AeHIN openIMIS CoP in Asia (2021 Activities)

AeHIN 7th General Meeting

AeHIN held its seventh AeHIN General Meeting virtually last January 7, 14, 21, and 28, 2021. This year’s theme discussed ‘Strengthening Regional Health Systems Response to COVID-19 focusing on digital health experiences in Asia.’ A total of 328 participants from 42 countries in and outside of the Asian region attended the conference. 

During the opening ceremony, AeHIN partners shared messages carrying the importance of the Governance, Architecture, Project Management, and Standards and Interoperability (GAPS) Framework in digital health to set the context of the whole conference.

Mr. Saurav Bhattarai, GIZ Advisor, discussed using standards-based tools and leveraging what is already available to avoid duplication of efforts. He stressed that “we needed digital health tools running on open and standards-based architectures that facilitate interoperability to ensure that we can effectively fight the COVID-19 pandemic.”

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Saurav Bhattarai welcoming participants to the 7th AeHIN General Meeting

On the third day of the conference, AeHIN facilitated a parallel community meeting for the openIMIS Regional Hub Asia (Philippines, Indonesia, and Sri Lanka) to gather their ideas on best moving forward with the community of practice. 

One of the suggestions in the meeting was to use a standard learning management system for learning openIMIS and to scale up the visibility of openIMIS in policy-oriented discussions in respective countries. Participants also suggested using openIMIS as a bridge to strengthen the collaboration between the ministry of finance and the ministry of health.

The AeHIN Partner Share session followed the parallel community meeting, wherein Saurav Bhattarai gave updates on the openIMIS initiative. He shared about their continued support in existing openIMIS implementations that manage the data of over five million beneficiaries.  

The initiative has also been working on new implementations and functionalities and expanding openIMIS for other social protection schemes. openIMIS is also strengthening its focus on interoperability. Saurav Bhattarai discussed that they have been “mapping openIMIS data model to be FHIR-compliant as well as working on direct interoperability with our other global goods such as DHIS2, OpenMRS, and Bahmni.”

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Saurav Bhattarai giving updates on openIMIS at the 7th AeHIN General Meeting Partner Share Session

Another important update from the openIMIS Initiative was the openIMIS Catalytic Implementation Fund that intends to “provide support to scheme operators that want to use openIMIS to manage their various social health protection schemes or beyond.”

AeHIN Hour - openIMIS Webinars 2021

Since 2019, AeHIN and the openIMIS have organized webinars to help bring information, updates, and discussions about openIMIS between the initiative and its communities of practice in Asia.

Saurav Bhattarai and Konstanz Lange, Advisors from the openIMIS Coordination Desk in GIZ, were the speakers at the first AeHIN-openIMIS webinar for 2021 held on March 9.

In this webinar, they introduced the openIMIS Catalytic Implementation Fund, a “mechanism to allow resources to be made available for getting started with openIMIS implementations.” 

The speakers also explained the various use cases where it can be applied and provided details on the procedures related to getting access to the fund.

The webinar recording is available at https://www.youtube.com/watch?v=4lfv_SlXjwE&ucbcb .

Other openIMIS webinars are available at AeHIN Hour-openIMIS Webinars .

openIMIS Enrollment App Testing

In mid-March, the AeHIN secretariat team contributed to testing the openIMIS enrollment application.

AeHIN focused on testing the openIMIS enrollment application via Android. The team used the openIMIS test link in documenting the test results. 

openIMIS Virtual Meetings

On March 17, 25, and 31, AeHIN participated in the openIMIS virtual community meetings spearheaded by the openIMIS coordination desk. On the first day, AeHIN co-facilitated the session on ‘Community-driven openIMIS 5th Anniversary Campaign.’ The session collated ideas from the implementers to further promote openIMIS’ anniversary.

openIMIS Discussion with MoH Lao PDR

On March 30, 2021, Dr. Bikash Devkota (Director of Quality Standards and Regulation Division from the Ministry of Health and Population Nepal) and Dr. Damodar Basaula (Executive Director of Health Insurance Board Nepal) presented at the Lao PDR Digital Health Convergence Workshop to discuss the experience of Nepal in implementing openIMIS.

As a follow-up action to the Lao PDR Digital Health Convergence Workshop, AeHIN facilitated a virtual meeting with Dr. Thepphouthone Sorsavanh (Head of Health Information Division, Ministry of Health Lao PDR) and Dr. Viravong Viengxay (National Health Insurance Board) last August 20, 2021. Dr. Sorsavanh also invited Kevin Billavarn (ADB Consultant) and Roland Dilipkumar Hensman (WHO Consultant) to the meeting.

The discussion from the meeting is summarized below:

• Invite Lao IT staff to join the AeHIN community/mailing list

  • Currently 1 IT specialist working with NHIB

  • Currently around 5 IT staff working with Health Information Division, MOH Lao

• MOH departments to meet again for the development of Lao's Digital Health Strategy (for the next five years); convergence workshop report to be published soon

• openIMIS can provide support through the following channels:

  • Through networking facilitated by AeHIN: support discussions in defining the functionalities required by NHIB for their health insurance management system

  • Through knowledge resources: openIMIS wiki page, openIMIS videos

  • Through the openIMIS implementation catalytic fund: technical assistance for implementation including customization, user training, etc.; more details are available here

  • Through ILO

• Suggested next steps based on the meeting:

  • At the country level, the Lao team defines system requirements for health insurance management

  • At the regional level, AeHIN facilitates inter-country discussion in defining minimum requirements for a generic health insurance information system

  • Meeting with Dr. Alvin and Saurav to discuss refined system requirements (wait for further details from NHIB)

  • openIMIS demo

  • Meet as a group on how to move forward

As of December 2021, MoH Lao PDR and NHIB Lao PDR did not yet give feedback on the systems requirements for their national health insurance.

Lao PDR Convergence Workshop - Use of openIMIS in Nepal

The Ministry of Health Lao PDR hosted a digital health convergence workshop last March 30-31, 2021. The workshop aims to help strengthen the digital health sector of Lao with the help of experts from the Asia eHealth Information Network, development partners, and other government agencies in the country.

The workshop's expected outcome is to develop a digital health architecture blueprint and a digital health strategy for the Lao PDR health sector. These outcomes will help improve stakeholder coordination and harmonization towards a sustainable and interoperable health information system.

AeHIN presented the AeHIN Mind the GAPS (Governance, Architecture, Program Management, and Standards, and Interoperability) Framework, which was the basis of strategy development sessions during the workshop. 

Neighboring countries also shared their experiences in the Digital Health Strategy Development session. Since its first digital health convergence workshop, Dr. Bikash Devkota, Director of Quality Standards and Regulation Division from the Ministry of Health and Population Nepal, shared Nepal's digital health journey.

According to Dr. Devkota, one of the lessons they learned is that digitalization is a significant component of quality care as it makes service easier and efficient. With this regard, Nepal prioritized digitalization in health. 

Dr. Damodar Basaula, Executive Director of Health Insurance Board Nepal, discussed how openIMIS played a big part in the country’s health digitalization, especially in managing Nepal’s national health insurance scheme. 

The Health Insurance Scheme of Nepal is a contribution-based Security Health Insurance (SHI) scheme with subsidies for the ultra-poor, poor, and the marginalized. The Nepal Health Insurance Board (HIB) manages it entirely. It is currently implemented in 69 districts and has a total of 3.7 million beneficiaries.

openIMIS supports the management of the core business processes of the Nepal HIB from the enrollment to verification of beneficiaries, claims generation, claims review, and data analysis. At present, there are 375 hospitals using openIMIS to send claims digitally, and there are 7,335 openIMIS users.

Since 2016, the Nepal HIB has been part of the openIMIS community of practice. They report bugs and issues, request new features, and discuss various technical topics with the community. The openIMIS community has provided them with a platform for exchange and regular updates, especially new features.

Dr. Basaulaa shared that the use of openIMIS in Nepal expedited the implementation of the Management Information System (MIS) for health insurance in Nepal. They also received support from the community of practice when needed, and the new versions of the openIMIS software are available regularly.

Nepal has learned that they need local capacities to manage and maintain software. Local teams have to lead implementations, and the openIMIS global community is available to support their local efforts.

AeHIN x APMC-SN M.D.igital 2021: National Telehealth Convention

AeHIN has co-presented this year’s M.D.igital Telehealth Convention with the theme “The Role of Medical Students in the Global Digital Health Strategy 2020-2025” last April 24-25, 2021.

The online conference, initiated by the Association of Philippine Medical Colleges Student Network (APMC-SN), served as a venue to discuss the role of medical students in the Global Digital Health Strategy 2020-2025. Four hundred sixty-one attendees attended the event.

In the international session, Saurav Bhattarai, Advisor from GIZ, introduced openIMIS, an open-source information system for managing insurance schemes and other related use cases. Saurav also discussed how systems can interoperate with openIMIS. openIMIS is being implemented in Nepal, Cameroon, Tanzania, Chad, and DRC. 

The conference proceedings and the MDigital Paper will also be shared once available.

Contribution to the openIMIS eLearning Course

In July 2021, AeHIN contributed to the development of the openIMIS eLearning course, particularly the second module on ‘openIMIS and National eHealth Landscape.’

In this module, AeHIN contributed slides on digital health challenges, AeHIN’s Mind the GAPS (Governance, Architecture, Program Management, and Standards) and Fill the GAPS Framework and some activities of the openIMIS community of practice in Asia.

Dr. Alvin Marcelo, AeHIN’s Executive Director, provided a voice recording of AeHIN's part in the module, corresponding to the contributed slides.

Convening the openIMIS Regional Hub Asia (Every First Tuesday of the Month)

The openIMIS Regional Hub Asia held its first internal meeting via Zoom with the country hub representatives for the year 2021 last August 3. Dr. Alvin Marcelo welcomed discussed the overview of the openIMIS community of practice in Asia as well as past activities from 2019 to 2020. He then explained the openIMIS regional hub work plan for 2021 to 2022, including the tentative schedule of activities. Lastly, the regional hub agreed to meet every first Tuesday of the month to discuss announcements and updates.

The succeeding meeting via Zoom took place on September 7. The regional hub discussed the upcoming testing activity for the openIMIS October 2021 release version, the openIMIS e-learning course to be cascaded in each country hub, proposed schedule of webinars, and some deliverable reminders for other consultants. The meeting also announced openIMIS related events as well as brainstorming for the regional hub’s abstract submission for the Global Digital Health Forum 2021.

In lieu of the monthly meetings for October and December 2021, the regional hub gathered for the openIMIS testing orientation held last September 29, 2021, and the openIMIS community of practice in Asia’s pre-formed panel at the GDHF held last December 7, 2021, respectively.

openIMIS Training with Metropolitan Medical Center

AeHIN shared its curriculum for ‘openIMIS training for medical schools in the Philippines’ with the Metropolitan Medical Center last August 2021. This initiative aimed to address Metropolitan Medical Center-College of Arts, Science, and Technology’s request to learn more about the field of health informatics. 

On August 14, Dr. Alvin Marcelo, AeHIN Executive Director, presented the overview of the curriculum and facilitated the module discussion on ‘Health Informatics’ via zoom to the faculty of Metropolitan Medical Center-College of Arts, Science. The session was attended by 16 participants.

The succeeding modules were offered as self-paced educational video resources, namely:

• Health Financing Module by Dr Dante Salvador

• Health Data Privacy Module by Dr/Atty Ivy Patdu 

• openIMIS Demo by Mr Eric Pareja 

openIMIS Testing for October 2021 Release Version

In support of the openIMIS October 2021 release version, the openIMIS Regional Hub Asia gathered testers who could contribute to completing the test case scenarios for the openIMIS modular release instance (174 test cases), openIMIS legacy release instance (74 test cases), and the openIMIS claims AI instance (12 test cases). 

On September 29, the openIMIS Regional Hub Asia facilitated an orientation and quick training on the testing activity with the identified testers from various country hubs.  The number of identified testers per group were outlined below.

• Philippines-St Luke’s College of Medicine Quezon City - 8 testers

• Philippines-San Beda College of Medicine - 5 testers

• Sri Lanka - 5 testers

• Cambodia - 5 testers

• Nepal-Kathmandu University - 2 testers

The testing is ongoing for the openIMIS instances assigned to the regional hub and is expected to be completed by the second week of October 2021.

Focus Group Discussion on Free and Open Source Software

The openIMIS Regional Hub in Asia aims to promote a demand-supply ecosystem that will support the adoption of Free and Open Source Software (FOSS) applied in healthcare, such as openIMIS.

To understand the needs and perspectives of stakeholders in the ecosystem, AeHIN hosted a Focus Group Discussion on Free and Open Source Software for Healthcare last 25 August 2021 at 5:00-6:00 PM GMT+8. AeHIN administered real-time questionnaires (via http://Mentimeter.com ) complemented with open discussion to surface the participants’ perceived benefits and risks of adopting FOSS like openIMIS.

The 23 participants from the Philippines, Germany, Sri Lanka, Malaysia, Nepal, Bangladesh, New Zealand, Switzerland, and the United States represented various sectors. The majority of the participants work in the private sector (34.8%), primarily electronic medical record providers and insurance companies. Other sectors represented are the academe, international development agency, government, and non-government agency (figure below).

Overall, the focus group discussion showed that the participants are familiar with examples of FOSS in healthcare. Participants also identified advantages and disadvantages of FOSS in healthcare as summarized below:

• Costs: FOSS is considered an affordable solution that can help low-resource countries manage their healthcare system. However, it can have a high impact on countries if it fails. While FOSS is known to be cost-effective with its free license, some participants believe that it may have unclear upfront costs.

• Community/Support: Some participants appreciate that FOSS has a thriving community of developers and users, allowing easy onboarding of local experts. On another note, some participants perceive the community as weak, lacking local technical experts who can provide a high quality of support (troubleshooting, core development, enterprise support).

• Features: FOSS allows implementers to have complete control of the source code. Thus, they can easily modify, customize, and localize software development. Other benefits highlighted are cross-platform deployment and easy interoperability with other information systems. With the degree of flexibility in FOSS, some are concerned with issues on security, deployment stability, and data privacy that may come with it.

• Overall Implementation: As it is vendor-independent, FOSS promotes ownership, sustainability, and fast implementation. However, some participants noted that FOSS implementation is prone to hiatus due to the unavailability of experts. Disadvantages include unclear licensing types and service level agreements as well as poor marketing.

For small and medium enterprises (SMEs) to invest in FOSS, they need support configuring the product to address clients’ needs. Thus, they are seeking a training program and budget to create a highly competent pool of developers who are well versed in FOSS development. To sustain the implementation, they want to ensure value for FOSS investment by reassuring product continuity, especially in its ability to provide stable and certified solutions. Thus, FOSS development should be well-secured by a funded program. They also want to guarantee a market for FOSS solutions to generate demand for the product. Lastly, they need government commitment to FOSS and its SME vendors. 

For the ministry of health (MoH) to adopt FOSS, implementers should avoid adverse lobbying (‘selling’ FOSS for FOSS’s sake). It is crucial to emphasize the specific features of FOSS that contribute to cost-effective innovation and address specific needs in managing health information. MoH should also understand that they have full control when adopting FOSS. Since most decision-makers do not have an IT background, networking is one of the ways for government staff to connect with FOSS experts. MoH would also need to develop an enterprise roadmap for FOSS implementation and, at the same time, strengthen and empower their technical team to ensure high quality of service and fast development in FOSS.

Lastly, the discussion also shows a need to develop a framework or model defining the role of SMEs and MoHs for FOSS implementations in highly regulated domains, such as healthcare. Demand for FOSS in national healthcare can only be generated if MoH adopts a clear governance framework in implementing and evaluating HIS solutions including FOSS. Supply for FOSS solutions can only be sustained if a local community of experts from the private sector is available.

AeHIN Webinar on DRGs

DRG 101

On October 14, 2021, Prof. Supasit Pannarunothai, Chair of the Center for Health Equity Monitoring Foundation, presented a webinar titled "DRG 101: What is the Diagnosis Related Group? Why is it important for UHC in Thailand?"

The Universal Health Coverage (UHC) has been unanimously endorsed by major multilateral policy organizations since 2000.

The Health Systems Research Institute, launched in 1993, funded research on diagnosis-related groups (DRG) in Thailand to promote a payment method for less evenly distributed events among populations like hospitalizations.

This webinar (Figure 1) provided frameworks of successful implementation of DRG inpatient payment policy after UHC law was enacted in 2002.

In this webinar, Prof. Supasit Pannarunothai explained the general principle of DRGs and also shared lessons learned on how to adapt the policy processes to fit with different political contexts among limited-resource countries (Figure 2).

The webinar recording is available at https://www.youtube.com/watch?v=m0v_XcjWHLg

Other openIMIS webinars are available atAeHIN Hour-openIMIS Webinars

DRG Information Systems

On October 26, 2021, Dr. Boonchai Kijsanayotin, Chair of the Asia eHealth Information Network, presented a webinar titled “DRG Information Systems: Thailand Experiences."

Thai diagnosis-related groups (TDRGs) have contributed to Thai UHC provider payment since Thailand implemented universal health insurance in 2002.

The development of TDRG goes hand in hand with the development of hospital and health information systems in Thailand.

This webinar (Figure 3) provided insights about the data needed for patient grouping and the calculation of DRG's cost weight (or relative weight), and how Thailand develops health information systems and data standards to be utilized by the TDRG system.

In this webinar, Dr. Boonchai Kijsanayotin explained also the essential building blocks of setting up a DRG system based on Thailand’s experience (Figure 4).

The webinar recording is available at AeHIN Hour - DRG Information Systems: Thailand Experiences

Other openIMIS webinars are available atAeHIN Hour-openIMIS Webinars .

openIMIS Community of Practice in Asia Pre-formed Panel at the Global Digital Health Forum 2021

On December 7, 2021, the openIMIS Regional Hub Asia conducted a pre-formed panel session at the Global Digital Health Forum (GDHF) 2021 with the title, “Strengthening a Community of Practice for openIMIS in Asia”.

Dr. Alvin Marcelo, AeHIN Executive Director, moderated the panel session. Country hub representatives from the Philippines (Dr. Julius Migriño), Sri Lanka (Dr. Chamika Senanayake), and Nepal (Mr. Nirmal Dhakal) shared their experiences on how they adopted openIMIS in their respective institutions.

1. Philippines (Dr. Julius Migriño, Associate Professor, San Beda University College of Medicine)

Dr. Julius Migriño started his presentation by giving a brief background of health financing in the Philippines. He explained that health financing in the Philippines can be categorized into general tax revenue, out-of-pocket, private insurance, and Philippine Health Insurance. He also introduced the primary electronic medical records (EMR) systems used in the country.

Dr. Julius Migriño’s focused on the use and plans for openIMIS at the San Beda College of Medicine, which offers a four-year medical degree program with a traditional subject-based curriculum and outcomes-based education formats. Based on the current directive from the Universal Health Care (UHC) Law in the country, the college has been implementing changes in curricular content to integrate public health concepts, including health financing and health informatics.

In February 2020, select students and faculty members of San Beda College of Medicine have undergone an openIMIS training tailored for medical students. Through this training, the college was able to discuss potential uses of openIMIS and also reflect on the limitation of the college’s curriculum rollout in the areas of health financing and health informatics.

Now as a member of the openIMIS community of practice in Asia, Dr. Julius Migriño presented the short, medium, and long-term goals of the San Beda University College of Medicine to adopt openIMIS (Figure 5).

As a short-term goal, the college aims to use the openIMIS manual for medical students as a reference in introducing ‘Health Financing’ as part of the ‘Health Management’ elective for the third and fourth-year levels.

As a medium-term goal, the college aims to demonstrate openIMIS as a tool for health financing. In this endeavor, the college has involved student volunteers in the user testing activities of openIMIS. The college is also planning to include the forthcoming openIMIS eLearning course as part of the ‘Health Management’ elective.

Lastly, for the long-term goal, the college aims to use openIMIS as a tool for patient enrolment in the community health station (for outpatient setting) that is currently being constructed in the university.

2. Sri Lanka (Dr. Chamika Senanayake, Medical Officer, Ministry of Health Sri Lanka)

Dr. Chamika Senanayake introduced the two types of insurance in Sri Lanka, namely life insurance and general insurance. There are also 28 private insurance companies in the country and another one used for the state sector, a national insurance trust fund for all government employees. Insurance in Sri Lanka is regulated by the Insurance Regulatory Commission of Sri Lanka. Other bodies included in the insurance mechanisms are the Sri Lanka Insurance Ombudsman, the Insurance Association of Sri Lanka, and the Sri Lanka Insurance Institute.

In Sri Lanka, health financing is usually from the out-of-pocket expenditure. According to Dr. Chamika Senanayake, one of the reasons why there is low insurance penetration in the country is that technology is not used to its full potential.

In terms of digital health ecosystem maturation, the National eHealth Steering Committee is governing digital health efforts in the country. Numerous health information systems are being used as well including the use of DHIS2 for COVID-19 surveillance.

Siloed systems, less coordination, less flexibility, ‘pilotitis’, and lack of alignment to national priorities are among the digital health challenges encountered in the country.

For openIMIS activities in Sri Lanka, Dr. Chamika Senanayake approached the Sri Lanka Institute of Insurance, which is composed of chief executive officers of insurance companies in Sri Lanka, to give an overview of openIMIS and its benefits (Figure 6). Some of the concerns raised by the representatives in the discussion include the visibility of medical records in the event of a claim, implication from the data protection act, customer consent, trends of various epidemics, and timeline on the national rollout of the country’s main Health Information Management System (HIMS). As part of awareness-building activities on openIMIS, Dr. Chamika Senanayake also held openIMIS webinars via AeHIN Hour.

Today, the health ministry is developing its national eHealth architecture and still figuring out how to implement the architecture’s middleware. In this initiative, the ministry is looking into how openIMIS can fit the architecture.

Dr. Chamika Senanayake also mentioned that they gathered health informatics graduate students in the user testing of openIMIS. Other potential opportunities for openIMIS as explained by Dr. Chamika Senanayake include:

• Academic commitment towards digital health innovation (M.D.  program in Health Informatics), specifically interest in health data utilization and prevention of fake claims

• Research project on health information management in the private health insurance industry of Sri Lanka, including a systematic review on health insurance information management

• Incorporation of openIMIS LMS module for postgraduate trainees at the University of Colombo

• Using openIMIS as a health insurance training platform for postgraduate trainees

• Implementation of domains such as health financing and health insurance in medical undergraduate and postgraduate

3. Nepal (Mr. Nirmal Dhakal, Senior Technical Advisor, GIZ Nepal)

Mr. Nirmal Dhakal gave an overview of openIMIS implementations in Nepal (Figure 7). As of now, openIMIS has been supporting the Health Insurance Board (HIB) and the Social Security Fund (SS) in Nepal in managing their respective insurance schemes.

• For the HIB, openIMIS supports the management of a voluntary social health insurance scheme for the informal sector. Since 2016, openIMIS has been implemented already in 76 districts in the country. openIMIS supports the management of core business processes at HIB which includes enrolment, verification, claims submission, claims review, and data analysis. To date, about 7,000 users actively rely on openIMIS for this scheme.

• For the SSS, openIMIS support the management of various insurance schemes, such as the mandatory health and maternal scheme, accident injury insurance scheme for formal sector employees, benefits for dependent family members, and old-age benefit.

After the presentations from the Philippines, Sri Lanka, and Nepal, Dr. Alvin Marcelo moderated the question and answer session with the audience. Mr. Saurav Bhattarai from the openIMIS coordination desk also joined and shared briefly about implementations in Africa, wherein openIMIS is used for multiple financing schemes.

The session recording is available until early March 2022 at the on-demand section of GDHF 2021’s platform via this link.

openIMIS Community Connect

On October 21, 2021, AeHIN participated in the openIMIS community connect spearheaded by the openIMIS coordination desk. In the openIMIS introductory e-learning course sub-session, the country hub representatives from the community participated in the online brainstorming activity on how to promote or market the openIMIS e-learning course.

Review of the openIMIS eLearning Course

Since November 17, 2021, the openIMIS regional hub in Asia, through country hub representatives, has started giving feedback to the tentative openIMIS eLearning course hosted through the SwissTPH moodle platform. The feedback was sent through the feedback box inside the moodle platform.