AeHIN openIMIS CoP in Asia (2024 Activities)

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Tinker Tech, NHIB, and CBHI Office discuss how workflows in community-based health insurance work, including implementation challenges

Vientiane, Lao PDR—On behalf of the openIMIS regional hub Asia hosted by the Asia eHealth Information Network (AeHIN), Mr. Sunil Parajuli (Team Lead) and Mr. Ranjeet Bhlon (System Analyst) from Tinker Technology based in Kathmandu, Nepal, visited the National Health Insurance Bureau (NHIB) of the Ministry of Health (MOH) Lao PDR on March 11-15, 2024 to assess the technical feasibility of using openIMIS. Recognized as a digital public good by the Digital Public Goods Alliance, openIMIS, an open-source software, supports the administration of health financing and social protection schemes. 

Understanding CBHI in Lao PDR

MOH recommended exploring the use of openIMIS for its Community-based Health Insurance (CBHI) scheme, which was established in 2002 to expand its social health protection program to informal workers and self-employed individuals through voluntary registration. 

Today, the Vientiane capital remains the only province operating CBHI as-is. CBHI is operated across nine districts in the capital, wherein 50 % of the contributions are provided by the beneficiary households, and the remaining 50% is subsidized by the government. 

During the visit, the CBHI team presented the current software application used for enrolling members. In this regard, the NHIB, the CBHI Office, and Tinker Technology discussed the status of community health insurance claims and the interoperability features of openIMIS. An exposure trip at the CBHI Central Hospital and Xaythany District Hospital allowed Tinker Technology to observe processes on the ground, particularly patient flow, patient record management, report generation, use of insurance services and items, inspection of use of standardization of diagnosis code, and standard coding in services and items. 

To explore how technological gaps in CBHI management can be addressed with openIMIS, Tinker Technology also facilitated hospital surveys and analysis of document records and data. 

Coordinating with Development Partners

Tinker Technology also had the opportunity to discuss with partners involved in developing and building capacity for electronic claims (eClaims) management in the country, such as the Swiss Red Cross (SRC), Korea Foundation for International Healthcare (KOFIH), and Japan International Cooperation Agency (JICA). These discussions were coordinated by the WHO Country Office in Lao PDR.

Tinker Technology presented openIMIS as a potential digital tool that can complement the current CBHI workflow in Lao PDR. The team also shared their hands-on experience using openIMIS to manage an employment injury insurance scheme with the Social Security Fund Nepal and a national health insurance scheme with the Health Insurance Board Nepal. The team discussed the preliminary assessment findings, highlighting that the types of CBHI claims are customizable in openIMIS.

NHIB and partners also expressed the need for human resources, especially IT experts, capacity-building, policy support, and change management procedures to meet the required operations and modifications for an efficient insurance management system.

To address these, all stakeholders, together with Tinker Technology, discussed and recognized the importance of investing in local capacity building, prioritizing operational support, allowing software modification and customization based on evolving requirements, developing comprehensive sustainable development plans for software implementation and maintenance, and supporting policy and procedure changes.

Customizing openIMIS for CBHI 

The stakeholders expect a digital claim management system to automate claim submission, verification, and reimbursement. Based on the preliminary findings of the technical feasibility assessment, AeHIN, through Tinker Technology, customized an openIMIS demonstration system for CBHI in Lao PDR. The CBHI administration manages eligibility cards for its beneficiaries, and hospitals rely on these cards for service delivery. However, workflows for member registration and eligibility checks, are not yet digitized. As such, the following features were customized on the basis of functional requirements analysis vis-a-vis requests of the CBHI office:

• Membership card for CBHI administration

• Invoice generation for hospitals as customer receipt (contribution paid slip)

• Sample Excel export based on filters for claims and insurees

Overall, openIMIS already has an inherent claim-tracking system that CBHI may use. It must also be noted that most of the scheme workflows in the current CBHI software are supported in openIMIS. To conclude, openIMIS can be used out of the box and is easily customizable. It also provides a solid foundation for integrating CBHI and Contribution-based Health Insurance seamlessly. Lastly, openIMIS is interoperable; its adaptable nature enables easy interfacing with Electronic Health Records (EHR) systems and the District Health Information System 2 (DHIS2), facilitating efficient data management and analysis. openIMIS' capacity to connect with existing third-party software promotes interoperability and streamlines administrative tasks.

Part of the recommendations for implementing openIMIS is the requirement for a technical workforce, local support for customization, change management, policy changes, and sustainability mechanisms for capacity-building, system maintenance, and support. Thus, the customized openIMIS demonstration system is envisioned to help health financing decision-makers and other stakeholders in Lao PDR better assess whether openIMIS can be implemented in the country. Concentrating on specific areas, such as CBHI, also allows potential openIMIS implementers to achieve a higher success rate. This approach enables them to begin with minimal infrastructure and resources.

The customized openIMIS instance was presented and demonstrated with the openIMIS implementers' committee on April 24, 2024, and with the primary stakeholders, NHIB Lao PDR and its partners, on April 30, 2024.  

More details about the technical feasibility assessment are available in the ‘AeHIN Hour: Exploring ‪openIMIS' Potential Use in Lao PDR's Community-based Health Insurance Scheme.’

Disclaimers:

• The observations and recommendations are based on the assessment carried out by AeHIN through Tinker Technology. These do not reflect those of the organizations and institutions involved or with whom we have coordinated this activity.

• The organizations we have collaborated with and corresponded with in Lao PDR do not necessarily endorse any mentioned technologies, solutions, service providers, and communities in this presentation.

• This technical feasibility assessment was conducted for exploratory purposes only. It does not commit future support or investment in any openIMIS implementation in the country, including pre-implementation readiness activities, full customization, testing/user acceptance, rollout, and other related activities.

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Screenshot of the openIMIS demo instance’s policy page

Coordinated by the AeHIN-openIMIS regional hub, ten identified testers from Nepal (Tinker Technology and Kathmandu University) and the Philippines (San Beda College of Medicine and AeHIN Secretariat based in Manila) joined the beta testing for the October 2024 software release of openIMIS. The testers were given the opportunity to play around with new features before the updated version of openIMIS was released. 

The openIMIS coordination desk, in its public announcement, shares that: “The current release further extended and improved the functionalities developed during the CORE-MIS migration project with strong support and feedback from several World Bank implementation teams in countries. The main activities in all four phases of the social protection delivery chain (Assess, Enroll, Provide, Manage) are now handled even more efficiently, qualifying openIMIS even more as a robust and dynamic social protection information system.”

For this release, the openIMIS developers committee included the following updates:

• Merger with the CORE-MIS software from The World Bank 

• New module for grievance management 

• Compliance to the GovStack standard specifications significantly, qualifying openIMIS as an official GovStack building block

• A number of features contributed by the Nepal team

• Many bug fixes and performance improvements 

• Special investments were provided for security improvements

The openIMIS regional hub in Asia, hosted by AeHIN, is part of a project supported by GIZ and commissioned by the Government of the Federal Republic of Germany.

AeHIN highlights global digital health collaborations, including its efforts in the openIMIS regional hub Asia at a World Health Summit side event

Berlin, Germany - The Global Digital Last Mile Health Lab (GDLMHL) at the Charité Center for Global Health, together with the Geneva Digital Health Hub (gdhub) and the Digital Transformations for Health Lab (DTH-Lab) in Geneva, held a side session to the World Health Summit, “Digital Health Unbound” Global Collaborations for Better Care” on 16 October 2024 at the Einstein Center Digital Future.

Recognizing the importance of cross-border and cross-sector collaboration in addressing global health challenges, the session speakers discussed how digital technologies can help transform healthcare delivery and access. In his keynote address, Asia eHealth Information Network (AeHIN) Executive Director Jai Ganesh Udayasankaran shared the network’s experience in fostering global collaborations for better care, specifically in digital health planning and implementation. He stressed, “Health is the focus, and digital is the means.” 

Udayasankaran also shared about efforts in the openIMIS regional hub Asia, a community convened and led by AeHIN to localize awareness-building and capacity-building in openIMIS. Recent efforts in the hub focused on moving from advocacy to supporting action-oriented activities by linking these with AeHIN’s larger role in guiding countries to implement digital health strategies. As an example, after the first digital health convergence workshop in Lao PDR, which resulted in the endorsement of the national digital health strategy, AeHIN, through the regional hub, collaborated with the Ministry of Health Lao PDR, World Health Organization Lao PDR, and several partners to explore the potential use of openIMIS in streamlining claims processing. Early this year, the hub conducted a technical feasibility assessment of openIMIS for community-based health insurance in Lao PDR, followed by partially customizing the software for demonstration purposes. 

The openIMIS regional hub in Asia, hosted by AeHIN, is part of a project supported by GIZ and commissioned by the Government of the Federal Republic of Germany.

Kathmandu University to use openIMIS as a case study to teach healthcare financing and economics in its newly launched Department of Health Informatics under the School of Engineering

The recently established Department of Health Informatics at the School of Engineering, Kathmandu University integrated openIMIS, a digital tool used for health financing management in Nepal, in its Health Care Financing and Economics course for both undergraduate and graduate programs.

With the goal of helping students understand healthcare financing in Nepal, the Health Care Financing and Economics course will focus on how openIMIS supports the country's health system. Students are expected to learn about informatics in the realm of health financing, specifically in the areas of architecture, Fast Healthcare Interoperability Resources (FHIR) integration, and server setup for openIMIS. Students will also explore real-world case studies on health financing models in Nepal and the role of government subsidies.

The course will be offered in the next semester, March to July 2025. Learnings from this cohort are also anticipated to help strengthen the openIMIS community of practice at the country and regional levels.

The openIMIS regional hub in Asia, hosted by AeHIN, is part of a project supported by GIZ and commissioned by the Government of the Federal Republic of Germany.