List of content:

1 List of content:
2 Description:
- 2.1 Notes / Assumptions:
3 FHIR resources:
4 Fields mapping:
- 4.1 Table legend:
- 4.2 Mapping:
5 Endpoint specification:
- 5.1 Coverage endpoint
  - 5.1.1 Example of endpoint URL:
  - 5.1.2 Supported HTTP operation:
6 Example JSON representation of content:
- 6.1 FHIR Coverage (http://127.0.0.1:8000/api_fhir/Coverage/covCode1):
  - 6.1.1 Example JOSN

Description:

The OpenIMIS Policy object (from the openimis-be-policy_py module) was mapped to the FHIR Coverage resource.

Notes / Assumptions:

The endpoint uses the UUID as a primary key

FHIR resources:

Coverage

Fields mapping:

Table legend:

Color	Description

Color	Description
	Mapped - the final choice, the most suitable choice
	Need to be found the best place for the field (not mapped currently)
	Currently not important - not mapped

Mapping:

OpenIMIS field	DB type	FHIR field	Description	Note	STPH	Mapping status
PolicyID	PK	Identifier			Use only PolicyUUID	This is the Database ID and should be used only internally
PolicyUUID	UniqueIdentifier	Identifier	The unique identifier used as PK for FHIR		Added	mapped
FamilyID	FK(tblFamilies)	policyHolder		We use the policyHolder to represent the reference to the Patient (head of the family). The insurance code is used to point the appropriate Patient.	(was updated by SD) OK	mapped
EnrollDate	date	Extension		The FHIR representation doesn't contain this type of value. If needed we can consider adding the FHIR extension.	Extension
StartDate	date	period			OK	mapped
EffectiveDate	date	Extension		The FHIR representation doesn't contain this type of value. If needed we can consider adding the FHIR extension.	Extension
ExpiryDate	date	period			OK	mapped
PolicyStatus	tinyint	status	Default: 1 1 - Idle 2 - active 4 - suspended 8 - Expired	There are some differences between the Policy and FHIR statuses. List of FHIR coverage statuses: 1) active 2) cancelled 3) draft 4) entered-in-error	ok	mapped
PolicyValue	decimal	contract.valuedItem.net		The FHIR representation doesn't contain this type of value. If needed we can consider adding the FHIR extension.	contract.valuedItem.net
ProdID	FK(tblProduct)	grouping		The FHIR representation doesn't contain exactly the same type of value. The coverage classifications can be contained in the "grouping" field and we can join it with a product using grouping.plan. See example: https://hl7.org/fhir/STU3/coverage-example.json.html	I would suggest to check Contract entity => Coverage.contract
OfficerID	FK(tblOfficer)	contract.agent.actor		The FHIR representation doesn't contain this type of value. If needed we can consider adding the FHIR extension.	subscriber
PolicyStage	char(1)		Default: N N - New Policy R - Renewed Policy	The FHIR representation doesn't contain this type of value. If needed we can consider adding the FHIR extension.		Will be added after when the final approach will be established
ValidityFrom	datetime		Audit information. More information can be found here (on page 113): https://github.com/openimis/openimis_docs/blob/master/specs/Web%20application%20-%20Functional%20Design%20Specification.pdf	This information are valuable for OpenIMIS but I probably not required by external systems.	Internal field
ValidityTo	datetime
LegacyID	int
AuditUserID	int
RowID	timestamp			I'm not sure but this is probably some unique value used to distinguish database rows. Probably not useful for external systems.	Internal field
isOffline	int			I'm not sure but this is probably used to determine the source of row (offline/online app). Probably information isn't valuable for external systems.	Internal field

Note:

The contract field could be use to map the Insurance Products to the Policies

Endpoint specification:

Coverage endpoint

Example of endpoint URL:

http://localhost:8000/api_fhir/Coverage/

Supported HTTP operation:

READ - by default return list of all available resources. To fetch information about a specific object you should add the primary key to URL for instance:
http://127.0.0.1:8000/api_fhir/Claim/{PolicyCode}, where "{PolicyCode}" is the value of the policy primary key. Should be used the GET HTTP method.
CREATE - the operation currently not supported
UPDATE - the operation currently not supported
DELETE - the operation currently not supported

default_audit_user_id	default value which will be used for 'audit_user_id' field	"default_audit_user_id": 1,
stu3_fhir_identifier_type_config	configuration of system and codes used to represent the specific types of identifiers	"stu3_fhir_identifier_type_config":{ "system":"https://hl7.org/fhir/valueset-identifier-type.html", "fhir_code_for_imis_db_id_type":"ACSN", "fhir_code_for_imis_chfid_type":"SB", "fhir_code_for_imis_passport_type":"PPN", "fhir_code_for_imis_facility_id_type":"FI", "fhir_code_for_imis_claim_admin_code_type":"FILL", "fhir_code_for_imis_claim_code_type":"MR", },
stu3_fhir_issue_type_config	configuration of system and codes used to represent the specific types of operation outcome	"stu3_fhir_issue_type_config":{ "fhir_code_for_exception":"exception", "fhir_code_for_not_found":"not-found", "fhir_code_for_informational":"informational" },
stu3_fhir_claim_config	configuration of system and codes used to represent the specific types of claim codes	"stu3_fhir_coverage_config": { "fhir_family_refereence_code": "FamilyReference", "fhir_status_idle_code": "Idle", "fhir_status_active_code": "active", "fhir_status_suspended_code": "suspended", "fhir_status_expired_code": "Expired", "fhir_item_code": "item", "fhir_service_code": "service", "fhir_practitioner_role_code": "Practitioner", "fhir_product_code": "Product" "fhir_effective_date_code": "EffectiveDate", "fhir_enroll_date_code": "EnrollDate" },

Example JSON representation of content:

FHIR Coverage (http://127.0.0.1:8000/api_fhir/Coverage/covCode1):

Example JOSN

{
    "resourceType": "Coverage",
    "contract": [
        {
            "resourceType": "Contract",
            "agent": [
                {
                    "actor": {
                        "reference": "Practitioner/officerCode"
                    },
                    "role": [
                        {
                            "text": "Practitioner"
                        }
                    ]
                }
            ],
            "valuedItem": [
                {
                    "net": {
                        "value": policyValue
                    }
                }
            ]
        }
    ],
    "extension": [
        {
            "url": "EffectiveDate"
        },
        {
            "url": "EnrollDate",
            "valueDate": "2019-08-06"
        }
    ],
    "grouping": {
        "group": "Product/productUuid",
        "groupDisplay": "productCode",
        "plan": "Product Name",
        "planDisplay": "{
			'item': ['itemCode1', 'itemCode2', 'itemCode3'], 
			'service': ['serviceCode1', 'serviceCode2']
		}"
    },
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "code": "ACSN",
                        "system": "https://hl7.org/fhir/valueset-identifier-type.html"
                    }
                ]
            },
            "use": "usual",
            "value": "covCode1"
        }
    ],
    "period": {
        "end": "2020-08-05",
        "start": "2019-08-06"
    },
    "policyHolder": {
        "reference": "FamilyReference/familyCode0"
    },
    "status": "Idle"
}

openIMIS

openIMIS tblPolicy resource (FHIR Coverage)

Analytics

List of content:

Description:

Notes / Assumptions:

FHIR resources:

Fields mapping:

Table legend:

Mapping:

Endpoint specification:

Coverage endpoint

Example of endpoint URL:

Supported HTTP operation:

Example JSON representation of content:

FHIR Coverage (http://127.0.0.1:8000/api_fhir/Coverage/covCode1):

Example JOSN

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