input from user research at the focal point of design decisions ensures that the system works in such a way that fulfils user needs.

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Template link: https://docs.google.com/document/d/1QDmdUpl1-WmBLxuuphXI7y8hz1-GDFB2SkVFuAqxvZw/edit

Types of Requirements

Functional i.e. what must the system do

Example of a HIGH-LEVEL functional requirement:

Number

Requirement

Role

Requirement Description

Process Map

Priority

(High,Medium,Low)

Complexity (High,Medium,Low)

Add Family/Group

FR1.1

Create a Family/Group

Enrolment Officer

The User is able to create a family/group by entering a list of relevant details on the form.

(See data dictionary section for the details displayed with respective formats.)

I1.

High

High

A good practice would be to document the functional requirements in a user story.

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Informational requirements refers to reports, data visualisation, dashboards. These requirements are often gathered from stakeholders rather than users. It is also more demanding and difficult for the analyst to obtain these requirements accurately, because it invariably requires much more in depth business knowledge. Reports may include, but not limited to:

  1. Operational reports e.g. Primary Operational Indicators-claims

  2. Management reports or dashboards e.g. Product Sales

  3. Exception reports e.g. Rejected Photos

  4. Control reports e.g. Matching Funds

  5. System Monitoring e.g. User activity Reports, Status of Registers

EXAMPLE USING TEMPLATE

IR03

Detailed Report Requirements

Report Category

Management Reports

Report Name

Product Sales

Report Description

Brief descriptions of the contents of the report

This report contains the value of sales of insurance policies by insurance sales agents/

enrollment officers.

Purpose

Describe the purpose of the report

The report gives an overview of the state of the sales activities. It shows within the chosen time frame the sales volumes (financial collections from sales) which helps analyze the financial performance of different regions and districts. Each financial transaction related to policy sales are listed in this report which can be used to cross verify payments received by the scheme for the chosen time period.

Audience

Scheme Manager, Accountant and Enrolment Officer

Triggers

Accountant requires sales report to cross verify payments received in the insurance office

Management required Product Sales reports on a monthly or ad hoc basis.

Input parameters

The user can select to filter the report using the following Parameters:

Parameter

Options

Date From

Date picker

Date To

Date picker

Region

List of regions

District

List of districts in the selected region

Product

List of products or services

Image RemovedImage Added

Sort Sequence

Default sort:

Other sort options e.g. allow the user to sort by any of the columns

Report Headers

Report Name:

Report Parameters:

Report Content

Describe the columns and expected data per column

Report layout

Add an example of what the report will look like with column headers and example data / add a wireframe

Image RemovedImage Added

Report Footer for printed reports

User (that ran the report)

Report Name - Product Sales

Date Created - 9/12/2019

Date and Time Printed (if printed) - 9/12/2019 12:15:28 PM

Number of pages - 1 of 1

Export

Allow user to export reports to .xls or csv, PDF or Word

Define the Non-Functional Requirements

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  • Scalability

  • Adaptability

  • Maintainability

  • Extensibility

Example of a Non-Functional Requirement for Performance:

NFR01

Allow users to find features within 3 clicks or less.

Example of a Security Matrix for a Non-functional Requirement that defines which users will be able to perform certain functions within the system.

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What level of data cleaning and transformation is required to ensure that the data meets the requirements and constraints of the new system?

Example of Transitional Requirements for Data Migration:

NFR03

The system must provide data migration functionality through the scanning of existing paper based records.

NFR04

by providing the ability to back capture existing paper records through manual data entry and flag as legacy records. The system must have the ability to enter existing insurance numbers to historical birth, death, marriage and divorce records that are migrated from existing paper-based and electronic records.

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  • What existing systems does the new system need to integrate with?

  • What data needs to be exchanged?

Example Integration / Interoperability requirements:

NFR05

The system must have the ability to securely interconnect with the central vital events registry, NIA, master person index etc. via a secure web-based interface or mobile application. The system must ensure that incoming data input is validated, evaluated for expected size, format and type before acceptance.

NFR06

The system must use open standards to promote interoperability.

NFR07

The system must support standard messaging protocols.

NFR08

The system must provide real-time response to mobile transactions submitted to the central database.

NFR09

The system must be able to interface with open source or existing third party reporting tools.

NFR10

The system must provide the capability for integration with other systems through an API.

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The Data Dictionary is a centralised repository of information about data such as meaning, relationships to other data, origin, usage, and format. A Data Dictionary is a set of information describing the contents, format and structure of a database and the relationship between its elements used to control access to and manipulation of the database.

Example of a data dictionary using the template

Field Name

Description

Entry Options

Data Type

(Numeric, text, date, alphanumeric, Y/N, Length of field)

Rules

Region

Region to be selected by user

Dropdown

Text(50)

Display a dropdown list of regions that the user will select

District

District to be selected by user

Dropdown

Test(50)

Display a dropdown list of districts only associated with the selected region for the user to select

Municipality

Municipality to be selected by user

Dropdown

Text(50)

Display a dropdown list of municipalities associated with the selected district for the user to select

Village

Village to be selected by user

Dropdown

Text(50)

Display a dropdown list of villages associated with the selected municipality for the user to select

Poverty Status

Poverty status of patient

Y/N

Y/N

Confirmation Type

Dropdown

Text(50)

Family/Group Type

Dropdown

Text(50)

Permanent Address Details

Address of patient

Free Text

Text(Unlimited)

Confirmation No.

Auto Generate

Numeric(11)

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