openIMIS data model mapping to FHIR

tblInsuree & tblFamilies

Open

Person

"Demographics and administrative information about a person independent of a specific health-related context."

Highlights:

• "The Person resource serves as a linkage resource that may provide a reference set of common demographics for an individual (human or animal) across multiple roles (Patient, Practitioner,...)."

• Patient may have several identifiers

• Warning "RelatedPerson" (here under) doesn't point (directly) to Person!

Group

"Represents a defined collection of entities that may be discussed or acted upon collectively but which are not expected to act collectively, and are not formally or legally recognized; i.e. a collection of entities that isn't an Organization."

Highlights:

Grouping persons, but not with the 'families' semantic: it has its meaning in the health service scope (patients for a group therapy,...)

Patient

"Demographics and other administrative information about an individual or animal receiving care or other health-related services."

Highlights:

• "A Patient record is generally created and maintained by each organization providing care for a patient. A patient or animal receiving care at multiple organizations may therefore have its information present in multiple Patient Resources."

• Patient may have several identifiers

• Patients are "Linked" to each other, according a LinkType... but this is NOT the equivalent of tblFamilies: it is used to depict patient entity merge (replaced-by, replaces,...), that master entity for information is another one (refer),...

• One can link Patients (in the tblFamilies meaning) via contact.relationship (supposed to be "partner", "friend",...) but contact detail is a very "weak" reference (keep a name, telecom,... but it is not a formal other Patient entity)

RelatedPerson

"Information about a person that is involved in the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process."

Highlights:

• RelatedPerson refer to ONE "Patient" (and not Person as its name seem to indicated it)

• RelatedPerson does hold the name, telecom(,...) of the actual "person" it represent (it is NOT the equivalent of the 'tblFamilies' concept in openIMIS

FamilyMemberHistory

"Significant health conditions for a person related to the patient relevant in the context of care for the patient."

Highlights:

• Refers to ONE "Patient"

• Used for contextual (can be vague) information (like 'had some sort of cancer')

tblPolicy & tblInsureePolicy

Open

Contract

"Legally enforceable, formally recorded unilateral or bilateral directive i.e., a policy or agreement."

Highlights:

• Contract is a rather complex resource in FHIR. It holds info like expiration, author, signer, terms, offer (with acceptation decision,....),...

• It looks like, all product (InsurancePlan) info is expected to be copied (as a 'snapshot') to the contract at creation (contract holds its 'rules')

tblProduct

InsurancePlan

"Details of a Health Insurance product/plan provided by an organization."

tblClaim

Claim

"A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement."

Highlights:

• Mandatory attributes:

  • Patient (↔ tblInsuree)

  • Provider {Practitioner | PractitionerRole | Organization} (↔ tblClaim.HFID)

  • Insurance(s) ... no direct relation between tblClaim and tblInsureePolicy... or "PolicyID"... but this is not a FK !?!

  • Item(s) (↔ tblClaimItems)... note: tblClaimItems are "first citizen entities" in openIMIS... and (complex) nested structure in FHIR