13-15 FEB 2018, FRANKFURT/ESCHBORN
Participants:
Caren Althaeuser (Path/JLN), George Atohmbom Yuh (BEPHA, Cameroon), Sosthenes Bagumhe (MOH, Tanzania), Saurav Bhattarai (GIZ Nepal), Sweta Purushotam (Consultant, GIZ Nepal) Patrick Ernst (Consultant), Lucas Gervas (PORALG, Tanzania), Christopher Gideon (HSSP, Tanzania), Sebastian Kuhn (GIZ), Gerald Laezer (KfW), Carl Leitner (Path/Digital Square), Michelle Lessa Nascimento (GIZ), Silvery Mgonza (NHIF, Tanzania), Jiric Neme (Swiss TPH), Alicia Spengler (GIZ), Siddharth Srivastava (Swiss TPH), Michael Stahl (GIZ), Hans van Hoppe (Exact), Alexandre Vanobberghen (Swiss TPH), Franz von Roenne (GIZ), Uwe Wahser (GIZ Kenya), NHIF Kenya
Agenda:
10:00 - 12:30: Digital Square Technical Proposal
12:30 - 13:30: Lunch
13:30 - 14:30: Preparatory coordination meeting
14:30 - 17:30: Opening of openIMIS system architecture
On the 13th a smaller group of participants from Swiss TPH, GIZ, Digital Square + consultants discussed jointly the work plan of Swiss TPH for the “Maintenance of openIMIS in 2018”. Further details of the work plan for 2018 Q1-Q4 have been discussed and defined. Focus was laid on (a) community tools and their set up,(b) the demo version and the main requirements it needs to serve, (c) Implementation Starter Kit and the usefulness of an interaktiv Moodle installation to host corresponding training materials as well as the Release Cycle Management for the Master Version of openIMIS.
SwissTPH as well as Jiric Neme presented the actual system architecture of MS IMIS as well as opportunities and challenges for opening the system under the following topics: (a) possibilities to use external DWHs;(b) HL7 FHIR use case for OpenIMIS and (c) import/export functionalities.Full presentations available here and here.
Agenda:
08.30 - 09:00: Arrival and coffee
09:00 - 09:30: Welcome
09:30 - 10:30: Current status and system architecture of master
10:30 - 10:45: Coffee break
10:45 - 12:15: Window into the future
12:15 - 13:15: Lunch
13:15 - 14:15: openIMIS governance structure
14:15 - 14:30: Introduction of the overall workplan
14:30 - 17:30: openIMIS workplan 2018
Alicia Spengler (GIZ) opened the second workshop day by reminding that there is a functioning IMIS implemented in Tanzania, which has been replicated and adapted in Cameroon and Nepal. Swiss and German Development Cooperation respectively, being present in different countries, perceived IMIS as a possible basis for a global system building upon national experiences and expertise. Based on synergies in this thematic area, Germany and Switzerland pushed for a joint initiative aiming at the implementation of such systems in various countries and meeting the high demand for information systems for health insurance and other financing mechanism. The initiatives’ vision is that all countries will have the insurance data they need to effectively manage their social insurance schemes, therefore contributing to Universal Social Protection. As, for now, the project is planned and budgeted for three years and setting up the platform until 2019 will be quite a challenge, the initiative is currently looking for additional funds and business models to be able to extend the time frame.
Work plan for 2018 for the transition of IMIS to openIMIS and maintainance of the openIMIS product is developed
Tools selected: Github (data storage), Jira (issue tracking), Confluence (documentation management); should be available soon; Readthedocs hasn’t been picked in the procurement process, but should be easily integratable into Confluence
Demo server setup (being procured); will make use of live examples
There is an openIMIS master version (17.5.4) implemented, and limited customizations can derive from it. Derivations so far, are: CHF-IMIS (Tanzania), NHIF-IMIS (Nepal), BEPHA-IMIS (Cameroon) and some pilot installation in DRC.
Key features:
Regional level of insurance products and operational support (besides district and national levels)
Capitation
Catchments areas of health facilities
Field activity of enrollment
Mobile app for enrollment officers (Android based)
Moving of territorial units
Bilingual – English, French (possibility of switching, but primary language has to be defined)
Claim management through mobile phone app, online format and offline form
Other minor enhancements
In the derivations, language is adapted to local terms and, depending on the context, openIMIS can be offered in a second language as well (e.g. Swahili in Tanzania). Other functionalities, such as drop-down menus, communication tools (e.g. SMS gateways for enrollment info), insurance numbers (Tanzania: 9 digits, Cameroon: 12 digits) and escape procedures, can be easily adapted in the resource files.
It is important to make sure that all country specific features are reflected in the master version, as openIMIS will be later maintained on the master version level. Once openIMIS is implemented, it is possible to operate different insurance schemes.
CHF-IMIS Tanzania – release 17.5.4 derived from master version
Implementation in 2012
Operating 3 community based insurance schemes
Using mobile phone (2300 users)
Used in 3 provinces, 25 districts
BEPHA-IMIS Cameroon – release from 2016 not yet derived from master version – launch of upgraded national version planned for spring 2018
Will migrate data
Mobile phone apps not used yet
Used for the whole insurance scheme
NHIF–IMIS Nepal – release from 2016, not started yet with the migration to the Master Version
Mobile phone apps are used
2013-2014 – introduction of social insurance policy; requirements analysis
Customized Nepal version (looked at using Cameroon vs Tanzania as base; features are used out of both)
2015 – slow down, other country priorities due to earthquake
2016 - new push from government
SHI launched in Nepal
4 enrollment cycles per year, started enrolling April
IMIS used as the MIS of NHI from the beginning
System is used for voluntary health insurance only
Set up:
One central IMIS server at government integrated data center
One smartphone per enrolment assistant – for enrolment and renewals (2300 with phones)
Smartphones and computers at health facilities for eligibility check and claim entry. No claims through phones (though functionality exists); faster to use computer at facilities
IT team in Kathmandu
Modifications:
Presentation layer. Design level modifications; documenting in an issue tracking system. Will upload/share, once Jira is operating.
Analysis dashboards – dump into a database for visualization/dashboards. Mostly operational
No changes to business logic. Don’t want to do any forks; supporting master version.
Use of ICD term field, rather than only code → facilitation for health professionals
Migration to master version:
Nepal is willing to do so; want to use opportunity for upgrade and take first steps to get prepared
Documenting all modifications they’ve made so they can be made in the master version
Developing test scenarios
VPS test server secured
Launch will need to coincide with enrolment cycles. Nepali calendar is constant challenges/requirement; difficulty to fix it in the system.
Where do you see openIMIS in… | |||
1 year? | 3 years? | 5 years? | |
Regarding country implementation | 5- 10 countries, including the existing ones; having stable master version and release plans; countries part of decision-making process of initiative 3 countries; country adaptations recorded; e-payment solutions and SMS notification system implemented | 10-30 countries using an adapted master version; increased uptake within and outside countries; more microinsurances on board Members feedback system established; 2 additional users contributing to the development | 15-50 countries; strengthening local capacity; openIMIS becoming a standard system for health insurance; local implementation agents are in place Constant growth in number of users, more than 6 countries implementing |
Standards and interoperability | Linkages to FHIR, API, SMS Gateways; education for stakeholders on IMIS functionalities RestAPI; integration between openIMIS, Epicor and OpenHIE; countries share knowledge and best practices; dialogue on interoperability initiated; discussion with governments on internat. standards | Linkage to civil register; FHIR, electronic medical records; Epicord, AMQP; establishment of universal openIMIS standards Standardized exchange mechanism; open standards are in place; governments understand and use internat. Standards for data transactions; Standards for claims reimbursement in place | Integration with government systems; broad stakeholder understanding openIMIS as (golden) standard; other partners/systems build apps to work with openIMIS |
Impact on health system | Transparency 24/7 availability | Use of insurance data beyond insurance managers Research activities implemented; quality of health insurance data improved significantly | All insurances covered; PPP; helps in policy decision making UHC (+USP); maternal mortality reduced; increased life expectancy |
Collaboration and participation | COP established with JLN; data exchange with OpenHIE Local universities contribute to capacity building and skill development; JLN, global networks, openHIE community established | Outreach into HISP local nodes; diverse donors for software development; standards for claims transactions are defined and deployed by the CoP Network of implementing partners; Sustainable funding model; international donor community around OpenIMIS | OpenIMIS recognized as a standard product by governments and donors; long-term business model established; collaboration with WHO, ADB, EU; IMIS version for micro insurance available |
Other successful open source mechanisms:
OpenMRS: has board of directors & leadership team, as well as OpenMRS community and OpenMRS incorporated (trademark and copyright); ca. 40 country representations; used for management of clinical data
OpenLMIS: has governance committee (for strategic decisions), product committee (for project management), technical committee (for operating the tasks); used for logistics and operational business flow
DHIS2: getting started with their governance structure; have advisory board; deployed in 50-70 countries
openIMIS:
Steering group consists of SDC and BMZ (donors of initiative); other donors, country representatives and others will participate; GIZ acts as the steering group facilitator → strategic decisions
TAG (technical advisory group): open group, will be called in when needed
Product Committee: program coordination desk, IT & Product Team (Swiss TPH)
Community of Practice
It is questioned where the partner countries will be placed in this organigramm, and whether the structure is based on a sustainable business model.
There is a need for further discussion on the governance structure.
The work plan has been developed according to the TOR of Swiss TPH as service provider to the OpenIMIS Initiative:
Part 1.1: tools are purchased, Github will be accessible under GIZ’s organization with different logins
Part 1.2: Saurav is in charge for procurement; the uploaded demo version should be tested
Part 2.1: the implementation consultants are preparing the documentation
Part 2.2: there are discussions on the choice of license for creative commons; documentation material will be uploaded on an online tool; more information from the countries is needed
Part 2.3: information will be compiled as a reference point for other countries
Part 2.6: Transition to the master version is not very advanced yet. TPH will clarify open queries, but migration itself will be done by the country teams
Part 3.2: There are some recurring activities for every release cycle
Due to time matters, the discussion on the openIMIS work plan has been postponed.
Agenda:
08.30 - 09:00: Arrival and coffee
09:00 - 09:15: Welcome and reflection of day 1
09:15 - 09:45: The importance of global networks
09:45 - 10:30: OpenHIE and Digital Square: opportunities
10:30 - 10:45: Coffee break
10:45 - 12:30: National system architecture
12:30 - 13:30: Lunch
13:30 - 16:00: Two parallel sessions: Session A (Technical) and Session B (Functional)
16:00 - 17:00: Wrap up and closing
Two more participants joined the workshop: Franz von Rönne (GIZ) & Gerald Laezer (KfW)
Joint Learning Network
Composed of 23 member countries and country core teams
Steering Committee decides on annual goals
Supported by Rockefeller, Gates, Wipro
IT Team is facilitated by Path
Existing Tools
Common Requirements for health insurance information systems - developed in 2011 using CRDM (common requirement development methodology) for creating a business matrix
Using Health Information Systems
Chicken & Egg
Proposed activity for 2018 = Community of Practice for Health Insurance Information System for learning and sharing purposes
Vendor/software tool neutral
Could be used for further developing requirements to feed into release cycles of openIMIS
Providing 4 Health (P4H)
Exits for 10 years, active on the country level & part of a network working towards UHC2030 as a specific form of health coverage foreseen in the SDGs; there are contact persons located in the countries and staff is going to be deployed to the World Bank as well
openIMIS needs to be systematically linked with the broader digitization of the countries;
Key network areas:
Service Provision (UHC2030 working group on fragility)
Legislation + Regulation (Health Governance Collaborative)
Data Exchange (Health Data Collaborative, in particular Digital Health & Interoperability WG; OpenHIE)
Risk Assessment
Early Warning (WHO, CDC)
Risk Protection (P4H)
Quality Control
Research
Financing (P4H - support countries in developing health financing strategies)
Endorsed eHealth strategy in 2017; until the end of the Nepali fiscal year (July 2017), they want to focus on structuring their eHealth architecture / roadmap and developing standards and interoperability
IMIS is using own codes for claims, ICD-10 for diagnostics
This year have contracts to develop Health Facility Registry (unique ID/code) .
will cover both public and private
will be mandatory - not yet endorsed with policy/regulation for financing
Health Unit wants to make it mandatory for any Health Information System component must use the same unique codes for the FR
WHO supports development of health workforce registry. Starting with councils - using iHRIS.
Developing electronic attendance system
Electronic grievance handling system for citizens to report on quality
Want to build out eHealth/informatics capacity within MOH (trainings, certifications, stand alone courses, modules in MPH/BPH programs)
National ID and CRVS is trying to get started
eHealth Initiative - national integrated health information system (NHIS)
Avoid fragmented / pilot systems and number HIS silos
Problem with pilots - what happens when money runs out?
Have 2013-2018 National eHealth Strategy
Established eHealth Steering Committee to:
control donors and implementing partners
evaluate proposed projects to see if it is a worthwhile investment
Governance to ensure that projects are really needed and not based on political demands
Establish eHealth standards rules and protocols for information exchange
Have 128 digital health systems across the sector - not a good situation
Health Sector Strategic Plan 2015-2020
Says to embrace ICT
MOHCDGEC will stimulate development and guide interoperability of systems
Interoperability - using HealthELink for interoperability layer
Want to avoid peer-to-peer data exchange
DHIS2 is integrated with RBF, VIMS, eLMIS, IDSR systems- currently Peer-to-Peer
HealthELink - is an Enterprise Service Bus
Aim to link to systems such as Plan Rep, LGA Epicor, NHIF/CHF, NIDA, RITA CRVS, Logistics (eLMIS, MSDE9, IHFeMS), Immunization (VIMS, TimR), HMIS (DHIS2), Hospital Management. Links to OpenHIE architectural components (e.g. HRHIS, HFR)
Multiple data transport methods are supported
Current implementation use cases
Clinical level data exchange for hospitals (medical services received, death by disease, bed occupancy, hospital revenue)
Aggregate data exchange to DHIS2
Link to HFR
eLMIS: count of stock received, consumed, stock on hand at facility level
VIMS: monthly counts of children vaccinated
E9: count of stock received, consumed(distributed), stock on hand at MSD
Have Developed Investment Roadmap with Data Use Partnership
2014-16 GIZ program health financing, support
2015-16 GIZ program to do statistical database on top of NHIF database for aggregate data warehouse
2017-19 limited support to data warehouse
2018- KfW investments starts
Not looking at openIMIS directly, but perhaps an option for the future
GIZ current work
supporting 10 health facilities in each of 4 counties
Did a health facility assessment
Sophisticated curricula and many local implementers
Has 2015-2030 eHealth Strategy
Facilities have donor driven implementations
Very diverse b/c of donor and health verticals - multiple systems in same hospital which are not connected.
Have guidelines for eHealth interoperability
NHIF is national provider for health insurance. Current mandate is for in-hospital, out-patient and informal sector
NHIF has mandate for insuring every Kenyan in next 4-5 year; NHIF shall become a law
NHIF has centralized database (IBM) w/
thin application layer for UI,
reports.
DB is accessible from all NHIF branches
Powerful but needs better structure
Hospitals can do eligibility verification
Allow mobile payment of insurance fees
Have biometric identification
Have ID cards
Looking at how they can better use high volume of data
Updating eClaims process?
Trying to automate all their systems
Mandate:
Registration
Receiving of fees - already automated (mobile, online)
Filing Claims - hospitals can file
Payment of claims - current work for mPayment
Have issues with member retention, especially after receiving the funds
There is also a National Hospital Insurance plan (not integrated yet with the MOH’s strategic plan)
OpenHIE is a blue print, an initial sketch to make systems interoperable (component layer, services layer and external systems)
Client registry (storing all information centrally)
Shared repository for all clinical information
HMIS as basic indicators for public health sectors
Facility registry (master list of all facilities, identified by an ID)
Health worker registry (who the health workers are? Are they properly trained?)
Interoperability layer (authentication, ILR, entity matching)
There is a lot of consensus on the value of OpenHIE among the user countries:
A community of communities (exchange among users)
Standards
Software
OpenHIE is a architectural reference model. Countries are free to choose their applications for each described system role. Tanzania is not using OpenHIE (the reference application of openHIE) as interoperability layer, but: http://www.wnyhealthelink.com/
Could openIMIS become the “reference system” for Health Insurance in openHIE?
Example of a health insurance architecture compared to openHIE. The goal will be to have the openHIE community develop a view that incorporates both together so that insurance will be represented in the openHIE.
Digital Square: in the midst of its current funding phase (funded by Gates Foundation & USAID); when openIMIS gets to a point where it can be applied to different countries, it is more available for financing.
To-dos as follow-Up to roadmap discussion:
Upload current Nepal version to GitHub, identify differences
Get requirements from Nepal and Tanzania on the issue queue
Principles for the transition:
Collect orientation on strategic direction: openness for the needs of the users & broad sounding board (partners JLN/OpenHIE)
Prioritize current customer base
Carefully transition technology; not starting with the core of the system, but the satellites; changes coming from the outside
Re-use existing modules, libraries, standards; benefit from development happening in openHIE.
We do currently use a Microsoft IMIS version, there are discussions whether it should be replaced in the future with another technology. What are possible solutions/restrictions/complexities? Is all this reflected in the business rules?
Understanding the current complexity in the business rules, e.g. in:
Initial configuration
Member registration
Pre-authorization
Claims processing
Post claims-processing analysis
Data management system:
Client registry (demographic info) → ID number → data transferred to openIMIS
Business rules are going to be preserved, but we open the system architecture! → expanding the schemes goes along with complexity
Some key points to consider (for flexibility):
Custom defined attributes
Custom defined workflows
Custom defined business rules
Key points:
Cost / Training of users, for interoperability → often underestimated; Capacity Building
Regulation on which system should be used
Marketing strategy needs to be clear how product can be used
openIMIS being part of UHC package
Identify needs for the system (awareness raising)
P4H can support this process
Is the product looking for the market or the market looking for the product
Have more functionalities to make product more visible; Which are the functionalities which make the product attractive, being looked for
Integrating IMIS and other systems (HMIS, Epicor,...)
Establish partnership with Mobile company - USSD technology (to check status of the insurees, e.g. on enquiry, enrollment); SMS Gateway integrated with IMIS
Have a strong system support (24/7)
Improve system performance
Figuring out the funding model
Partnership with universities and research (analytics of insurance data, how is the data used?)
Support for policy / scheme design → need of an overall eHealth strategy
How to set up the secondary market of implementing partners (certification, who does implementations, bad implementations lead to bad reputation)
Reliability of IT solution (if insurer has faith in it) → does the system deliver what it is needed for?
Make a business case (Canvas)
Benefits instead of revenue
The download is free, but still you need to make investment happen so it can be run
Comprehensive e-payment solution
Make openIMIS usable for other insurance/finance products (e.g. microinsurances) → increasing the potential customer base, not only national insurers; defining user profiles