Request for Application #2019-016

openIMIS Modularization, Nepali Functionality, and Community Development

The open source Insurance Management Information System (openIMIS) Initiative envisions a transformation into a Management Information System (MIS) which is interoperable with national health information architectures. Digital Square, in coordination with the Gesellschaft für Internationale Zusammenarbeit (GIZ), is accepting applications to further the development of openIMIS according to the priorities and roadmap (see Figure 4.A-1) as described on the Wiki of the openIMIS Initiative and building on the work initiated under “Notice C1 – Modular Transformation OF openIMIS” and projects from last years' GIZ tenders.

This RFA seeks applications covering three major work streams as indicated below. Note that the links within each of the components are at varying levels of finalization or point to current discussions and it is envisaged that the successful applicant will actively engage in the refinement of the functionality.

  1. Modular Migration of Core openIMIS: Work is ongoing on the modularization of openIMIS to support the migration from the monolithic legacy code base of openIMIS under the MS .NET programming framework to a modular software design using open-source technologies such as Python and other relevant tools that are necessary in the openIMIS systems landscape.  Development has started for the migration of the claims module, but several modules are yet to be taken up and should be prioritized including: the migration of the Beneficiary Enrollment module; support for health insurance schemes in the Formal Sector, and linkages to Digital Social Protection Registers or Civil Registration and Vital Statistics systems. Other work contributing to the modularization of openIMIS and which supports administrative tasks (e.g. batch processing) will also be considered. ​
  2. Nepal Feature Requests: openIMIS maintains a list of requested features. Prioritized feature requests that will be considered in this application are driven by the needs of the Nepal implementation and include: the development of automated claim processing with fraud detection using ML and AI technologies; configurable workflows for enrollment and claim management; and linkages to an accounting system and mobile payment gateways. Other feature requests that will be considered are those task sets highlighted in the JLN process matrix and linkages to other components of OpenHIE such as a Facility Registry or a Product Registry. All feature development for Nepal should be done in a generic and scalable fashion in order to ease adoption in other countries. 

  3. Community Support: Provide support for the governance of community and community management tasks for the openIMIS community with specific focus on the integration and community building of user organizations. Community support should facilitate the development of new community-requested features to support new implementations, provide feedback from local to global-level, and helping implementations contribute their enhancements back to the shared global version resulting in greater capacity for this open source community to support a larger number of adoptions on one shared common codebase.

Applications should align with the current openIMIS development roadmap, emphasize the use of open source technologies and open standards such as HL7 FHIR, and engage with the broader openIMIS and OpenHIE and communities. The resulting work is expected to be published under a compatible open source or creative commons license using the official communication platforms of the communities.

 

Click here to access RFA #2019-016 openIMIS Modularization, Nepali Functionality, and Community Development.

  • Aug. 7 - 26: Concept note development

    Digital Square issues a call for applications, and applicants upload concept notes to Digital Square's public-facing OAP platform. Applicants must submit concept notes by August 26, 2019 11:59 PDF in order to proceed to Step 2. 
    Applicants must use the concept note template.

  • Aug. 27 - Sept 2 : Digital Square review of concept notes

    Following the concept note submission, Digital Square assesses concept notes to ensure alignment with funding round objectives identified in the RFA #2019-016. Digital Square eliminates concept notes that are not strategically aligned with the above.

    Digital Square identifies a set of short-listed concept notes based on the RFA criteria and emails applicants who are eligible to move on to the application phase.

  • Sept. 4 - 16: Preliminary technical application co-creation

    Using feedback received in the Concept Note Phase, applicants will begin preliminary application development.

    Applicants must use the technical application template and post an application iteration on the OAP platform in the first 2 weeks.

     

    The comment feature is available beginning the day of application posting. The applicant should continue to iterate on the application submission based on comments from other applicants and stakeholders.
    At the conclusion of this step, Digital Square will close the ability to upload new content to OAP platform.

  • Sept. 17 - 20: Preliminary technical application comment period

    Following preliminary application development step, Digital Square will close the ability to upload content to the OAP platform.

    During this time, other applicants and other stakeholders in the community should provide feedback, comments, and suggestions.

  • Sept. 23 - Oct. 7: Application finalization

    Using feedback during the preliminary technical application comment period, applicants revise the technical application, develop a budget and budget narrative, and submit these to the Digital Square OAP platform. Applicants must use the provided technical application, budget, and budget narrative templates.

    The budget and budget narrative are not shared publicly on the platform. Commenters see only the high-level summary budget provided in the technical application

  • Oct. 8 - 14: PRC review

    Digital Square groups applications for PRC scoring and technical feedback. Three PRC members will review each application.

    The PRC reviews applications according to the Prioritization Framework, RFA scope of work technical requirements and evaluates applications as green-, amber-, or red-lit per the terms of reference. Green-lit applications are recommended for funding immediately; amber-lit applications are recommended for future funding or further exploration; red-lit applications do not fully meet the selection standards/criteria.
    The PRC sees only the high-level summary budget. Proprietary information including salaries, indirect rates, or other factors are not shared with anyone outside of the funder and Digital Square.

  • Oct. 15 - 17: Digital Square recommendation

    Digital Square compiles the evaluation provided by the Peer Review Committee by clustering the applications according to the Prioritization Framework for Governing Board review.

    Digital Square creates an investment package recommendation of the highly scored applications for the Governing Boardbased on the funding round objectives, donor priorities, and Digital Square vision.

  • October: Governing Board Review

    Digital Square presents the applications, high-level budget summary, Peer Review Committee feedback within the Prioritization Framework, and Digital Square recommendation to the Governing Board.

    The Governing Board evaluates whether to approve the investment packages and reserves the right to modify the recommendation at their discretion.

  • October/ November: Award phase

    Digital Square shares the investment decisions approved by the Governing Board with applicants. Upon applicant request, Peer Review Committee feedback shall be shared with applicant.

    Investment decisions are contingent on funder approval.

Applications (8 total)

Displaying 6 - 8

JLN-Claims-Management and Automation of AI and ML fraud Detection

Workstream: 
Nepal Feature Requests
Two-sentence overview: 

Healthcare claims management is the single most expensive process done by the payers. The JLN Processes (Claims Management) and the development of Automated Claims Processing with fraud detection using ML and AI technologies are two tasks that Healthix Solutions will be looking to work on in the OpenIMIS project.

Claims management and payment processing currently involves lots of manual processes including:- data gathering, benefit plans mapping and matching, correctly configure deductions and accounting for the payments done.

Application Status: 
Pending Review & Investment

OpenIMIS-Product Registry Interoperability

Workstream: 
Nepal Feature Requests
Two-sentence overview: 

VillageReach proposes to collaborate with the OpenIMIS community to make OpenIMIS interoperable with an OpenHIE Product Registry powered by PCMT (Product Catalog Management Tool). VillageReach, as lead creators of the open source PCMT, proposes to provide technical advisory services and collaborate with OpenIMIS software developers to establish this important interoperability.

Supporting Documents: 
Application Status: 
Pending Review & Investment

Support for Formal Sector schemes and Configurable Claims Workflow in openIMIS

Workstream: 
Modular Migration of Core openIMIS
Nepal Feature Requests
Community Support
Two-sentence overview: 

This Technical application proposes to enable the coverage and management of health insurance schemes in the Formal Sector (for people with regular wages and normal work hours), further improving the claim review process by establishing a configurable claim workflow engine and building the community by integrating the users’ organizations.

These developments will be achieved under the new modular openIMIS architecture by migrating the required modules from the legacy system, integrating with specific external systems and by developing new modules based on the specifications developed by Swiss Tropical and Public Health Institute (Swiss TPH), the designer and developer of openIMIS, and with the IT support of SolDevelo, one of the main contributors to openIMIS.

Application Status: 
Pending Review & Investment

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