Overview

Date: 13.05.2020

Objective: Align scope and roadmap for Formal Sector Integration

Participants:

• @Uwe Wahser

• @Purushottam Sapkota

• @Maguette T. NDONG

• @Fourie, Carl

• @Xavier Gillmann (Unlicensed)

• @Patrick Delcroix

• @Dragos Dobre

• @Siddharth Srivastava

• @Saurav Bhattarai

• @Nirmal Dhakal

• Umesh Prasad Bhusal

• @Doreen G. Wamiti

Topic Proposals:

Date	Topic	Presenter	Comments

Date	Topic	Presenter	Comments
13.05.2020	Overview of Formal Sector requirements from Nepal Open	GIZ Nepal
20.05.2020	Gap analysis and conception for core modules	SwissTPH
27.05.2020	Gap analysis and conception for APIs	Healthix
03.05.2020	Overview of the https://openimis.atlassian.net/wiki/spaces/OP/pages/40763442 for the openIMIS modular re-architecture	BlueSquare
	Align the https://openimis.atlassian.net/wiki/spaces/OP/pages/40763442	https://openimis.atlassian.net/wiki/spaces/OP/pages/589561913

Minutes

scope

• Changing the claim flow (add the admin checks for the claims) was supported by the workflow package that was not accepted by DS

  • workpackage budget for formal sector in Notice D1 does not cover generic workflow engine

• contribution is paid by employer directly

• Nepali Developer / Beneficiary Management System (SOSYS) will remain and needs interoperability

• Beneficiary can claim directly for treatment in hospitals without MoU with SSF - not in scope for this formal sector work package, will be needed with accident insurance, is in issue queue and waiting for other funds

  • Reimboursement of cash payment (HF W/O MoU) are important for the Nepali but they are not covered by the RfA answers.

• Beneficiary / employer is responsible to update basic salary.

• Interface standard: FHIR, SOSYS will be able to adapt to that

• The maternity, sick pays are handled by SOSYS, therefore they are not is scope

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stakeholders

• invite representatives from Social Security Fund (technical & business staff) for more detailed analysis - focus on specific topics at a later stage, also involving representatives from other scheme operators

• SOSYS Developers ()

further activities

• share SOP document of SOSYS processes (GIZ Nepal)

  • presentation from last weeks call ( )

• clearly map out entities (beneficiary, employer etc.) workflows (claiming, enrollment etc) and system components (enrollment system, claiming system, payment system etc..) - SwissTPH & GIZ Nepal

• need detailed view on workflows and needed FHIR APIs: rely on existing openIMIS FHIR ressources and map out gaps (Healthix & SwissTPH)

Challenges

• dependencies: database, FHIR APIs

• product management will not be migrated in time (items, services)

Additional Resources

• - Incubator page in this wiki

• http://hl7.org/fhir/financial-module.html - FHIR R4 objects (financial Module)

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