Notice C

Promoting the collaborative development of proposals for investments in digital health global goods

Develop a claim submission, enrollment and enrollment verification module with a clinical point of service application using the relevant HL7 FHIR standards, openIMIS and OpenMRS

Notice C Opportunity: 
Announcement C1: Modular transformation of openIMIS
Proposal Status: 
Approved - Fully Funded

Executive summary

The Insurance Management Information System (IMIS) was designed by the Swiss Tropical and Public Health Institute (Swiss TPH) in the context of the Swiss Agency for Development and Cooperation (SDC)’s Health Promotion and Systems Strengthening Project in Tanzania.

 

IMIS was first implemented in 2012, as the IT backbone for the Government of Tanzania’s Community Health Fund (CHF). Over the last years IMIS has developed into a flexible health insurance solution that is ready for deployment and should be able to accommodate most immediate needs of many potential users. However, IMIS also has some limitations regarding parametrization, modularity and interoperability.

 

The technical roadmap points towards a step-wise integration of modularity, interoperability and open source components. During the technical workshop in February 2018, these elements were discussed and agreed upon by a wider team of stakeholders.

 

All the parties agreed on the following approach for moving forward:

  1. Keep the current IMIS code maintained as a core module for the time being, without any significant investment.

  2. All major functional updates will be made based on the open source technology or existing HL7 standards or modules, whenever possible.

  3. Elements of the openHIE architecture will be used and integrated with whenever possible.

 

As an outcome of this project, we will build the working integration between openIMIS and OpenMRS - the world's largest open source project to develop health information technology for resource-constrained environments. We will develop claim submission, enrollment and enrollment verification module with a clinical point of service application using the relevant HL7 FHIR standards. This will help healthcare facilities gain easier and better access to the insurance information of their patients, enroll them faster in the system and allow them to provide their medical services without any bureaucratic set-backs.

Consortium team

Consortium includes the following organizations:

 

SolDevelo

  • Responsible for:

    • technical project management, software development

  • Point of contact:

    • Jakub Sławiński - SolDevelo CTO

  • Organization’s relevant qualifications

    • SolDevelo is a dynamic IT company focused on delivering high-quality software and innovative solutions. It has a deep expertise in the IT projects management and development, gathering experience in various projects during the last decade, for such institutions as:

      • VillageReach

      • Terre des hommes

      • Grameen Foundation

      • Pathfinder International

      • Benetech

      • FrontlineSMS

      • And many, many others

    • SolDevelo will be able to gather exact requirements, prepare project timeline, manage development according to SCRUM principles and deliver the final results back to the community.

  • Relevant experience and examples of related work

    • SolDevelo has been involved in many opportunities that required skill sets relevant to this particular project, especially OpenMRS (core contributors), HL7 FHIR (OpenMRS Sync 2.0 module), nation wide micro-service based implementations (OpenLMIS), nation wide OpenHIE architecture based implementations (National Health Infrastructure project with such components like OpenELIS, DHIS2, OpenMRS and many other HIE compatible applications, health standards-based workflows for the Client Registry, Facility Registry, Health Management Information System, Shared Health Record, and Interoperability Layer).

  • Qualifications of key members of the proposed project team

    • Paweł

      • Senior Java Developer/Team Leader/Project Manager

      • Working in international teams for various projects/clients:

        • Mifos

        • MOTECH

        • NDT

        • Ananya Care reporting

        • VillageReach

        • International Rescue Committee

        • Terre des homes

      • Preparing high-level designs

      • Creating solutions architecture

      • Performing code review

      • Leading several frontend and backend development teams

      • Taking care of all arrangements and delegation of tasks

    • Kamil

      • Java Developer/Team Leader

      • Working in international teams for various projects/clients, like:

        • MOTECH

        • Terre des homes

  • Number of years in operation

    • SolDevelo was established in 2009 and started contributing to OpenMRS in 2013 and is consistently supporting this fantastic community since then.

 

Swiss TPH

  • Responsible for:

    • Know-how of openIMIS, inputs for Concept development, openIMIS system/architecture design, drafting of technical specifications for development to be undertaken on openIMIS  

  • Point of contact:

    • Dragos Dobre - IT Systems Architect

  • Organization’s relevant qualifications

    • The Swiss Tropical and Public Health Institute (Swiss TPH) is a world-leading institute in global health, with a particular focus on low- and middle-income countries. By uniquely combining research, services, and education and training, Swiss TPH aims to improve the health and well being of populations through a better understanding of disease and health systems and by acting on this knowledge.

  • Relevant experience and examples of related work

    • Swiss TPH is currently active in 300 projects in over 100 countries, working across a variety of topics from infectious and non-communicable diseases, environment, society and health as well as health systems and innovative interventions. It has more than 800 employees and students from over 70 nations currently work at Swiss TPH. About 600 are based in Basel, while another 200 are based abroad in 40 different countries.

    • Swiss TPH currently hosts the WHO Collaborating Centre for Health Technology Management and eHealth. The Swiss Centre for International Health (SCIH) provides consultancy and project implementation services. As a department of the Swiss TPH, SCIH draws on in-house expertise and synergies between the research and education departments to design and innovate solutions including information systems. The in-house know-how is state-of-the-art knowledge in a broad range of topics including primary healthcare, health economics and financing, health technologies, sexual and reproductive health and health promotion.

    • The Health Economics and Financing and the Health Technology and Telemedicine Unit jointly has been involved in the design and implementation of the Insurance Management Information System (which is the genesis of the openIMIS initiative) since its inception in Tanzania and has supported its implementation in a number of countries. Having worked on grounded solutions with local software vendors and generalizing it for operations by different insurance models it now supports the direction of the software to becoming more modularized and adhering to global standards to ensure better interoperability in its IT environment.

    • Swiss TPH is currently implementing two projects at scale for deployment of insurance schemes through openIMIS, in Tanzania and Cameroun, and two openIMIS pilots in Chad and Democratic Republic of Congo. In addition, Swiss TPH is actively involved in the development of openIMIS as part of the IT & product team of the openIMIS initiative.

    • In parallel of these health insurance-related projects, Swiss TPH is also implementing projects focused on systems’ interoperability such as a Clinical Decision Support System (CDSS) in Nigeria where data collected through CommCare is automatically integrated in DHIS2, or more globally, a civil registration system collecting and evaluating birth and death events through ODK and integrating them as tracked entities in DHIS2.

  • Qualifications of key members of the proposed project team

    • Dragos

      • IT System Architect at Swiss Tropical and Public Health Institute

      • OMG-Certified Systems Modeling Professional™

      • Over 4 years of IT teaching experience at University Level

      • Management of software life cycle (from specification to development to deployment)

      • Development of open source applications

      • Maintenance of open source software source code

      • Speaking at international conferences

      • Publication of scientific articles

  • Number of years in operation

    • Swiss TPH founded in 1943 is based in Basel, Switzerland and is an associated institute of the University of Basel.

Project Description

Technical approach

The development effort can be split into two parts: the openIMIS side and the OpenMRS side.

 

On the OpenMRS side, we will implement a module that will be responsible for checking patient enrollment status and submitting claims. This module will be responsible for checking patient insurance enrollment on registration and managing patient billing. We will also implement an app module that will extend the user interface in OpenMRS using extension points (fragments) in other modules, such as the Registration App Module, responsible for the patient registration interface. The interface responsible for recording patient visits (form entry) will also need to be extended to support billing details. The module will also provide its own interface that will give a billing/claim overview.    

 

This module will depend on the existing OpenMRS FHIR module - it will leverage it to act as a FHIR client that will communicate with openIMIS. Any extension that will be required to the FHIR module will be contributed to the FHIR module codebase. The new module will allow configuring connection details through an admin interface.

 

On the openIMIS side we will implement a module acting as a FHIR server. We will use an open source implementation of FHIR STU3 for .NET - https://github.com/ewoutkramer/fhir-net-api. The module will be responsible for exposing the relevant FHIR resources and mapping them to domain objects.

 

During the development process, we will host publicly accessible test instances. The test infrastructure for openIMIS and OpenMRS demo servers will be hosted in the cloud (Amazon Web Services). These servers will be continuously updated with the latest versions of modules being developed. This server will be used QA for testing of new features as well as it will be shared with the community and anyone interested in the development as a single point of reference for the current state of the systems and their integration.

Use of Digital Health Technologies

FHIR STU3 will be the main standard of communication between openIMIS and OpenMRS. The financial module of FHIR will be used to represent the claim/enrollment data being exchanged between OpenMRS and openIMIS. Exact mapping of business domains to FHIR resources will be worked out with the involvement of openIMIS and OpenMRS communities to achieve the best possible result.

 

Since FHIR will be used as the standard of data exchange it will be possible both for OpenMRS and openIMIS to integrate with different systems that implement the standard - the integration will not be specific to these two systems.

Workplan and schedule

Current plan:

Below are the man day estimations for the tasks identified in the project.

Task

Estimation (man-days)

Set up of code bases, development environment, automated tests and code quality tools - Openmrs

5

Set up of code bases, development environment, automated tests and code quality tools - openIMIS

5

Set up of CI/CD process - OpenMRS

5

Set up of CI/CD process - openIMIS

5

Creation of a module that can extend the current functionality of openIMIS

10

Implementation of a FHIR server module for openIMIS

20

Connecting the openIMIS FHIR server with business logic

20

Extend the OpenMRS FHIR module

5

Creation of a basic OpenMRS claims module

5

Implementation of billing management in OpenMRS

25

Connecting the OpenMRS module with openIMIS through FHIR

10

Claim submission user interface

15

Extension of the patient registration screen with enrollment verification

10

Form entry user interface extension

10

Module admin screen in OpenMRS

5

Documentation

5

Testing & bug fixing

15

OVERALL

175

Team composition

For this proposal, following team composition is proposed:

  • SolDevelo

    • 2 FTE developers

    • 0.5-1 FTE Tester/QA

    • 0.25 FTE Project Manager

  • Swiss TPH

    • 0.25 FTE Consultant



This team composition is assumed in the RACI Matrix below, and the Gantt chart timeline.

RACI Matrix

The RACI Matrix includes the roles on the project team, as well as the role of the OpenMRS/openIMIS Communities, which will be regularly consulted and updated during the development process.

 

Task\Role

Project Manager

SolDevelo Developers

SolDevelo QA

Swiss TPH

OpenMRS Community

OpenIMIS Community

Design of OpenMRS features

Accountable

Responsible

Informed

Consulted

Consulted

 

Design of openIMIS features

Informed

Consulted

Informed

Responsible/Accountable

 

Consulted

Development of OpenMRS modules

Accountable

Responsible

Informed

Informed

Consulted

 

Development of openIMIS modules

Accountable

Responsible

Informed

Consulted

 

Consulted

Review of code submissions for OpenMRS

Informed

Responsible/Accountable

  

Consulted

 

Review of code submissions for openIMIS

Informed

Responsible/Accountable

 

Consulted

 

Consulted

Test Infrastructure management

Accountable

Responsible

Consulted

Consulted

Informed

Informed

Testing in the test environment  

Accountable

Consulted

Responsible

Consulted

Informed

Informed

Documentation and user guide

Accountable

Consulted

Responsible

Consulted

Informed

Informed

 

The timeline assumes the already mentioned team composition. Notes:

  • Start & end dates are exemplary and can be shifted. (start assumed at 07.01.2019)

 

Gantt Chart in the attachment.

Digital Health Atlas

Registered

Project Deliverables

  • openIMIS FHIR module integrated acting as a FHIR server

  • OpenMRS claims module, able to communicate with openIMIS by FHIR

  • OpenMRS claims app that extend patient registration and form interface with insurance billing

  • Extensions to the OpenMRS FHIR module

  • Comprehensive documentation for the OpenMRS module

  • Comprehensive documentation for the openIMIS module

  • Recorded bi-weekly demonstrations of development progress

  • Testing reports & a list of test cases and scenarios

 

2-sentence overview

 

a) A description of your global good for a non-technical audience.

Connecting two open-source health projects to save time and resources of the healthcare providers in the developing countries. Making access to affordable healthcare easier and faster.

b) What this investment from Digital Square will specifically go towards

Investment from Digital Square will go towards team of experienced developers, who will make sure that whole project will be created in time and great quality. Their experience with work on social impact software and open-source projects will guarantee involvement of the OpenMRS and openIMIS community and their collaboration.

Community Feedback

 

SolDevelo is very involved in OpenMRS community, thanks to being one of the core contributors to this project. OpenMRS forum -  “Talk” had in 2017:

  • 29,986 total visits

  • 2,816 topics created

  • 20,323 posts written

 

Thanks to this engagement, 209 developers from around the globe made 4,250 commits to 112 code repositories in 2017 alone. OpenMRS is a one of the endorsers of the Principles for Digital Development, which means every project with in it has to be collaborative.

 

We want to use the creative power of this enormous community. Creating topics on Talk, doing daily stand-ups, that are public and open to everyone who is interested to this project and also doing showcases will help us achieve this task. Working with community everyday of the project will allow us to incorporate their feedback, comments and suggestions as quick as it is possible.

 

Swiss TPH has been involved in the design and development of openIMIS in all its implementation sites so far, and as such, will be able to source feedback from users on new developed features and their practicality in the field. Also, Swiss TPH is currently mandated  as the IT & Product team within the openIMIS initiative which will allow direct feedback of the developments to the community via it's dedicated communication and contribution platforms (JIRA, Wiki, GitHub).

 

Use Cases, User Stories

The following use case will be covered by the developments for this proposal:

 

 

  1. A person gets enrolled by the Insurer and receives the insurance card with an unique insuree number.

  2. Once the person gets sick they would go to a health facility that uses openMRS. The patient might or might not be already registered in openMRS with a unique ID number. Once registered in openMRS the patients insurance ID number would be entered in the openMRS record of the patient.

  3. The insurance ID number would be queried to get details from openIMIS on the patient’s eligibility. Details needed to establish the clients identity and the benefits covered by the insurance will be provided from openIMIS to openMRS.

  4. The treatment of the patient will be undertaken by the health facility and the information recording and processing of payments/billing will be (as per details shared by openIMIS) managed in openMRS.

  5. Once the patient treatment is completed, the relevant details from openMRS are sent to openIMIS as part of submission of a claim in order to get reimbursed. The claim is then processed in openIMIS as per its internal claim scrutinization process and final results of the scrutinization concluding with the amount to be paid to the health facility against the claim is sent back to openMRS.

Self-Assessment on the Global Goods Maturity Model

Two attachments:

  • OMRS evaluation

  • openIMIS evaluation

Tagging

  • OpenMRS

  • Interoperability

  • HL7 FHIR

  • Claim submission

  • Enrollment

  • Enrollment verification

List of attachments

  • Budget

  • Budget narrative

  • CVs

    • Paweł

    • Kamil

    • Dragos

  • Global Goods Maturity Model

    • OpenMRS

    • openIMIS

  • Gantt Chart

Comments

Hi Jakub,

Thanks for your submission. Great to see the emphasis on the use of HL7 standards!

I would encourage you to reach out to some of the other submissions around OpenMRS and openIMIS. Maybe there are ways to create to collaborate on a proposal and split in a way that makes sense regarding the respective strengths of the different partners?

Cheers,

Nils