List of content:
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OpenIMIS field | DB type | Request or response | FHIR field | Description | Note | STPH | Mapping status |
ClaimID | PK | Request | claim.Identifier | this isn't required, most important is the ClaimCode (see below) but FHIR claim can have multiple identifiers | I would include ClaimUUID into the Claim instead of ClaimID. | This is the Database ID and should be used only internally | |
ClaimUUID | uniqueidentifier | Response | claim.Identifier | The unique identifier used as PK for FHIR | Will be added when will be available in the python claim module | mapped | |
InsureeID | FK(tblInsuree) | Request | claim.patient - Reference(Patient) | The subject of the Products and Services | We can represent the insuree as the FHIR patient resource but the most important is claim.patient.identifier | claim.patient.identifier | mapped |
ClaimCode | nvarchar | Request | claim.Identifier | Claim number | OK | mapped | |
DateFrom | smalldatetime | Request | claim.billablePeriod | Period for charge submission | OK | mapped | |
DateTo | smalldatetime | Request | Period for charge submission | mapped | |||
ICDID | FK(tblICDCodes) | Request | claim.diagnosis | List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | OK | mapped |
ClaimStatus | tinyint | Response | claimResponse.outcome | Default value: 2; | Used the FHIR codeable concept (code = imis_status, text = displayed status) | Can be also a combination of claimResponse.status and claimResponse.outcome but limited in values. Extension required? | mapped |
Adjuster | FK(tblUsers) | Request | claim.provider - Reference(Practitioner) | Responsible provider | I'm not sure if this field is used, all records created by me have null values in that field. | Only reference to openIMIS user. | |
Adjustment | ntext | Response | claimResponse.payment.adjustmentReason | Used FHIR adjustmentReason because of the IMIS Adjustment is text. | claimResponse.payment.adjustment | mapped | |
Claimed | decimal | Request | claim.total | Total claim cost | OK | mapped | |
Approved | decimal | Response | claimResponse.totalBenefit | OK | mapped | ||
Reinsured | decimal | Response | If needed we can create the FHIR extension. | ||||
Valuated | decimal | Response | If needed we can create the FHIR extension. | ||||
DateClaimed | date | Request | claim.created | default: getDate() | OK | mapped | |
DateProcessed | smalldatetime | Response | claimResponse.payment.date | claimResponse.created is used is the request date | If different endpoint to claimResponse, claimResponse.created will be the request date. Maybe claimResponse.payment.date | mapped | |
Feedback | bit | default value: 0 | No need. To see if replaced by FeedbackID | ||||
FeedbackID | FK(tblFeedback) | Response | claimResponse.communicationRequest | default value: 0 | claimResponse.communicationRequest | mapped | |
Explanation | ntext | Request | claim.information.valueString | Additional Data or supporting information | OK | mapped | |
FeedbackStatus | tinyint | - | default value: 1 | This field probably is used only by the OpenIMIS and isn't requirement by external systems. | Only used internally | ||
ReviewStatus | tinyint | - | default value: 1 | This field probably is used only by the OpenIMIS and isn't requirement by external systems. | Only used internally | ||
ApprovalStatus | tinyint | - | default value: 1; | Probably not used field | |||
RejectionReason | tinyint | Response | claimResponse.error | default value: 0 | In Web App we have the rejection reason for each Item and Service in a Claim. We should provide these reasons. | mapped | |
ValidityFrom | datetime | - | Audit information. More information can be found here (on page 113): | This information are valuable for OpenIMIS but probably not required by external systems. | |||
ValidityTo | datetime | - | |||||
LegacyID | int | - | |||||
AuditUserID | int | - | |||||
ValidityFromReview | datetime | Response | I'm not sure if this information are valuable for external systems. If needed we can try to use the claimResponse.processNote or add the FHIR extensions. | I don't think this information is valuable for external systems. It's only used internally. | |||
ValidityToReview | datetime | Response | |||||
AuditUserIDReview | int | Response | |||||
RowID | timestamp | - | I'm not sure but this is probably some unique value used to distinguish database rows. Probably not useful for external systems. | Not used by external systems. | |||
HFID | FK(tblHF) | Request | claim.facility - Reference(Location) | Servicing Facility | Could also be Claim.organization | ||
RunID | FK(tblBatchRun) | - | This is probably useful only for the internal system not for external systems. If needed add the FHIR extension can be considered. | Not used by external systems. | |||
AuditUserIDSubmit | int | Response | I'm not sure if this information are valuable for external systems. If needed we can try to use the claimResponse.processNote or add the FHIR extensions. | ||||
AuditUserIDProcess | int | Response | |||||
SubmitStamp | datetime | Response | |||||
ProcessStamp | datetime | Response | |||||
Remunerated | decimal | Response | If needed we can create the FHIR extension. | ||||
GuaranteeId | nvarchar | Request | claim.information.valueString | Additional Data or supporting information | I couldn't find a better place for information about the guarantee Id. The FHIR claim can consider multiple information elements. We can use the information category to distinguish the type of information. | Claim.insurance.preAuthRef | |
ClaimAdminId | FK(tblClaimAdmin) | Request | claim.enterer - Reference(PractitionerRole) | Author | This information is present in the API token? | ||
ICDID1 | int | Request | claim.diagnosis | diagnosis 1 from List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | OK | |
ICDID2 | int | Request | claim.diagnosis | diagnosis 2 from List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | OK | |
ICDID3 | int | Request | claim.diagnosis | diagnosis 3 from List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | Ok | |
ICDID4 | int | Request | claim.diagnosis | diagnosis 4 from List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | OK | |
VisitType | char | Request | claim.type | E - emergency | OK | ||
ClaimCategory | char | - | I didn't find the logic related to this field. | I don't think is used externally. |
...
CREATE - used to submitting the claim. The FHIR claim representation is converted to python ClaimSubmit (https://github.com/openimis/openimis-be-claim_py/blob/master/claim/services.py#L38) which is used by the python claim service. List of supported fields can be found in the table which shows the mapping between OpenIMIS and FHIR. Should be used the POST HTTP method and the body as JSON representation (example can be found below).
Note:
The claim service is used to process the request (https://github.com/openimis/openimis-be-claim_py/blob/master/claim/services.py#L146).
The response is (example of the outcome can be found below)
OperationOutcome which notice about the failure (list of possible errors);
ClaimResponse which notice about the success
READ - by default return list of all available resources. To fetch information about a specific object you should add the primary key to URL for instance:
http://127.0.0.1:8000/api_fhir/Claim/{claimcode}
, where "{claimcode}" is the value of the primary key (claim code in case of that resource). Should be used the GET HTTP method.UPDATE - the operation currently not supported
DELETE - the operation currently not supported
...
CREATE - the operation not supported
READ - by default return list of all available resources. To fetch information about a specific object you should add the primary key to URL for instance:
http://127.0.0.1:8000/api_fhir/ClaimResponse/{claimcode}
, where "{claimcode}" is the value of the primary key (claim code in case of that resource). Should be used the GET HTTP method.UPDATE - the operation not supported
DELETE - the operation not supported
...
Example JSON representation of content:
FHIR Claim (http://127.0.0.1:8000/api_fhir/Claim/clCode1):
| Code Block |
|---|
{
"resourceType":"Claim",
"billablePeriod":{
"end":"2019-06-12T00:00:00",
"start":"2019-06-01T00:00:00"
},
"created":"2019-06-12T00:00:00",
"diagnosis":[
{
"diagnosisCodeableConcept":{
"coding":[
{
"code":"ICD_CD"
}
]
},
"sequence":1,
"type":[
{
"text":"icd_0"
}
]
}
],
"enterer":{
"reference":"Practitioner/1234abcd"
},
"facility":{
"reference":"Location/12345678"
},
"id":"code",
"identifier":[
{
"type":{
"coding":[
{
"code":"ACSN",
"system":"https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use":"usual",
"value":"E9B13CFA-62D0-4B2C-B08B-477265B1587D"
},
{
"type":{
"coding":[
{
"code":"MR",
"system":"https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use":"usual",
"value":"code"
}
],
"information":[
{
"category":{
"text":"guarantee_id"
},
"sequence":1,
"valueString":"guarantee_id"
},
{
"category":{
"text":"explanation"
},
"sequence":2,
"valueString":"explanation"
},
{
"category":{
"text":"item_explanation"
},
"sequence":3,
"valueString":"item_explanation"
},
{
"category":{
"text":"item_explanation"
},
"sequence":4,
"valueString":"service_explanation"
}
],
"item":[
{
"category":{
"text":"item"
},
"informationLinkId":[
3
],
"quantity":{
"value":4
},
"sequence":1,
"service":{
"text":"iCode"
},
"unitPrice":{
"value":21.1
}
},
{
"category":{
"text":"service"
},
"informationLinkId":[
4
],
"quantity":{
"value":3
},
"sequence":2,
"service":{
"text":"sCode"
},
"unitPrice":{
"value":16.1
}
}
],
"patient":{
"reference":"Patient/TEST_CHF_ID"
},
"total":{
"value":42
},
"type":{
"text":"E"
}
} |
FHIR ClaimResponse (http://127.0.0.1:8000/api_fhir/ClaimResponse/clCode1/):
| Code Block |
|---|
{
"resourceType": "ClaimResponse",
"communicationRequest": [
{
"reference": "CommunicationRequest/F719B223-83A7-44A1-8F21-7B80E5B9FDD0"
}
],
"error": [
{
"code": {
"coding": [
{
"code": "1"
}
]
}
}
],
"id": "code",
"identifier": [
{
"type": {
"coding": [
{
"code": "ACSN",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "E9B13CFA-62D0-4B2C-B08B-477265B1587D"
},
{
"type": {
"coding": [
{
"code": "MR",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "code"
}
],
"item": [
{
"adjudication": [
{
"amount": {
"value": 2
},
"category": {
"text": "general"
},
"reason": {
"coding": [
{
"code": "1",
"system": "passed"
}
]
},
"value": 4
},
{
"category": {
"text": "rejected_reason"
},
"reason": {
"coding": [
{
"code": "1"
}
]
}
}
],
"noteNumber": [
1
],
"sequenceLinkId": 1
},
{
"adjudication": [
{
"amount": {
"value": 4
},
"category": {
"text": "general"
},
"reason": {
"coding": [
{
"code": "2",
"system": "rejected"
}
]
},
"value": 3
},
{
"category": {
"text": "rejected_reason"
},
"reason": {
"coding": [
{
"code": "3"
}
]
}
}
],
"noteNumber": [
2
],
"sequenceLinkId": 2
}
],
"outcome": {
"coding": [
{
"code": "1"
}
],
"text": "rejected"
},
"payment": {
"adjustmentReason": {
"text": "adjustment"
},
"date": "2010-11-16T00:00:00"
},
"processNote": [
{
"number": 1,
"text": "item justification"
},
{
"number": 2,
"text": "service justification"
}
],
"totalBenefit": {
"value": 214.25
}
"request": {
"reference": "Claim/clCode1"
}
} |
...