AeHIN openIMIS CoP in Asia (2025 Country Hub Reports)

The San Beda University College of Medicine (SBCM) program has two primary courses that may be able to contain topics and activities related to health insurance systems and electronic health records, including openIMIS: (a) Family and Community Medicine (FCM) and (b) Practice of Medicine (POM). Currently, these courses introduce the topics at a high level, creating an opportunity to deepen engagement through more hands-on activities. Through this project, updated openIMIS scenarios were successfully developed for medical students in the Philippines, enabling practical application using the openIMIS demo server.

Curriculum Review. Currently, these courses introduce the topics at a high level, creating an opportunity to deepen engagement through more hands-on activities. Through this project, updated openIMIS scenarios were successfully developed for medical students in the Philippines, enabling practical application using the openIMIS demo server. Initial talks with SBCM coordinators resulted in tentative agreements and scheduling of the openIMIS demonstration session in the second semester of AY 2024-2025. However, succeeding talks failed to finalize the activity schedule. As a result, the activity was conducted independently outside of the FCM and POM courses for AY 2024-2025.

Preparation of Localized openIMIS Scenarios. The project focused on creating a step-by-step student guide that introduces San Beda College of Medicine students to the features of openIMIS that are aligned with their training as Beda physicians as outlined above. Specifically, the outcomes of this phase are as follows:

• The participants should be able to log in to the demo server of openIMIS using administrator credentials.

• As enrollment officers, participants should be able to appreciate the structure of health insurance enrollment by enrolling a new family member as insuree as well as identify the information needed to enroll a household and household members in an insurance scheme.

• As claims administrators, participants should be able to create a medical insurance claim by the new insuree from a health facility, as well as identify the information needed to process medical insurance claims;

• As claims reviewers, participants should be able to appreciate the multi-step check-and-balance process involved in medical insurance claims.

Webinar Delivery (University). A webinar was delivered online via Zoom, and was attended by 124 unique attendees. The attendees were mostly year level 2 students of SBCM, but there were a few year level 3 students and SBCM faculty in attendance as well. The webinar introductory presentation lasted for 49 minutes, while the live hands-on demonstration lasted for 36 minutes.

Evaluation of openIMIS Usability. There were a total of 106 completed responses in the System Usability Scale (SUS survey). The median age was 25 (IQR: 24-26), with a majority of them female (68.9%). Students were the large majority of the respondents (99.1%). On a scale from 1 to 5 (5 being the highest), a majority of the respondents (53.8%) rated their technical skills as 4 out of 5, while 28.3% rated themselves with a 5. A small number of respondents (7.5%) have had previous experience using openIMIS in some capacity prior to the session. Surprisingly, 35.8% of respondents have used a software or program that was similar to openIMIS in their previous studies or professional experience. Notable results were that the respondents 1) did not find openIMIS awkward to use; 2) did not find too much inconsistency; 3) found openIMIS functions well integrated; 4) found openIMIS easy to use; and 5) found that they would like to use openIMIS frequently. In order to achieve a greater SUS score, the two main concerns that need to be addressed include 1) participants need to learn a lot of things before they can use the system; and 2) participants think they need the support of a technical person to be able to use the system.

Medical students from SBCM rated openIMIS within the 59th percentile based on the SUS scoring system. The respondents found openIMIS easy to use and well-integrated; the main issues raised are the needs for proper usage training as well as dedicated IT support. The activity (introductory lecture and live demonstration using the updated scenarios) will be formally incorporated into the POM syllabus starting AY 2025-2026. It is recommended to perform regular evaluation of the activity and scenarios to make sure that the outcomes align with SBCM’s program outcomes.

A central pillar of the Healthcare Financing and Economics (HIMS 525) course in the newly launched Department of Health Informatics, School of Engineering, Kathmandu University is the practical application of openIMIS, an open-source Insurance Management Information System that is currently being integrated by the Health Insurance Board (HIB) of Nepal as part of the country’s national health financing reforms. As a university in Nepal, equipping students with knowledge of openIMIS is essential, as it aligns directly with ongoing national digital health initiatives and prepares graduates to contribute effectively to public health insurance operations, digital transformation, and health system strengthening efforts. This combined theoretical and technical approach ensured that students gained both a conceptual understanding of health financing and practical, industry-aligned experience with an information system currently shaping Nepal’s digital health ecosystem.

Course Content. The hub created a modified material referencing the openIMIS regional hub manual’s web-based simulation, which provided the opportunity for students to wear different hats in exploring the health insurance process through an information management system: as an enrolment officer, claims administrator (health facility), and claims reviewer (health insurer). 

Additionally, the hub developed a lab manual featuring multi-day exercises such as the (a) openIMIS case study and (b) Linux installation and configuration. Lecture topics on health financing, openIMIS fundamentals, system architecture, and FHIR integration provided the theoretical foundation necessary for research-based and academic assessments, while the installation and configuration exercises delivered essential hands-on experience.

Course Delivery. The course intended to equip students with a comprehensive understanding of healthcare financing in Nepal, focusing on how openIMIS supports the country's health system. The delivery of the course spanned 15 hours following the schedule below.

Assessment (Practical and Research Components). Student performance in HIMS 525 is assessed through a blend of practical, research-oriented, and academic components. The practical component focuses on data entry proficiency within the openIMIS system, requiring students to simulate the role of a system administrator by creating insurees, linking family members, and processing claims. This hands-on experience strengthens their understanding of healthcare insurance administration and system workflows, and is evaluated through simulation exercises conducted on the locally hosted openIMIS server.

The research and academic components measure students’ analytical abilities and foundational knowledge. Research assignments, including survey papers and term papers, require students to analyze healthcare financing interoperability, evaluate the role of openIMIS in Nepal, and support their work with relevant literature using APA format. Academic performance is further assessed through quizzes and exams that test students’ understanding of theoretical and practical course concepts, such as health financing models, FHIR integration, HL7 standards, OpenIMIS architecture, and Nepal’s health insurance scheme.

The first run of the course, held from July to September 2024, had 14 student passers, while the second run from March to May 2025 resulted in 15 students successfully completing the program. Both iterations of the openIMIS course at Kathmandu University were highly successful, reflecting improvements in curriculum delivery, lab organization, and practical engagement, and enabling students to gain comprehensive hands-on experience in Linux-based server deployment, system administration, enrolment workflows, claims processing, and FHIR-based interoperability—all effectively connecting theoretical health financing concepts with real-world digital health systems.

The course has proven instrumental in developing a future openIMIS workforce, equipping students with both technical skills: server management, data handling, system configuration and managerial insight into healthcare financing operations. By bridging theory and practice, students are now better prepared to support government institutions, health facilities, and private-sector digital health initiatives in Nepal.

Integration with the Health Insurance Board (HIB) underscores the course’s national relevance, while potential virtual sessions with openIMIS experts can further enrich learning, provide global perspectives, and reinforce institutional backing. Between the two course runs, refinements in lab structure, guided installations, and interactive exercises enhanced both learning outcomes and student confidence.

For future iterations, recommendations include pre-course technical orientation (linux and server based classes with demos), expanded virtual labs, real-case studies with HIB collaboration, and ongoing feedback mechanisms. Overall, the course establishes a strong foundation for producing skilled, adaptable, and industry-ready professionals, supporting Nepal’s digital health transformation and long-term health financing goals.

This proposal outlines a comprehensive plan for the establishment of a national openIMIS Simulation Laboratory at the Postgraduate Institute of Medicine (PGIM), University of Colombo/Faculty of Medicine, University of Colombo/Ministry of Health. The primary objective is to create a centre of excellence for practical training in digital health financing. The initiative is designed to build critical national capacity, equipping Sri Lanka’s next generation of health informatics specialists with the hands-on skills required to implement, manage, and innovate within the nation's evolving digital health ecosystem.

The project is strategically anchored in Sri Lanka's national digital health agenda, demonstrating profound alignment with the vision and architectural principles of the Sri Lanka Digital Health Blueprint. The proposed simulation laboratory will function as a practical, scaled-down model of the health financing domain of the national Digital Health Platform (DHP), providing trainees with invaluable experience in managing open-source, standards-based systems that are central to the Blueprint's philosophy. By focusing on openIMIS, a globally recognized open-source platform for managing health financing schemes, this initiative directly supports the national goal of reducing high Out-of-Pocket (OOP) expenditure and advancing towards Universal Health Coverage (UHC).

Core Areas/Objectives. Upon completion of the training modules associated with the laboratory, trainees will be able to demonstrate mastery in the following core areas:

1. Health Financing Scheme Management: To design, configure, and manage the complete lifecycle of a health insurance scheme.

2. Provider Network and Contract Management: To establish and manage the relationship between a health insurance scheme and its network of healthcare providers.

3. Digital Claims Adjudication and Processing: To manage the end-to-end workflow of electronic claims submission, validation, and review.

4. Financial Management and Reconciliation: To oversee the financial flows within a health financing scheme, ensuring timely payments and accountability.

5. Data Analysis for Evidence-Based Policy and Management: To leverage the data generated by the insurance scheme to inform strategic decision-making, directly applying the principles of Health Economics.

Methodology. This proposal builds upon the successful foundation of a pilot Health Economics module introduced for MD (Health Informatics) trainees in September 2025, which established a clear demand for practical, tool-based learning. Recognizing the need for a phased approach that prioritizes stakeholder consensus, the project will first focus on formalizing the curriculum and securing administrative support. The subsequent establishment of a simulation lab is positioned as the logical next step, justified by the proven value of the curriculum. The second, long-term phase (beyond the current scope of the project) details an actionable roadmap for a major curriculum revision, navigating the formal approval processes of the PGIM, the University of Colombo Senate, and the University Grants Commission (UGC) to ensure permanent institutionalization.

Target Output: For the establishment of the simulation lab, the following are the target output:

• Draft Curriculum Package v1.0.: Develop comprehensive curriculum materials (lab manuals, exercises, assessment tools) for the OpenIMIS module.

• Advocacy Toolkit: Develop advocacy materials (concept notes, presentations) for key stakeholders (PGIM, FoM, MoH).

• Documented in-principle agreement from stakeholders: Conduct a series of meetings with stakeholders to demonstrate value and secure administrative clearance for pilot integration.

The proposal includes a simplified and practical workplan, with a strong emphasis on curriculum development and stakeholder engagement, demonstrating value through a pilot program before committing to institutional infrastructure. By fostering a symbiotic learning environment between strategic-thinking MD specialists and technically-proficient MSc graduates, this initiative will position the PGIM as a national hub for producing complete, multi-disciplinary digital health teams. Ultimately, the openIMIS Simulation Laboratory represents a strategic, cost-effective, and sustainable investment in the human capital essential for the successful realization of a modern, efficient, and equitable digital health ecosystem for all citizens of Sri Lanka.

The Virtual Interoperability Lab has been established as a sub-cluster under the Lab Cluster – Big Data, Interoperability, and Computing within the Department of Electronics and Computer Engineering, Pulchowk Campus with approval from the Head of Department on March 1^st 2025. The lab aimed to address key challenges in Nepal’s digital health ecosystem by strengthening collaboration between academia, healthcare institutions, and government bodies, while also contributing to the growth of the openIMIS community in Nepal. By building on the expertise of IoE, Pulchowk Campus, and aligning with the Standards and Interoperability Laboratory initiative by MoHP, the Lab will serve as a catalyst for advancing interoperability, health financing systems, and open-source digital health innovation. After the permission of the authorities, a webpage was set up for Virtual Interoperability Lab:

https://doece.pcampus.edu.np/virtual-lab-big-data-and-computing/

Kick-off. A kick-off meeting was held on 16 March 2025 at the Tribhuvan University, wherein the proposal (see previous report) was discussed with representatives from the Ministry of Health and Population (MoHP) Nepal and the Standards and Interoperability Lab (SIL) Nepal. The team agreed to the proposed operation guidelines that are aligned with following SIL-Nepal’s 4T’s framework. Assist. Dean Dr. Baburam Dawadi, also a lab member, initiated the discussion on the proposed Biomedical Engineering syllabus to be offered at the Institute of Engineering. Participants also emphasized the need of incorporating Health Informatics, Interoperability, and Health data analytics in the proposed revised curriculum.

Open Call. As per the approved operation guidelines, an open call for associate student members was announced for all undergraduate/graduate students of the Department of Electronics and Computer Engineering, Pulchowk Campus, which resulted in 44 undergraduate and 38 graduate students expressing interest to be part of the lab. The students exhibited diverse aspirations spanning AI, big data, digital health, research, and

Entrepreneurship. The additional responses reinforced biomedical engineering, optimization strategies, decision science, and network engineering as growing interests. Students expect the lab to provide:

• Hands-on Experience – Practical exposure to interoperability frameworks, real-world healthcare projects, and scalable systems.

• Skill Development – Learning big data processing, cloud computing, health informatics, AI, cybersecurity, and system design.

• Collaboration & Networking – Opportunities to engage with professionals, mentors, and international organizations (WHO, AeHIN, GIZ) for impactful research.

• Interoperability & Standards Mastery – Understanding HL7 FHIR, SNOMED CT, and other health data exchange protocols.

• Healthcare System Integration – Gaining knowledge on seamless data exchange across platforms for enhanced medical care.

• Scalable & Real-World Applications – Working on projects with national and global significance, particularly in Nepal’s digital health infrastructure.

• Research & Thesis Preparation – Aligning their work with MSc thesis, BE projects, and interdisciplinary studies.

Collaboration with External Partners. With the formation of the lab, its members have started collaborating with MOHP and SIL-Nepal, AeHIN-COIL, and international universities.

• MoHP and SIL-Nepal: During the tenure of MoHP IT Director Mr. Ramesh Subedi and SIL-Nepal Lead Mr. Sanjay Poudel, meetings on 15 January and 10 March 2025 were held to discuss collaboration between MoHP and the university lab by encouraging student involvement in SIL-Nepal projects. A visit to the SIL-Nepal office was also conducted, where students were considered for roles as Lab Student Brand Ambassadors. After Mr. Subedi’s transfer, discussions were put on hold; however, with support from MoHP’s Mr. Nirmal Dhakal, a follow-up meeting with Mr. Subash Adhikari and Mr. Shashank Neupane successfully revived the plans for collaboration, specifically involving faculty in developing digital health guidelines and for engaging students in SIL-Nepal’s priority projects.

• AeHIN COIL: Dr. Alvin Marcelo, AeHIN-COIL Convenor, gave a virtual guest lecture session on 18 June 2025 to lab members, faculties, and students on the topic, “Intro to AeHIN COIL, Digital Health Ecosystem (Asia-Pacific), and Interoperability in the Philippines.” 

• International Universities: Collaboration with the University of South Florida Sarasota-Manatee (USFSM) and Utsunomiya University were initiated to start capacity building and research projects. With the former, guest lecture topics included ‘Bridging Research and Industry: AI, Machine Learning, and Explainability’ and ‘Strengthening Academic Excellence and Research Collaborations in AI and Digital Transformation.’ The latter focused on exercises on brainwave data analysis.

Capacity-building. As a result of the collaborative efforts, the lab organized a capacity-building session for its 50 members. The lab organized a capacity-building session on “Digital Health Ecosystem and Interoperability” on 9 May 2025. The session opened with remarks from Dr. Basanta Joshi, followed by expert presentations from GIZ, MoHP, Sunya Yek, and MEDIC. Speakers covered the digital health landscape, key medical perspectives, ongoing digital health interventions in Nepal, and MoHP’s initiatives and future plans. They also suggested potential master’s thesis and BE project topics, providing valuable direction for participating students. 

Planning Meeting: A meeting was held on 16 March 2025 with experts in the field to decide the future activities of the lab (see below for next steps).

The discussions from the planning meeting emphasized the importance of strengthening student engagement in digital health initiatives. It was concluded that the Interoperability Lab at the Institute of Engineering, Tribhuvan University, will prioritize involving as many student members as possible in collaborative projects, particularly through Bachelor’s and Master’s thesis work with relevant national and international stakeholders.

A key recommendation arising from the meeting was the development of an elective undergraduate course on Digital Health and Interoperability.  This course would include hands-on training with openIMIS and featuring real-world case studies such as its deployment within HIB and SSF in Nepal. Students will install openIMIS, study its database architecture, and explore the full system workflow. This practical exposure will serve as an important first step toward engaging students in openIMIS community development, enabling them to contribute to local customization, feature enhancement, and broader community-building efforts through the Virtual Interoperability Lab. 

As a next step, a stakeholder consultation will be conducted prior to submitting the course proposal to the Subject Committee, with the aim of finalizing the delivery modality, involvement of domain experts, and potential employment opportunities for graduates of the course.

Future activities of the lab will align with its operational guidelines. Recommended next steps include:

• organizing workshops, competitions, and exhibitions on digital health, medical terminology, and interoperability standards;

• supporting the government in developing the Nepal Core Data for Interoperability (CDI) and subsequently the Nepal Core (FHIR profile);

• contributing to the maintenance of national health enterprise architecture;

• transitioning the virtual laboratory into a fully functional physical lab;

• formulating a long-term sustainability plans;

• establishing infrastructure through collaborations with international universities and industry partners;

• conducting regular capacity-building programs on health standards and interoperability, including hands-on training with FHIR and OpenHIE; and 

• strengthening collaboration with government entities to provide training at central and regional levels.

The lab remains committed to advancing digital health interoperability in Nepal through continued collaboration with MoHP, SIL-Nepal, GIZ, AeHIN, WHO, and other key stakeholders.

The openIMIS instance (initially built by Tinker Technology) was successfully installed and currently hosted on a dedicated virtual server provided and managed by Gennexs Solutions Company. The hosting environment operates under the domain, openimislao.gennexs.com, which serves as the central access point for the NHIB and Ministry of Health technical teams.

Note: In the previous report, this section was part of the AeHIN-openIMIS research track as an academic activity.

System Hosting and Maintenance. The server has been configured with the following specifications:

• CPU: 8 cores (dedicated)

• RAM: 4 GB

• Storage: 100 GB SSD

This configuration has been optimized to ensure stable system performance and availability for daily operational needs, including user access, data entry, claims processing, and report generation. Both systems share fundamental goals: digitizing and automating health insurance processes, reducing reliance on manual paper-based workflows, improving speed and accuracy of claims processing, enhancing data collection and reporting capabilities, and providing more efficient and transparent systems for all stakeholders. Both are web-based platforms that support integration with other health information systems through APIs. Key differences

Customization Review and Functional Assessment. The hub conducted a comprehensive review of the partially customized CHIB modules and validated data workflows between registration, claims, and reporting components. The hub also assessed alignment of the current implementation with NHIB business processes, documenting findings and identified key gaps requiring further optimization.

Comparative Analysis of openIMIS and E-Claims: During this period, the NHIB has been developing and piloting its own E-claim system in two provinces. The E-claim system is built on a modern technology stack using Flutter for mobile applications (enabling native iOS and Android apps from a single codebase), Golang for the backend (known for performance and scalability), and PostgreSQL for the database. Key differences were identified below:

Strategic Recommendation for Customization. This report recommends customizing openIMIS to incorporate the best features and lessons learned from the E-claim system. This approach leverages the comprehensive functionality and global best practices of openIMIS while ensuring context-appropriateness for Lao PDR. It avoids vendor lock-in, ensures long-term sustainability through the open-source model, provides access to continuous development from the global community, supports interoperability through FHIR compliance, and positions Lao PDR as a leader in health financing digitalization in the region. The technical recommendations were categorized into critical, high priority, and medium priority features, as well as risk mitigation.

• Critical Features to Add (Priority 1)

  • Robust Offline-First Architecture

  • NHIB Standard Forms Integration

  • Native Mobile Applications

• High Priority Features (Priority 2)

  • Multi-Level Hierarchical Workflow System

  • Dual Insurance Scheme Management

  • System Integration Capabilities

  • Provider Portal and Claims Submission Interface

• Medium Priority Features (Priority 3)

  • Advanced Analytics and Decision Support

  • Beneficiary Self-Service Portal

  • Capacity Building and Training Module (1-2 months)

• Risks Areas

  • Resistance to change from E-claim users

  • Technical complexity of offline sync

  • Insufficient local technical capacity

  • Integration challenges

  • Institutional merger delays

  • Budget constraints

This report has presented a comprehensive analysis of health insurance information systems in Lao PDR, comparing the globally-recognized openIMIS platform with the locally-developed E-claim system. Both systems represent significant advances over previous manual and Excel-based approaches. openIMIS provides comprehensive health financing functionality, global best practices, strong interoperability, and long-term sustainability through its open-source model. The E-claim system demonstrates strong context-specific features, particularly robust offline capabilities, alignment with NHIB workflows, and modern technology stack.

The recommended approach is to customize openIMIS to incorporate critical features and lessons learned from the E-claim system, creating a world-class health financing information system that is both globally aligned and locally relevant. Critical customizations include offline-first architecture, native mobile applications, NHIB standard forms with Lao language support, multi-level hierarchical workflows, and dual insurance scheme management. Combined with openIMIS's comprehensive functionality in beneficiary management, provider management, benefit package design, and advanced analytics, this would provide Lao PDR with a system superior to either system alone.

The planned merger of the NHIB (Ministry of Health) with the SSF (Ministry of Labour and Welfare) has created a strategic pause in the pilot implementation of the proposed openIMIS activity. During this period, the NHIB has been developing and piloting its own E-claim system in two provinces. This evolving context necessitates a comprehensive reassessment that examines both systems to inform future decisions and advocacy efforts. To address this challenge, AeHIN plans to organize a meeting between the Lao PDR country hub and the openIMIS coordination desk to collaboratively plan the next steps.