Date: February 15, 2018
Location: Sea Cliff Hotel, Dar es Salaam
Moderator: Christian
A. Expectation Setting
-Mapping hospital workflows
-Use of data from openIMIS for research
-Use of data from openIMIS for decision-making and national policy making
-Integration with Health Curriculum
-Integration with SMART policy
-Digitizing claims
-Fit openIMIS with Enterprise Architecture in Tanzania
-Capacity-building on openIMIS
-How openIMIS can come in as a system for medical insurance
-Operationalizing the system (field level)
-Translation of field lessons to national level implementation
-Tanzanian perspective in technology/ digital health
-Learn more about openIMIS, knowledge and resource sharing
-Learn how openIMIS can fit with health financing schemes
-Coordination with other partners
-Linkages with health management systems
-Perspective on sustainability with evolving technologies
-Inclusion of indigents with openIMIS as a tool (Chad)
-Requirements gathering from countries
-Understanding country needs
-Sharing of lessons learned
-Governance structure of openIMIS
-Strengthening the management of openIMIS implementation
-Look forward into proposing it as a test tool in a local town in Cameroon
-Advance implementation with BEPHA in Cameroon
B. Field Trip Experiences
Group 1:
| Observation | Challenges | Recommendation |
|---|
- Members' enrolment: central them, a lot of data entry done and similar data is entered in different systems
- Members' enrolment: concern about keeping data on phone and the security issues related to this (theft etc)
- Client Identification: no patient verification without internet is a challenge
- Client Identification: Definitions of household is loose (up to 6 people).
- Cards don’t have photos which makes it difficult for illiterate people to know which card is there’s
- Capitation: reimbursement system calculated on number of cases but provider still needs to add diagnosis in OpenIMIS. Should we be putting this level of effort on the provider when this data is not required for capitation payment
Group 2:
Members' Enrolment
- obersvation - User familiar and efficient using system
- Obersvation - QR codes being used
- observation - lots of paper still around
- No means of confirming family/household size. Need a definition of household and how we implement it (Rwanda eg)
- Is it possible to do enrollment the household to get the GIS
- Linking with other systems is important
- Diagnosis code should be accompanied by text. This has positives and negatives - issues of data security.
- Data security is also an issue with people using personal phones at the health facilities.
- didn’t get to the reporting functionality which would have been valuable
- is the computer version also bilingual? App is yes don’t know about computer version
C. openIMIS Global Initiative
- Timeline: From IMIS to openIMIS
- Vision & Mission: Link health financing schemes into interoperable digital health systems by using open source software
- Components
- Open Source
- Sustainable Community
- Interoperability
- Customizable Architecture
- Open Source Sofware is free but needs to consider:
- Licensing Agreement
- Free to use as-is
- Costs for customization and implementation
- The community of practice (DHIS2, openLMIS, etc)
- Governance Structure
- Developers Committee
- Continuity: SwissTPH and SolDevelo
- Re-architecture: BlueSquare
- Interoperability: HISP India, etc
- Implementation Committee
- Communication: FFW
- Capacity: SwissTPH and EPOS
- Community: AeHIN and Jembi
- Developers Committee
- Clarifications
- openIMIS as an avenue to create an environment for solving issues
- Specific country customizations to be done by responsible payer in the system
- 2 versiosn at least in a year
- Data ownership is locally managed 2019: small releases, knowledge production, master version
D. openIMIS Regional Hub Africa: Jembi Health Systems
- NGO in Africa
- Started in 2009
- Technical development, business analysis, implementation
- Requirements definition, system architecture and design, development of software,
- Implementation in countries in Africa
- Managing and evaluation of projects
- International open software communities
- Role with openIMIS:
- Define requirements and provide technical assistance
- Technical specifications for interoperability
- Helping in implementation (matching with donors)
E1. Parallel Session: Developers Committee
- Alignment with digital development
- Alignment with digital investment
- Embedded in sustainable development goals
- From MS IMIS to openIMS
- Components
- Open Source: openIMIS in an open source environment
- Local Development: IMIS in TZ, NP, CM (adapt with unique requirements)
- Modulat Transformation: From a monolithic web structure to a mode modular structure
- Slow Transition: Prioritize modules depending on country needs
- Interoperability: Data exchange among different systems anchored on openHIE framework that would allow fire data to en ESB as an itneroperability layer
- Vision: Integrated Workflows (Examples: Eligibility, Claiming)
- openIMIS Outsourcing 2019
- Continuity: Software maintenance and support (Swiss TPH and SolDevelo)
- Re-architecture: Modular transformation (BlueSquare)
- Interoperability: HISP India (openIMIS and DHIS2), SwissTPH and SolDevelo (openMRS and openIMIS for claims management), Possible Health (openIMIS and Bahmni for claims management)
- Current Activities
- Routine support and release building
- Getting the teams on board
- Concise weekly coordination calls
- Need-oriented special topic calls
- Developers workshop (February 2019 in Bonn)
- Decide on technology options
- Learn new technologies
- Harmonize work plans
Q&A Session 1:
- How insurance will come into the new diagram of openHIE? The new version will include openIMIS.
- To have a lot of buy-in in Tanzania and other countries, there is a need for local developers for customization and development. How to ensure that they meaningfully come in (like they are paid on a regular basis)? This is where the regional and country hubs come in.
- Are there local developers in Tanzania? These are contracted by another implementing partner.
- To be part of openIMIS, what does it require?
E2. Parallel Session: Implementers Community
- UHC is the aim - through health financing sysems
- health financing processes
- resource collection
- taxes/payroll
- Insurance contributions
- user fees/co-pooling
- resource pooling
- purchasing of services (holds the funds for resource pooling, we need data to design a strategic purchase -match with services needed)
- capitation
- budget
- case based payment / fee for service
- more fee for service focus the more information we need. Always need data if we want to move away from a general budget
- how do we use openIMIS
- registration / enrollment (also collect money)
- verification of member
- claim submission
- Claims review
- client feedback
- reporting _ basic but growing (what are you diagnosing, getting money for etc)
- OpenIMIS is a flexible tool that can be used for main health financing schemes: NI, tax funded national health system, community-based health fund, vouchers scheme, strategic purchasing arrangements (P4P and RBF)
- What we do at the implementing committee? Next. Steps for OpenIMIS - globally
- position OpenIMIS globally as digital tool for health financing and UHC (so countries don't start from scratch)
- software development - collecting and defining new user requested features
- formal sector enrollment
- additional reporting and monitoring functionality
- dashboards for management and policy decision making
- interoperability with other systems
- marketing and communications: new website
- expanding the network of development and implementing partners (promote sustainability at the local level)
- Next steps: country-level
- bringing new countries onboard
- COuntries: RW, MW, CAM CH
- country assessments to gather requirements and software functionality requirements
- expansion of network of developent and implementing partners (support possibilities for country level implementation)
- implementation steps
- starter kit (including costing estimates)
- costing estimates
- Demo on software
-
- online video, wiki guide
- Capacity-building: alliances and strategic partnerships
- Q&A session 1:
- from persepctive of operators already using a system would you have to do this twice
- different insurance providers different systems. Can look at interoperability for single form for data import
- paralel systems currently running. It’s a policy level decision.
- from persepctive of operators already using a system would you have to do this twice
- resource collection
OpenForum Q&A:
- In Chad, how can this request for change (for co-payment) at the global level can be accommodated or we have it to develop it via local projects? We'll talk about the channels being used later in the afternoon. This shall be discussed among the implementers - it's something we need to find out based on your priorities. Local implementation structure and teams are needed for local development and features. Prioritization of requests is being assessed based on discussions with the technical advisory group.
- How can we be registered to openIMIS (as a local company)?
- How can we be capacitated? (Communication between local and global) Self-learning via wiki platform for architecture.. also via github
- For interoperability initiatives, how can we coordinate (so we don't end up doing the same thing)? Communicate with our developers.
- How high is the risk if I cannot fund local developers into the redesigned and modular system? Roadmap for communication among developers to be released by the end of the month.
- is there a timeline for redesign? 2 modules by end of 2019 but size of module not clear. There is a will. Will have roadmap and timeline at end of Feb 2019. Until then we will be sticking with the MS based system for implementation? Yes. It should also allow for seamless transition to modular approach
- Would you know about the licensing agreement (when it will be offered for free)? At the end of feb, they would most probably know about the new architectures
- Can this whole work be done offline? Enquiry part is still online.
- Recommendation: Big opportunity to involve developers from pioneer countries like Tanzania (re-architecure phases, etc) . Response: Academic outreach with universities
- Recommendation: Need to involve local institutions like academia as early as now. Include in their curricula activities
- Comment: Local private software firms may be willing to participate in the developers' committee. Response: Universities can be entry points for capacity-building.
- How can we benefit from the global initiative when the complete package is complete? We want to add open source development languages that are not dependent on Microsoft. Ideal scenarios is that the database layer exchangeable that can be run on a Microsoft server and Linode server.
- Comment: Potential for openIMIS to interoperate with other systems or existing systems that are up and running (GOTOHOMIS, etc)?
- Will there be a claims management demo? Rejection reports