openIMIS is able to interoperate with DHIS2, primarily to be able to send data from openIMIS to a DHIS2 instance for advanced analytics and the creation of dashboards. While every implementation of openIMIS has their own set of indicators, dashboards, and data analysis needs, the openIMIS initiative has created a sample dashboard based on a variety of indicators related to Beneficiary Management and Claims Management, as well as some overall Operational aspects.
Sample Dashboards
You can access a demo version of the DHIS2 instance for openIMIS here:
Demo Instance: https://ln1.hispindia.org/openimis/
Username: openIMIS
Password: Imis@1234
If you would like to understand the software development aspects of the interoperability/integration between openIMIS and DHIS2, the resources are available at: openIMIS-DHIS2 Integration
Indicators
The dashboards were created based on indicators designed and collected from various implementations of openIMIS and other sources focused on Beneficiary Management, Claims Management, and Scheme Operations.
Beneficiary Management
S.No. | Indicator | Numerator | Denominator | Disaggregation | OpenIMIS Concept | FHIR Resource | FHIR Mapping | OpenIMIS Concept | FHIR Resource | FHIR Mapping |
|---|---|---|---|---|---|---|---|---|---|---|
Numerator | Denominator | |||||||||
1 | Individuals enrolled | Individuals enrolled | 1 | Gender, Age groups, Geography/Level, Residence, Ethnic group, Education, Facility Type, Income Category | InsureeID | Patient | identifier | NA | NA | NA |
2 | Individuals enrolled (%) | Individuals enrolled | Total individuals | Gender, Age groups, Geography/Level, Residence, Ethnic group, Education, Facility Type, Income Category | InsureeID | Patient | identifier | InsureeID | Patient | Identifier |
3 | Households enrolled | Households enrolled | 1 | Geography/Level, Residence | InsureeID | Patient | identifier | NA | NA | NA |
4 | Households enrolled (%) | Households enrolled | Total Households | Geography/Level, Residence | InsureeID | Patient | identifier | InsureeID | Patient | Identifier |
5 | Individuals enrolled and covered with an active policy | Individuals with an active policy | 1 | Gender, Age groups, Geography/Level, Residence, Ethnic group, Education, Facility Type, Income Category | PolicyStatus | Coverage | status | NA | NA | NA |
6 | Individuals enrolled and not covered (policy suspended, idle or expired) | Individuals with inactive policy | 1 | Gender, Age groups, Geography/Leve, Residence, Ethnic group, Education, Facility Type, Income Category | PolicyStatus | Coverage | status | NA | NA | NA |
7 | HHs enrolled and covered with an active policy | Households with an active policy | 1 | Geography/Level, Residence | PolicyStatus
| Coverage | status | NA | NA | NA |
8 | HHs enrolled and not covered (policy suspended, idle or expired) | Households with inactive policy (suspended, idle, or expired) | 1 | Geography/Level, Residence | PolicyStatus | Coverage | status | NA | NA | NA |
9 | Enrollment rate (individuals) | Individuals enrolled | Total Population | Gender, Age groups, Geography/Level, Residence, Ethnic group, Education, Facility Type, Income Category | InsureeID | Patient | identifier | NA | NA | NA |
10 | Enrollment rate (HHs) | Households enrolled | Total Households (number) | Geography/Level, Residence | InsureeID | Patient | identifier | NA | NA | NA |
11 | Individuals enrolled with a new policy | Individuals with a new policy | 1 | Gender, Age groups, Geography/Level, Residence, Ethnic group, Education, Facility Type, Income Category, Product type | PolicyStage and Prod ID | Coverage |
| NA | NA | NA |
12 | Individuals enrolled with a renewed policy | Individuals with a renewed policy | 1 | Gender, Age groups, Geography/Level, Residence, Ethnic group, Education, Facility Type, Income Category, Product type | PolicyStage and Prod ID | Coverage |
| NA | NA | NA |
13 | Households enrolled with a new policy | Households with a new policy | 1 | Geography/Level, Residence | PolicyStage | Coverage |
| NA | NA | NA |
14 | Households enrolled with a renewed policy | Households with a renewed policy | 1 | Geography/Level, Residence | PolicyStage | Coverage |
| NA | NA | NA |
15 | Renewable rate (individuals) of active policies | Individuals with a renewed policy | Individuals with active policy minus newly enrolled | Gender, Age groups, Geography/Level, Residence, Ethnic group, Education, Facility Type, Income Category | PolicyStage | Coverage |
| NA | NA | NA |
15a | Renewable and remigration rate (individuals) | Individuals with a renewed policy | Individuals enrolled | Gender, Age groups, Geography/Level, Residence, Ethnic group, Education, Facility Type, Income Category | InsureeID | Patient | identifier | NA | NA | NA |
16 | Renewable rate (households) of active policies | Households with a renewed policy | Households with active policy minus newly enrolled | Geography/Level, Residence | PolicyStage | Coverage |
| NA | NA | NA |
16a | Renewable and remigration rate (households) | Households with a renewed policy | Households enrolled | Geography/Level, Residence | InsureeID | Patient | identifier | NA | NA | NA |
17 | Poor HH registered | Poor households enrolled | 1 | NA | InsureeID | Patient | identifier | NA | NA | NA |
18 | Poor vs. non-poor HH coverage in the scheme | Poor households enrolled | Non-Poor Households enrolled | NA | InsureeID | Patient | identifier | NA | NA | NA |
19 | Poverty outreach ratio | Poor households enrolled | Total poor households | NA | InsureeID | Patient | identifier | NA | NA | NA |
20 | First service point distribution | First service point disaggregated by facility type | 1 | Facility Type | HFlevel | Location | type | NA | NA | NA |
21 | First service point distribution (%) | First service point disaggregated by facility type | Total of all first service point distribution availed by individuals/households | Facility Type | HFlevel | Location | type | HFlevel | Location | type |
Claims Management
S No | Indicator | Numerator | Denominator | Disaggregation | openIMIS Concept | FHIR Mapping | openIMIS Concept | FHIR Mapping |
|---|---|---|---|---|---|---|---|---|
|
|
|
|
| Numerator | Denominator | ||
1 | Value of all claims entered in openIMIS | Value of all claims |
|
| ClaimStatus | claimResponse.processNotexx |
|
|
2 | Individuals/HHs with claims |
|
|
| ClaimCode | claim.Identifier |
|
|
3 | Average value claimed per member/HH with claims | Value of all claims | Number of members with claims |
| RemuneratedAmount | claimResponse.item.adjudication.amount |
|
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4 | Incurred claims per capita | Value of all claims | Total number of enrolled persons |
| RemuneratedAmount | claimResponse.item.adjudication.amount |
|
|
5 | Average claim value | Value of all claims |
|
| RemuneratedAmount | claimResponse.item.adjudication.amount |
|
|
6 | HHs hitting ceiling | HHs whose claims add up to 50000 NPR |
|
| ExceedCeilingAmount | claimResponse.item.adjudication.amount |
|
|
7 | HHs hitting ceiling through families (%) | HHs hitting ceiling up to 50000 NPR during the time period | Families with claims during the time period |
| ExceedCeilingAmount | claimResponse.item.adjudication.amount |
|
|
8 | Rejected claims | Number of rejected claims |
| Facility type | ClaimStatus | claimResponse.processNote |
|
|
9 | Submitted claims | Number of submitted claims |
| Facility type |
|
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|
|
10 | Pending claims | Number of pending claims |
| Facility type | ClaimStatus | claimResponse.processNotexx |
|
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11 | Pending claims (%) | Number of pending claims | Number of submitted claims | Facility type | ClaimStatus | claimResponse.processNotexx |
|
|
12 | Reimbursed claims | Number of reimbursed claims |
| Facility type | RemuneratedAmount | claimResponse.item.adjudication.amount |
|
|
13 | Reimbursed claims (%) | Number of reimbursed claims | Number of submitted claims | Facility type | ClaimStatus | claimResponse.processNotexx |
|
|
14 | Rejection rate of claims (automated/by claims review) | Total Number of rejected claims during the time period | Total number of claims during the time period | Facility type, Type of Claim, emergency, OPD, IPD, Referral | ClaimStatus | claimResponse.processNote |
|
|
15 | Total Revenue in Health Insurance Fund | Premium plus subsidy from public fund/MoF plus other private sources (e.g. donations) | NA | Enrollment data, MOF/HIB, |
|
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|
|
16 | HHs revenue contribution (%) | Total premium collected from HHs | Total revenue in Health Insurance fund |
|
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17 | Government subsidy contribution (%) | Total premium received from MoF | Total revenue in Health Insurance fund |
|
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18 | Total claims by types | Total claims by the type (OPD, Emergency, IPD, Referral) |
|
| VisitType | claim.type |
|
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19 | Claim type (%) | Number of claims by each type (OPD, Emergency, IPD, Referral) | Total number/value of all types of claims |
| VisitType | claim.type |
|
|
20 | Top 10 Diagnoses | Number of claims per diagnosis |
|
| ICDID | claim.diagnosis |
|
|
21 | Trend of Diagnoses-Groups, i.e. NCD | Number of Claims for Treatment of Diagnosis Group | several possible: Number of Claims for Diagn. A group in year before, an average of several years before |
| ICDID | claim.diagnosis |
|
|
22 | List of number/value of the type of service per period per level |
|
|
| ServiceID | claim.item.service |
|
|
23 | List of Numbers/Value of most prescribed drugs per period | Numbers/Value of most prescribed drugs per period of time |
|
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24 | List of Numbers/Value of most prescribed drugs per period as % of total Number/Value of claims | List of Numbers/Value of most prescribed drugs per period of time | Total Number/Value of all claims |
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25 | List of Numbers/Value of most prescribed drugs per period as % of total Number/Value of claims which prescribed drugs | List of Numbers/Value of most prescribed drugs per period | Total Number/Value of all claims which prescribed drugs |
| HFLevel/LegalForm | type |
|
|
26 | Number/Value of Claims reviewed/valuated |
|
| Claim reviewer | HFLevel/LegalForm/Valuated | type |
| Facility Type, Gender |
27 | Number/Value of Claims reviewed/valuated (%) | Total Number/Value of claims reviewed/valuated | Total Number/Value of all claims submitted | Claim reviewer | HFLevel/LegalForm/Valuated | type |
| Facility Type, Gender, Age Group |
28 | Valuated Value of claims as a share of total value of submitted claims | Aggregated Value of claims after being revised (include rejected claims?) | aggregated Value of all submitted claims | Facility types |
|
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29 | Incurred administration expense ratio | Total value of incurred administration expenses | Total value of collected contributions and subsidies |
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30 | Incurred claims ratio | Total value of incurred claims | Total value of earned contributions and subsidies |
|
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31 | OOP ratio | Total sum of OOP spending | Total sum of health expenditure = OOP + claims |
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32 | Benefit coverage rate | Number of accepted claims | Total number of reported medical cases |
| Approved | claimResponse.totalBenefit |
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33 | Complaint ratio | Total number of complaints | Total number of covered individuals |
|
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34 | Promptness of claim approval | Period of time between submission and approval of a claim |
|
| DateClaimed - DateProcessed | claim.created - claimResponse.created |
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35 | Health infrastructure | Number of health facilities/health personnel | Population |
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36 | Average cost per (inpatient) visit | Total Value of all (inpatient) claims | Total number of inpatients |
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37 | Number of cases for specific diseases |
|
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| ICDID | claim.diagnosis |
|
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38 (a) | Payment allocation by diseases and its severity/Inpatient admissions/Primary health care sensitive diagnosis/tracer conditions | Total payments in the defined time period | Total enrolled population in the defined time period |
| RemuneratedAmount | claimResponse.item.adjudication.amount |
|
|
39 (b) | Ratio of highly complex to fewer complex patients. | Total number of highly complex patients seen in the defined area during the defined time period | Total number of low complexity patients seen in the defined area during the defined time period |
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40 | Net income(profit) ratio | Total Value of collected (premiums + subsidies) - paid claims | Total amount of collected premiums + subsidies |
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