Improving financing for UHC workflows in OpenHIE: using openIMIS as a reference technology

Health Information Systems Architecture: High-level systems design, and aligning technology with people and their data needs. Enterprise Architecture, OpenHIE, etc.

The OpenHIE Health Financing toward UHC working group is focused on identifying health care financing data exchange needs, and working synergistically with the OpenHIE community to ensure that data exchange processes and requirements meet the needs of the health care financing communities. openIMIS is an open-source software tool for the digitalisation and efficient management of health financing workflows. Currently being used to manage a variety of health protection schemes in Nepal, Tanzania, Cameroon, Chad, and DRC, openIMIS offers seamless connections between beneficiaries, health service providers, and payers. In its various implementations, openIMIS users have felt the need for interoperability with other digital health systems and the initiative has already launched efforts to create standards-based communication architecture allowing for interoperability with OpenMRS/Bahmni and DHIS2. As the openIMIS and OpenHIE communities are working closely together in these developments we are confident that openIMIS will act as the reference technology for the interoperability architecture for UHC that the OpenHIE subcommunity is working on developing in 2019. This session will give participants not only a platform to learn about the Architecture Diagram for UHC (v0.1), but will also showcase how the architecture can be realized through a software tool. For the two communities, the session will provide an opportunity to learn about the various interoperability requirements of implementers, so as to address them in future developments as well as the opportunity to contribute towards their development.

Attendees will come away with a better understanding of how interoperability is being positioned to support the data exchange needs of low resource setting UHC tools, in particular, the openIMIS platform. In addition attendees will support in the reviewing, building and enhancing of core requirements and workflows to support UHC have gained a stronger understanding of the openIMIS tool and its ability, functionality and future direction.

Specific objectives:
1. Provide information on how the openIMIS community is leveraging standards such as HL7 FHIR for interoperability with OpenMRS/Bahmni and DHIS2
2. Provide participants with detailed information regarding the health financing towards UHC subcommunity of OpenHIE, and the Architecture Diagram for UHC (v0.1)
3. Learn from participants on their interoperability needs when dealing with tools for health financing: what are the different systems that need to interact in their use cases? What standards are they using? What standards need to be developed?

The session is designed to have three major parts:
1. Inputs
a. OpenHIE (with a focus on the Health Financing towards UHC Subcommunity)
b. openIMIS initiative
c. Interoperability between openIMIS and OpenMRS/Bahmni, and openIMIS and DHIS2

2. Technical Session: This session will focus on providing the participants with hands-on experience with openIMIS, Bahmni, and DHIS2. There will be local instances of the tools available in the room, and participants will be able to generate an insurance claim from a medical record in Bahmni, process it in openIMIS, and analyze the data in DHIS2.

3. Group work: In this session, the participants will be divided into groups, in which they will discuss interoperability requirements for a particular business process in the health financing/health insurance landscape. They will work on a structured template to identify systems to interoperate with, and using what standards.

The digital health landscape is filled with tools that are required to be interoperable with each other to achieve a common goal. This session provides participants with real world, tangible, workable tools and concepts to see interoperability in action. Also, this session aims to learn from implementation experiences of practitioners in the field of health financing and UHC so that the two communities of practice are aware and can create solutions that address their needs as well as provide those in attendance with demonstrable scenarios and examples of tools working together to support UHC.

The concepts in the abstract are applicable worldwide. Currently, openIMIS as a technology is being implemented in Asia (Nepal) and Africa (Tanzania, Cameroon, Chad, DRC).

Yes. Both openIMIS and OpenHIE are listed in the WHO Digital Health Atlas.

@Alicia Spengler, @Fourie, Carl, @Saurav Bhattarai

openIMIS: the open source tool for the digitalisation of health financing

Sustainable Financing for Digital Health: Sustainable financing for digital health and the roles of digital health in support of health financing, including UHC

More and more countries in the world seek to achieve Universal Health Coverage (UHC) and Universal Social Protection (USP) for their populations. Interactions between stakeholders in health and social protection systems are very complex and generate a lot of data. That is why Information and Communication Technologies (ICT) can provide essential support and help to navigate through a system for policymakers and users. Unfortunately, ICT solutions can be expensive and difficult to maintain. Furthermore, many countries do not have sufficient technical and financial capacity to cope with complex ICT structures. Many health system-related ICT projects have been focusing on data extraction, monitoring and evaluation in recent years. What has been lacking is a tool addressing health financing interactions among the key stakeholders in a health care system. As an open-source product, openIMIS is a comprehensive and affordable tool, linking beneficiary, provider and payer data. openIMIS offers a simple and user-friendly way to manage core processes from enrolling beneficiary management to transmitting and verifying claims. The openIMIS Initiative promotes global exchange around the openIMIS software and links global and local communities to benefit from each other. The Initiative was founded and is collaboratively financed by the Swiss Agency for Development and Cooperation (SDC) and the German Federal Ministry of Economic Cooperation and Development (BMZ). Currently, the Initiative is coordinated by GIZ. The presentation will ideally be embedded in a panel discussion on UHC and the underlying principles of a health financing system. If classic health financing functions (resource generation, resource pooling, service purchasing) are addressed, the panel could discuss how those functions can be supported through digital tools to create more efficiency and strategic purchasing of health care services.

The learning objective of this presentation is to provide the audience with information on: 1. The role of digital tools for health financing and UHC 2. openIMIS as open-source software: functionalities and workflows 3. openIMIS: learnings from the country implementation (an example will probably be submitted by Swiss TPH on the national scale-up of openIMIS in Tanzania) 4. openIMIS Initiative: global community, resources, and governance structure.

Sustainable health financing is the base and a major building block for UHC. So far, openIMIS is the first and only open-source tool worldwide supporting the financial flows between beneficiaries/patients, providers, and payers. Moreover, from a health (financing) system perspective, the purchasing of services and provider payment set up are the crucial elements for efficient resource allocation and health care system management. openIMIS provides the needed functionalities to manage these processes efficiently. The demand for schemes in various countries is growing and it is important to avoid inefficiencies due to either re-creating local solutions or spending resources on expensive software solutions (rather than spending it on health). The objective of this presentation is to raise awareness and knowledge about the existence of openIMIS, its potential, and learnings from current implementations.

Global good = global level; Implementations in Nepal, Tanzania, Cameroon, Chad, DRC

Yes: https://digitalhealthatlas.org/en/-/projects/775/published

@Alicia Spengler, @Saurav Bhattarai, @Viktoria Rabovskaja

openIMIS: The open source software for managing payer-provider mechanisms!

Sustainable Financing for Digital Health: Sustainable financing for digital health and the roles of digital health in support of health financing, including UHC

openIMIS is an open-source software tool for the digitalisation and efficient management of health financing workflows. Currently being used to manage a variety of health protection schemes in Nepal, Tanzania, Cameroon, Chad, and DRC, openIMIS offers seamless connections between beneficiaries, health service providers, and payers. The software is designed for a variety of business processes ranging from enrolling beneficiaries at the community level to generating electronic claims at health facilities to the automated and human-led adjudication of claims at the offices of the payer institution. This appy hour session will be designed to showcase to the user how easy it is to use openIMIS for the various processes in a health protection scheme. For the developer audience, there will be material available to inform them about the openIMIS technical roadmap and to encourage them to join the community of practice. Through a local instance of openIMIS, we will demonstrate how Android apps can be used to enroll beneficiaries and provide ID cards in the communities. Additionally, the workflows around claim entry and processing will also be demonstrated through a live demonstration of the openIMIS system.

The main learning objective of this session is to provide the audience with information on how the software functions - from both a technical viewpoint as well as a user of the system. With a live demonstration running, the audience will be able to see the concepts openIMIS utilizes to enroll beneficiaries, generate, and adjudicate claims.

The business processes around provider-payer health financing mechanisms are complex, and for many scheme-operators, a barrier to realizing an efficient system. Digital technologies offer a large potential in reducing these complexities to the user. openIMIS is the first and only open-source tool to offer this solution. The digital health landscape needs to be aware of the existence of such solutions and help build a community of practice together, further. The proposed appy hour session provides this opportunity for potential users, developers, and system owners to understand the tool and provide valuable feedback, requests, insights for its further development.

Nepal, Tanzania, Cameroon, Chad, DRC

Yes.

@Saurav Bhattarai