The open-source Insurance Management Information System (openIMIS) is the first open-source software that manages social (health) protection schemes by linking beneficiary, provider, and payer data. With a modular structure, openIMIS can be modified according to country-specific needs.
The initiative aims to contribute to the "gradual inclusion of hitherto excluded populations into social (health) protection schemes by improving the schemes' data and information management capacities through openIMIS." Part of its objectives is to complement ICT infrastructure for insurance and other finance mechanisms with openIMIS or specific modules.
One of the expected outputs of the initiative is establishing a Community of Practice (CoP) for existing users and interested groups to inform the direction and development of openIMIS. Currently being implemented in Tanzania, Nepal, and select countries, the openIMIS initiative collaborated with the Asia eHealth Information Network (AeHIN) to expand its reach in Asia.
AeHIN is a collaboration of digital health advocates created by the World Health Organization in 2011 to help Asian countries with digital health development. It has helped build capacity in the region by laying down national health information foundations: (1) governance; (1) architecture, (3) program management; and (4) standards, and interoperability.
In 2019, AeHIN established an openIMIS regional hub (Philippines, Indonesia, and Sri Lanka) in Asia to provide country-input on challenges, priorities, and user requirements for openIMIS, especially in the academic setting.
Since then, partner universities and groups have started using openIMIS to demonstrate a health information system's core functionalities and a social health insurance scheme's critical business processes.
The openIMIS Regional Hub Asia consists of health education institutions, medical student associations, and other related networks that actively review, implement, and evaluate openIMIS in various use cases, particularly in the academic setting, to support the application of ICT solutions for social health protection
Goal:
Management of social health insurance and other health protection schemes to achieve universal health coverage (UHC) through openIMIS
Vision:
Position openIMIS as a global good that can support the application of concepts and skills on social health protection and health informatics
Mission:
Strengthen the openIMIS community in Asia by localizing capacity-building strategies and supplementary knowledge materials with the reality of concrete country cases
Objectives:
Continue facilitating regional knowledge sharing and networking around openIMIS;
Develop a regional capacity-building program on health financing and digital heath with openIMIS as the laboratory component; and
Expand the openIMIS community of practice in Asia by supporting open source ecosystems for national and subnational schemes.
Contact Persons:
Dr Alvin Marcelo
Executive Director
Kristin Chloe Pascual
Operations and CoP Management
Charisse Orjalo
Online Community Management
2021 ACTIVITIES
AeHIN 7th General Meeting
AeHIN held its seventh AeHIN General Meeting virtually last January 7, 14, 21, and 28, 2021. This year’s theme discussed ‘Strengthening Regional Health Systems Response to COVID-19 focusing on digital health experiences in Asia.’ A total of 328 participants from 42 countries in and outside of the Asian region attended the conference.
During the opening ceremony, AeHIN partners shared messages carrying the importance of the Governance, Architecture, Project Management, and Standards and Interoperability (GAPS) Framework in digital health to set the context of the whole conference.
Mr. Saurav Bhattarai, GIZ Advisor, discussed using standards-based tools and leveraging what is already available to avoid duplication of efforts. He stressed that “we needed digital health tools running on open and standards-based architectures that facilitate interoperability to ensure that we can effectively fight the COVID-19 pandemic.”
On the third day of the conference, AeHIN facilitated a parallel community meeting for the openIMIS Regional Hub Asia (Philippines, Indonesia, and Sri Lanka) to gather their ideas on best moving forward with the community of practice.
One of the suggestions in the meeting was to use a standard learning management system for learning openIMIS and to scale up the visibility of openIMIS in policy-oriented discussions in respective countries. Participants also suggested using openIMIS as a bridge to strengthen the collaboration between the ministry of finance and the ministry of health.
The AeHIN Partner Share session followed the parallel community meeting, wherein Saurav Bhattarai gave updates on the openIMIS initiative. He shared about their continued support in existing openIMIS implementations that manage the data of over five million beneficiaries.
The initiative has also been working on new implementations and functionalities and expanding openIMIS for other social protection schemes. openIMIS is also strengthening its focus on interoperability. Saurav Bhattarai discussed that they have been “mapping openIMIS data model to be FHIR-compliant as well as working on direct interoperability with our other global goods such as DHIS2, OpenMRS, and Bahmni.”
Another important update from the openIMIS Initiative was the openIMIS Catalytic Implementation Fund that intends to “provide support to scheme operators that want to use openIMIS to manage their various social health protection schemes or beyond.”
AeHIN Hour - openIMIS Webinars 2021
Since 2019, AeHIN and the openIMIS have organized webinars to help bring information, updates, and discussions about openIMIS between the initiative and its communities of practice in Asia.
Saurav Bhattarai and Konstanz Lange, Advisors from the openIMIS Coordination Desk in GIZ, were the speakers at the first AeHIN-openIMIS webinar for 2021 held on March 9.
In this webinar, they introduced the openIMIS Catalytic Implementation Fund, a “mechanism to allow resources to be made available for getting started with openIMIS implementations.”
The speakers also explained the various use cases where it can be applied and provided details on the procedures related to getting access to the fund.
The webinar recording is available at https://youtu.be/4lfv_SlXjwE .
Other openIMIS webinars are available at https://youtube.com/playlist?list=PLN7M3nT7qGnfu329R2YTiuLQV_m4J6vIO .
openIMIS Enrollment App Testing
In mid-March, the AeHIN secretariat team contributed to testing the openIMIS enrollment application.
AeHIN focused on testing the openIMIS enrollment application via Android. The team used the openIMIS test link in documenting the test results.
openIMIS Virtual Meetings
On March 17, 25, and 31, AeHIN participated in the openIMIS virtual community meetings spearheaded by the openIMIS coordination desk. On the first day, AeHIN co-facilitated the session on ‘Community-driven openIMIS 5th Anniversary Campaign.’ The session collated ideas from the implementers to further promote openIMIS’ anniversary.
Lao PDR Convergence Workshop - Use of openIMIS in Nepal
The Ministry of Health Lao PDR hosted a digital health convergence workshop last March 30-31, 2021. The workshop aims to help strengthen the digital health sector of Lao with the help of experts from the Asia eHealth Information Network, development partners, and other government agencies in the country.
The workshop's expected outcome is to develop a digital health architecture blueprint and a digital health strategy for the Lao PDR health sector. These outcomes will help improve stakeholder coordination and harmonization towards a sustainable and interoperable health information system.
AeHIN presented the AeHIN Mind the GAPS (Governance, Architecture, Program Management, and Standards, and Interoperability) Framework, which was the basis of strategy development sessions during the workshop.
Neighboring countries also shared their experiences in the Digital Health Strategy Development session. Since its first digital health convergence workshop, Dr. Bikash Devkota, Director of Quality Standards and Regulation Division from the Ministry of Health and Population Nepal, shared Nepal's digital health journey.
According to Dr. Devkota, one of the lessons they learned is that digitalization is a significant component of quality care as it makes service easier and efficient. With this regard, Nepal prioritized digitalization in health.
Dr. Damodar Basaula, Executive Director of Health Insurance Board Nepal, discussed how openIMIS played a big part in the country’s health digitalization, especially in managing Nepal’s national health insurance scheme.
The Health Insurance Scheme of Nepal is a contribution-based Security Health Insurance (SHI) scheme with subsidies for the ultra-poor, poor, and the marginalized. The Nepal Health Insurance Board (HIB) manages it entirely. It is currently implemented in 69 districts and has a total of 3.7 million beneficiaries.
openIMIS supports the management of the core business processes of the Nepal HIB from the enrollment to verification of beneficiaries, claims generation, claims review, and data analysis. At present, there are 375 hospitals using openIMIS to send claims digitally, and there are 7,335 openIMIS users.
Since 2016, the Nepal HIB has been part of the openIMIS community of practice. They report bugs and issues, request new features, and discuss various technical topics with the community. The openIMIS community has provided them with a platform for exchange and regular updates, especially new features.
Dr. Basaulaa shared that the use of openIMIS in Nepal expedited the implementation of the Management Information System (MIS) for health insurance in Nepal. They also received support from the community of practice when needed, and the new versions of the openIMIS software are available regularly.
Nepal has learned that they need local capacities to manage and maintain software. Local teams have to lead implementations, and the openIMIS global community is available to support their local efforts.
AeHIN x APMC-SN M.D.igital 2021: National Telehealth Convention
AeHIN has co-presented this year’s M.D.igital Telehealth Convention with the theme “The Role of Medical Students in the Global Digital Health Strategy 2020-2025” last April 24-25, 2021.
The online conference, initiated by the Association of Philippine Medical Colleges Student Network (APMC-SN), served as a venue to discuss the role of medical students in the Global Digital Health Strategy 2020-2025. Four hundred sixty-one attendees attended the event.
In the international session, Saurav Bhattarai, Advisor from GIZ, introduced openIMIS, an open-source information system for managing insurance schemes and other related use cases. Saurav also discussed how systems can interoperate with openIMIS. openIMIS is being implemented in Nepal, Cameroon, Tanzania, Chad, and DRC.
The conference proceedings and the MDigital Paper will also be shared once available.
openIMIS Training with Metropolitan Medical Center
AeHIN shared its curriculum for ‘openIMIS training for medical schools in the Philippines’ with the Metropolitan Medical Center last August 2021. This initiative aimed to address Metropolitan Medical Center-College of Arts, Science, and Technology’s request to learn more about the field of health informatics.
On August 14, Dr. Alvin Marcelo, AeHIN Executive Director, presented the overview of the curriculum and facilitated the module discussion on ‘Health Informatics’ via zoom to the faculty of Metropolitan Medical Center-College of Arts, Science. The session was attended by 16 participants.
Dr. Alvin Marcelo with Dr. Sonny Matias Habacon, Dean of Metropolitan Medical Center College of Medicine, talking about health informatics curricula, how faculty and students can teach and learn how to encode health data into a free open source software (openIMIS), and how Metropolitan can start their community of practice.
The succeeding modules were offered as self-paced educational video resources, namely:
Health Financing Module by Dr Dante Salvador
Health Data Privacy Module by Dr/Atty Ivy Patdu
openIMIS Demo by Mr Eric Pareja
openIMIS Testing for October 2021 Release Version
In support of the openIMIS October 2021 release version, the openIMIS Regional Hub Asia gathered testers who could contribute to completing the test case scenarios for the openIMIS modular release instance (174 test cases), openIMIS legacy release instance (74 test cases), and the openIMIS claims AI instance (12 test cases).
On September 29, the openIMIS Regional Hub Asia facilitated an orientation and quick training on the testing activity with the identified testers from various country hubs. The number of identified testers per group were outlined below.
Philippines-St Luke’s College of Medicine Quezon City - 8 testers
Philippines-San Beda College of Medicine - 5 testers
Sri Lanka - 5 testers
Cambodia - 5 testers
Nepal-Kathmandu University - 2 testers
The testing is ongoing for the openIMIS instances assigned to the regional hub and is expected to be completed by the second week of October 2021.
Focus Group Discussion on Free and Open Source Software
The openIMIS Regional Hub in Asia aims to promote a demand-supply ecosystem that will support the adoption of Free and Open Source Software (FOSS) applied in healthcare, such as openIMIS.
To understand the needs and perspectives of stakeholders in the ecosystem, AeHIN hosted a Focus Group Discussion on Free and Open Source Software for Healthcare last 25 August 2021 at 5:00-6:00 PM GMT+8. AeHIN administered real-time questionnaires (via Mentimeter.com) complemented with open discussion to surface the participants’ perceived benefits and risks of adopting FOSS like openIMIS.
The 23 participants from the Philippines, Germany, Sri Lanka, Malaysia, Nepal, Bangladesh, New Zealand, Switzerland, and the United States represented various sectors. The majority of the participants work in the private sector (34.8%), primarily electronic medical record providers and insurance companies. Other sectors represented are the academe, international development agency, government, and non-government agency (figure below).
Sectoral Representation of the Participants
Overall, the focus group discussion showed that the participants are familiar with examples of FOSS in healthcare. Participants also identified advantages and disadvantages of FOSS in healthcare as summarized below:
Costs: FOSS is considered an affordable solution that can help low-resource countries manage their healthcare system. However, it can have a high impact on countries if it fails. While FOSS is known to be cost-effective with its free license, some participants believe that it may have unclear upfront costs.
Community/Support: Some participants appreciate that FOSS has a thriving community of developers and users, allowing easy onboarding of local experts. On another note, some participants perceive the community as weak, lacking local technical experts who can provide a high quality of support (troubleshooting, core development, enterprise support).
Features: FOSS allows implementers to have complete control of the source code. Thus, they can easily modify, customize, and localize software development. Other benefits highlighted are cross-platform deployment and easy interoperability with other information systems. With the degree of flexibility in FOSS, some are concerned with issues on security, deployment stability, and data privacy that may come with it.
Overall Implementation: As it is vendor-independent, FOSS promotes ownership, sustainability, and fast implementation. However, some participants noted that FOSS implementation is prone to hiatus due to the unavailability of experts. Disadvantages include unclear licensing types and service level agreements as well as poor marketing.
For small and medium enterprises (SMEs) to invest in FOSS, they need support configuring the product to address clients’ needs. Thus, they are seeking a training program and budget to create a highly competent pool of developers who are well versed in FOSS development. To sustain the implementation, they want to ensure value for FOSS investment by reassuring product continuity, especially in its ability to provide stable and certified solutions. Thus, FOSS development should be well-secured by a funded program. They also want to guarantee a market for FOSS solutions to generate demand for the product. Lastly, they need government commitment to FOSS and its SME vendors.
For the ministry of health (MoH) to adopt FOSS, implementers should avoid adverse lobbying (‘selling’ FOSS for FOSS’s sake). It is crucial to emphasize the specific features of FOSS that contribute to cost-effective innovation and address specific needs in managing health information. MoH should also understand that they have full control when adopting FOSS. Since most decision-makers do not have an IT background, networking is one of the ways for government staff to connect with FOSS experts. MoH would also need to develop an enterprise roadmap for FOSS implementation and, at the same time, strengthen and empower their technical team to ensure high quality of service and fast development in FOSS.
Lastly, the discussion also shows a need to develop a framework or model defining the role of SMEs and MoHs for FOSS implementations in highly regulated domains, such as healthcare. Demand for FOSS in national healthcare can only be generated if MoH adopts a clear governance framework in implementing and evaluating HIS solutions including FOSS. Supply for FOSS solutions can only be sustained if a local community of experts from the private sector is available.