2019-02-15&16 openIMIS Implementers' Workshop Minutes

Date: February 15-16, 2018

Location: Sea Cliff Hotel, Dar es Salaam

Moderator: Christian Pfleiderer

DAY 1 

A. Expectation Setting

-Mapping hospital workflows

-Use of data from openIMIS for research 

-Use of data from openIMIS for decision-making and national policy making

-Integration with Health Curriculum

-Integration with SMART policy

-Digitizing claims

-Fit openIMIS with Enterprise Architecture in Tanzania

-Capacity-building on openIMIS

-How openIMIS can come in as a system for medical insurance

-Operationalizing the system (field level)

-Translation of field lessons to national level implementation

-Tanzanian perspective in technology/ digital health

-Learn more about openIMIS, knowledge and resource sharing

-Learn how openIMIS can fit with health financing schemes

-Coordination with other partners

-Linkages with health management systems

-Perspective on sustainability with evolving technologies

-Inclusion of indigents with openIMIS as a tool (Chad)

-Requirements gathering from countries

-Understanding country needs 

-Sharing of lessons learned

-Governance structure of openIMIS

-Strengthening the management of openIMIS implementation 

-Look forward into proposing it as a test tool in a local town in Cameroon

-Advance implementation with BEPHA in Cameroon

B. Field Trip Experiences

Group 1

Group 2

C. openIMIS Global Initiative

• Timeline: From IMIS to openIMIS

• Vision & Mission: Link health financing schemes into interoperable digital health systems by using open source software

• Components

  • Open Source

  • Sustainable Community

  • Interoperability

  • Customizable Architecture

• Open Source Sofware is free but needs to consider:

  • Licensing Agreement

  • Free to use as-is

  • Costs for customization and implementation

  • The community of practice (DHIS2, openLMIS, etc)

• Governance Structure

  • Developers Committee

    • Continuity: SwissTPH and SolDevelo

    • Re-architecture: BlueSquare

    • Interoperability: HISP India, Swiss TPH, SolDevelo, Possible Health

  • Implementation Committee

    • Communication: FFW

    • Capacity: SwissTPH and EPOS

    • Community: AeHIN and Jembi

• Clarifications

  • openIMIS as an avenue to create an environment for solving issues

  • Specific country customizations to be done by the responsible payer in the system

  • 2 versions at least in a year

  • Data ownership is locally managed

  • Plans for 2019: small releases, knowledge production, development of the master version

D. openIMIS Regional Hub Africa: Jembi Health Systems

• NGO in Africa

• Started in 2009

• Technical development, business analysis, implementation

• Requirements definition, system architecture and design, development of software, 

• Country implementations in Africa

• Managing and evaluation of projects

• International open software communities

• Role with openIMIS:

  • Define requirements and provide technical assistance

  • Technical specifications for interoperability

  • Helping in implementation (matching with donors)

E1. Parallel Session: Developers Committee

• Alignment with digital development

• Alignment with digital investment

• Embedded in sustainable development goals

• From MS IMIS to openIMIS

• Components

  • Open Source: openIMIS in an open source environment

  • Local Development: IMIS in TZ, NP, CM (adapt with unique requirements)

  • Modulat Transformation: From a monolithic web structure to a mode modular structure  

  • Slow Transition: Prioritize modules depending on country needs

  • Interoperability: Data exchange among different systems anchored on openHIE framework that would allow fire data to an ESB as an interoperability layer

  • Vision: Integrated Workflows (Examples: Eligibility, Claiming)

  • openIMIS Outsourcing 2019

    • Continuity: Software maintenance and support (Swiss TPH and SolDevelo)

    • Re-architecture: Modular transformation (BlueSquare)

    • Interoperability: HISP India (openIMIS and DHIS2), SwissTPH and SolDevelo (openMRS and openIMIS for claims management), Possible Health (openIMIS and Bahmni for claims management)

  • Current Activities

    • Routine support and release building

    • Getting the teams on board

    • Concise weekly coordination calls

    • Need-oriented special topic calls

    • Developers workshop (February 2019 in Bonn)

      • Decide on technology options

      • Learn new technologies

      • Harmonize work plans

Q&A Session:

• How insurance will come into the new diagram of openHIE?

  • The new version will include openIMIS.

• To have a lot of buy-in in Tanzania and other countries, there is a need for local developers for customization and development. How to ensure that they meaningfully come in (like they are paid on a regular basis)?

  • This is where the regional and country hubs come in. 

• Are there local developers in Tanzania?

  • These are contracted by another implementing partner. 

• To be part of openIMIS, what does it require? 

  • Unanswered due to time limit

E2. Parallel Session: Implementers Committee

• Aim: UHC through health financing systems

• Health Financing Processes

  • Resource Collection

    • Taxes/payroll

    • Insurance contributions

    • User fees/co-pooling

  • Resource Pooling

  • Purchasing of Services (holds the funds for resource pooling, we need data to design a strategic purchase -match with services needed)

    • Capitation

    • Budget

    • Case-based payment/fee for service 

•  How do we use openIMIS? (the more fee for service-focused, the more information we need; always need data if we want to move away from a general budget)

  • Registration / enrollment (also collect money)

  • Verification of member

  • Claims submission

  • Claims review 

  • Client feedback

  • Reporting (what are you diagnosing, getting money for etc)

• OpenIMIS is a flexible tool that can be used for many health financing schemes (NI, tax funded national health system, community-based health fund, vouchers scheme, strategic purchasing arrangements)
  
  

  •  

    • Next Steps for openIMIS (Global Level)

      • Position OpenIMIS globally as a digital tool for health financing and UHC (so countries don't start from scratch)

      • Software development - collecting and defining new user requested features

        • Formal sector enrollment 

        • Additional reporting and monitoring functionality 

        • Dashboards for management and policy decision making

        • Interoperability with other systems

      • Marketing and communications: new website

      • Expanding the network of development and implementing partners (promote sustainability at the local level)

    • Next Steps for openIMIS (Local Level)
      
      

      • Bringing new countries onboard

      • Current countries: RW, MW, CAM CH

      • Country assessments to gather requirements and software functionality requirements

      • Expansion of a network of developent and implementing partners (support possibilities for country-level implementation)

      • Implementation steps

        • Starter kit

        • Costing estimates

      • Demo on software
        
        

        • Online video

        • Wiki guide

      • Capacity-building: alliances and strategic partnerships

Q&A Session:

• From the persepctive of operators already using a system, would you have to do this twice?

  • Different insurance providers have different systems. Can look at interoperability from single form for data import

  • Parallel systems currently running. It’s a policy level decision

• In Chad, how can this request for change (for co-payment) at the global level can be accommodated or we have it to develop it via local projects?

  • We'll talk about the channels being used later in the afternoon. This shall be discussed among the implementers - it's something we need to find out based on your priorities. Local implementation structure and teams are needed for local development and features. Prioritization of requests is being assessed based on discussions with the technical advisory group. 

• How can we be capacitated?

  • There shall be communication between local and global implementers.

  • Self-learning via wiki platform and via github for architecture.

• For interoperability initiatives, how can we coordinate (so we don't end up doing the same thing)?

  • Communicate with our developers.

• How high is the risk if I cannot fund local developers into the redesigned and modular system?

  • Roadmap for communication among developers to be released by the end of the month.

• Is there a timeline for the redesign?

  • Two modules by end of 2019 but the size of the modules are not yet clear.

  • Roadmap and timeline by the end of Feb 2019. Until then, we will be sticking with the MS based system for implementation. It should also allow for a seamless transition to a modular approach

• Would you know about the licensing agreement (when it will be offered for free)?

  • At the end of February, they would most probably know about the new architectures

• Can this whole work be done offline?

  • Enquiry part is still online

• How can we benefit from the global initiative when the complete package is complete? We want to add open source development languages that are not dependent on Microsoft.

  • Ideal scenarios are that the database layer exchangeable that can be run on a Microsoft server and Linode server.

• Recommendation: Big opportunity to involve developers from pioneer countries like Tanzania (re-architectural phases, etc)

  • Academic outreach with universities

  • Need to involve local institutions like academia as early as now (to include openIMIS in their curricular activities)

• Recommendation: Local private software firms may be willing to participate in the developers' committee.

  • Universities can be entry points for capacity-building. 

• Comment: Potential for openIMIS to interoperate with other systems or existing systems that are up and running (GOTOHOMIS, etc)

• Comment: Claims management demo for rejection reports

F1. Parallel Session: openIMIS Country System and Requirements in Tanzania

F2. Parallel Session: openIMIS Country System and Requirements in Cameroon