openIMIS is a web-based software that allows for seamless exchange of information between beneficiaries, providers and payers of health financing and social protection schemes.
Modular construction
openIMIS is modular and customisable. It offers functionality in beneficiary management (including registration), benefits administration (including payments), and data analysis. Users can pick and choose the modules they wish to use, and can adapt these to their specific needs.
Business processes
openIMIS is custom built to manage the high-volume data flows which are required to administer insurance and social protection schemes. It has been specially designed to manage beneficiaries; benefit packages; providers; claims generation, review and processing; payments; and data analysis.
Enrolment
openIMIS supports the enrolment of individuals and families into schemes. Enrolment information can be captured directly in openIMIS, or imported into openIMIS from existing beneficiary management systems using shared interoperability standards (i.e. HL7 FHIR). The software supports the renewal of coverage at designated intervals, the updating of beneficiary records and the issuing of ID cards using QR codes and unique identifiers. Enrolment and renewal data, including photos of beneficiaries, can be collected and transmitted using a mobile app.
Service delivery
openIMIS supports the verification of scheme membership. When beneficiaries present their ID cards at health facilities, healthcare workers can check their eligibility for services via openIMIS. Beneficiaries are examined and treated, and provided with tests and medicines as needed. Using openIMIS, health facilities can generate claims for insurance scheme operators by entering codes for diagnosis and services rendered.
Claims management
openIMIS supports the processing of claims, the generation of payroll (in the case of cash transfer schemes) and the distribution of payments to beneficiaries and healthcare providers. Health facilities which use openIMIS can electronically submit claims to insurance scheme operators for review and reimbursement. openIMIS calculates reimbursements and processes payments to healthcare providers.
In the case of cash transfer schemes, the payer or scheme operator can use openIMIS to define the criteria for cash transfers (e.g. inclusion criteria, payment amount, frequency) and to generate a payroll with the amounts to be disbursed to beneficiaries in a given payment cycle. Payment service providers use this list to disburse funds. openIMIS also allows for reconciliation of issued payments against payroll. Unique payment transaction numbers can be generated for each payment, allowing them to be traced to individual households.
Monitoring and data analysis
The payer/scheme operator can use openIMIS to generate reports from the collected data and to analyse the reach and effectiveness of the cash transfer scheme.
Standards
openIMIS follows the HL7FHIR R4 standard for information exchange, allowing it to work seamlessly with other systems. This means that it can readily exchange data with everything from widely used data analytics platforms such as DHIS2 to electronic medical record systems like OpenMRS and other existing beneficiary management systems, such as those maintained by social security agencies.
To learn more about the mapping, visit this Wiki page
Data security and privacy
openIMIS takes care to ensure that the software is free of security-related issues and that all required measures to ensure the safety of data are in place.
However, there is an added layer of security that you are responsible for during implementation. As you implement openIMIS, you will need to install and host the software on either a virtual or physical server. This server(s) is where your data will be stored. You should ensure that the server you choose to host openIMIS on has the required security measures in place.
The openIMIS initiative will never have access to any data from your implementation of openIMIS.