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Medic / CHT Feedback - Claim Subscription → openIMIS Interoperability

Medic / CHT Feedback - Claim Subscription → openIMIS Interoperability

Content

Reference

https://guides.ohie.org/arch-spec/introduction/openhie-finance-and-insurance-services-workflows/hfw-004-claiming

Sector

Health

Components

  • Instance: OpenHIM (IO Sandbox)

  • openIMIS

  • Medic CHT

github

https://github.com/medic/cht-core https://github.com/jembi/ https://github.com/openimis

Purpose

When a Community Health Worker (CHW) provides care in the field, the insurance system should know about it and respond. This workflow connects CHT, the tool CHWs use daily, directly to openIMIS: when a claim is validated, the CHW is automatically notified and can submit feedback without any manual administrative step. The goal is simple reduce the gap between care delivery and health financing, while keeping CHWs in the loop.

This workflow enables CHT (Community Health Toolkit) to subscribe to claim validation events emitted by openIMIS, and to automatically trigger CHW (Community Health Worker) feedback collection when a claim reaches the validated status.

It demonstrates how a community health platform can be integrated into a health financing loop using FHIR Subscription resources, enabling timely clinical feedback tied to adjudicated claims.

image-20260616-152208.png

 

Trigger

A claim status change in openIMIS where Claim.status transitions to validated.

Workflow

 

 

 

 

Workflow Maturity

Newly Defined - Specified and approved. Initial implementation in progress.

Referenced Standards

HL7 FHIR Subscription Resource (R4): https://hl7.org/fhir/subscription.html

HL7 FHIR Financial Module: http://hl7.org/fhir/financial-module.html

Assumptions & Prerequisites

  • Patient identity is already managed via openIMIS FHIR API (unique insuree identifiers assigned).

  • openHIM is deployed and configured to validate and route FHIR messages.

  • CHT exposes a secure HTTPS webhook endpoint to receive subscription notifications.

  • openIMIS is extended to emit notifications when Claim.status = validated.

  • Authentication is enforced via OAuth2 / JWT between all components.

Actors

POS (CHT)

Captures patient interactions and CHW feedback. Subscribes to claim events and collects post-validation responses.

IOL (openHIM)

Mediates all transactions between CHT and openIMIS. Enforces syntax validation, security (OAuth2/JWT), and delivery guarantees.

FIS (openIMIS)

Manages beneficiary data, claim lifecycle, adjudication, and subscription event emission.

Validations

openHIM (IOL) must validate:

  • Syntax of incoming FHIR Subscription requests

  • Security credentials (OAuth2/JWT token verification)

  • Notification delivery (retry logic on failure)

openIMIS (FIS) must validate:

  • Presence of active subscriptions before emitting notifications

  • Structure and completeness of outbound Claim resource payloads

Diagram

Workflow Steps

Step 1 — CHT Subscribes to Claim Validation Events

CHT submits a FHIR Subscription resource to openHIM, specifying:

  • Criteria: Claim?status=validated

  • Channel type: rest-hook

  • Endpoint: CHT's HTTPS webhook URL

Transaction: POST /fhir/Subscription (CHT → openHIM → openIMIS)

Step 2 — Claim Validation in openIMIS

When an adjudicator validates a claim in openIMIS:

  • Claim.status changes to validated

  • openIMIS identifies all active matching subscriptions

  • Notification dispatch is triggered

Transaction: Internal FIS processing

Step 3 — Claim Validation Notification Sent

openIMIS pushes a notification to the CHT webhook endpoint defined in the subscription.

Transaction: REST-hook notification (openIMIS → CHT) Resource: Claim (validated)

Step 4 — CHT Processes the Notification

Upon receiving the notification, CHT:

  • Optionally fetches full claim details: GET /fhir/Claim/{claimUUID} (CHT → openHIM → openIMIS)

  • Creates a feedback task assigned to the responsible CHW

  • Notifies the CHW to complete the feedback form

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