Interoperability Frameworks for Universal Health Coverage: The Case of openIMIS in Nepal's Healthcare System
Abstract:
There is a growing consensus in the global health community that digital transformation requires robust, full-stack interoperability frameworks to effectively achieve Universal Health Coverage (UHC). One of the major challenges in this effort is integrating diverse healthcare systems while maintaining data standardization and ensuring the secure, seamless exchange of health information. This paper argues for a comprehensive interoperability model in healthcare digitization by examining the implementation of openIMIS in Nepal’s national health insurance system, which has been successfully deployed across all 77 districts.
To enable interoperability across fragmented systems, the implementation integrated various electronic medical record (EMR) platforms used by hospitals, transformed their data into standardized FHIR resources, and centralized this information within Nepal’s government-run healthcare infrastructure. This study analyzes how Nepal’s Health Insurance Board leveraged interoperable digital systems to strengthen healthcare service delivery and advance progress toward UHC. Designed as a central interoperability hub, openIMIS ingests, translates, and standardizes data from a wide array of EMRs. These include open-source platforms like Bahmni/openMRS as well as numerous proprietary private systems. The data is transformed into standardized FHIR resources and centralized within Nepal’s government-run healthcare infrastructure. This study explores how Nepal’s Health Insurance Board is leveraging interoperable digital systems to strengthen healthcare service delivery and drive progress toward UHC. We hypothesize that this approach enables even resource-limited facilities to participate meaningfully in the national health information exchange, thereby improving inclusiveness and system reliability.
Furthermore, we investigate the potential impact of this interoperability framework on digital health financing. We will demonstrate that aligning technical implementation with policy reforms can help bridge critical gaps between service delivery and insurance coverage. Specifically, we analyze how openIMIS, functioning as a centralized platform for claims processing, patient eligibility verification, and insurance data exchange, may improve efficiency, enhance transparency in financial workflows, and reduce delays in provider reimbursement. This proposed analysis will explore , such integration not only simplifies administrative processes but also creates a scalable foundation for inclusive, data-driven health system financing. It demonstrates that the success of this interoperability framework lies not only in technical integration but also in the enabling governance, local innovation capacity, and alignment with national digital health financing goals.
Keywords: Healthcare interoperability, Health information exchange, Universal health coverage, digital health financing, openIMIS, full-stack interoperability, FHIR standards, e-health infrastructure, EMR integration, social health insurance, open standards, Nepal,
Poster presentation at GDHF Kenya , 2025 December
