Formal Sector API Scope - Healthix

Healthix solutions was contracted by Digital Square to extend the openIMIS FHIR modules to accommodate the Formal Sector in Nepal. The extension was expected to be compliant with the FHIR API to facilitate interoperability and exchange of information between Providers, OpenIMIS and Payer Systems for easier and efficient integration models. Nepal uses openIMIS to manage its national health insurance program for the informal sector and Nepal has since extended the same to the formal sector through their SOSYS system.

The project required re-architecting an API development to accommodate OpenHIM which is an OpenHIE integration approach to enable multisystem integration (Including OpenIMIS) going into the future. The Fast Healthcare Interoperability (FHIR) Resources module will respectively connect both Instant OpenHIE project requirements and openIMIS Initiative’s expectations.

In our scenario, our development focused on the Nepal System which uses SOSYS as the Payer system, OpenMRS as the Provider system, and the OpenHIM platform. We shall be using the FHIR R4 Standard to support interoperability. Since it was not possible to use the SOSYS system, Healthix system was used instead to show the integration to openHIM.

Project objectives

1. To extend the development of the FHIR APIs that enable data exchange between SOSYS, Providers and openIMIS.

2. Setup the OpenHIM gateway to enable Insurance Integration

Activities undertaken by Healthix in collaboration with SwissTPH (Formal Sector) and Technical Developers Committee within OpenIMIS Project.

1. Technical Design and Architecture

This is the design of technical architectures, workflows (high- and low-level) and specifications that will be used as blueprints for the development of FHIR 4 API and standard interface modules.

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2. Extending the development of the FHIR API module to integrate to OpenHIM and Write on the OpenIMIS Database

Currently, OpenHIM has implemented FHIR API as proof of concept. Healthix used the concept to adapt, extend and integrate FHIR 4 API modules into OpenHIM Interoperability Layer. This activity was building on existing APIs modules developed by Bluesquare to extend the endpoints to a standard FHIR 4 APIs that allow stakeholders to push data into OpenIMIS transactional database. Fields were mapped for these extensions which were touching four modules: Organisation, Coverage, Group, Contract. Healthix also provided documentation on an overview of the design decisions made in the process of integrating openIMIS FHIR R4 modules into openHIM using open source tools. openHIM mediators were developed using two frameworks Node.js and Django (Python web) and the code can be found in the openIMIS github repository – Python-based and Node.js (: contract, claimresponse, organisation, coverageEligibility, claim, coverage, patient).

3. Upgrading FHIR STU3 communication between OpenMRS and OpenIMIS to FHIR R4

To take advantage of services supported by FHIR 4, there was a need to upgrade the FHIR STU3 APIs endpoints between BahMNi and OpenIMIS. SwissTPH team developed the following modules:

1. Patient Eligibility – FHIR resource for checking on eligibility status of a patient or group and Healthix tested the APIs

2. Claims and Valuated Claims – FHIR resource for validation of submitted claims and valuated claims and Healthix tested the APIs

4. Developing FHIR APIs to collect Insurance details from SOSYS through OpenHIM

This activity required implementation of the following standard FHIR modules that were missing in the existing implementation:

1. Register Organization, Contract and Coverage – Creation of the three registration FHIR 4 APIs and standard interface based on the design specifications created in activity 1

2. Register Person and Family + Contribution Payment – Creation of the two registration FHIR 4 APIs and standard interface based on the design specifications created in activity 1

3. Submit Claims and Valuated Claims – Upgrading and extending the claim API to support FHIR 4 design specifications created in activity 1

5. UATs and Handover of the modules

1. UATs with SwissTPH (formal Sector Developers), PATH (Nepal Insurance Platform): - Healthix held two separate sessions to walk the participants through all the new FHIR 4 platforms in a live demo that served as user acceptance tests.

2. Migration of services from the Test Environment to the Live Environment: Healthix worked with the OpenIMIS Developers team to migrate the services from Test Environment to the Live Environment. Code was published in openIMIS repositories.

3. Online Technical documentation for the Modules developed: - These are detailed technical documents that describe the design, implementation and deployment and troubleshooting strategies for all the artifacts developed by Healthix. Healthix worked on the python-based openHIM mediators for openIMIS technical documentation published with the code on the openIMIS repository here and here.

6. Quality Assurance checklist

Healthix collaborated with the development teams to ensure the released products meet metrics of quality assurance: functionality, reliability, usability, efficiency, maintainability, and portability. Two reports were produced – server security and access reports.