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The initial set of draft workflows are FHIR-based workflows leveraging Health Financing and FHIR workflows and ongoing work on Integrating openIMIS health financing into the OpenHIE Landscape. The workflows are being documented by the OpenHIE community and will be included in the OpenHIE Specification.  

Beneficiary Enrollment

Query Beneficiary

//query for beneficiary - should come close to mirror CR workflow.

Check enrollment status


Code Block
title Check enrollment status

PoS->PoS: [1] Register patient
PoS->IOL: [2] FHIR Coverage resource search
IOL->IOL: [3] Validate FHIR resource
IOL->openIMIS: [4] Search for beneficiary
openIMIS->IOL: [5] Return beneficiary details
IOL->PoS: [6] Return FHIR Coverage resource
PoS->PoS: [7] Add details to patient record

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Code Block
title Submit claim

PoS->PoS: [1] Fetch patient visit data 
PoS->IOL: [2] Submit FHIR Claim {use=complete} resource
IOL->IOL: [3] Validate FHIR resource
IOL->openIMIS: [4] Submit patient claim
openIMIS->openIMIS: [5] Process claim
openIMIS->IOL: [6] Return claim outcomes
IOL->PoS: [7] Return FHIR ClaimResponse resource
PoS->PoS: [8] Process response

Indicator Reporting

openIMIS Indicator Reporting

Image Added

Code Block
title openIMIS Indicator Reporting

openIMIS->openIMIS: [1] Generate indicators to meet reporting needs
openIMIS->IOL: [2] Submit report
IOL->IOL: [3] Validate report / indicators
IOL->IOL: [4] Transform report (e.g. FHIR Measure Report to ADX)
IOL->HMIS: [5] Submit to HMIS
HMIS->HMIS: [6] Evaluate and persist report / indicators

openIMIS Patient Level Indicator Reporting

Image Added

Code Block
title openIMIS Patient Level Indicator Reporting

openIMIS->openIMIS: [1] Generate FHIR resources to meet reporting needs
openIMIS->IOL: [2] Submit FHIR resources
IOL->IOL: [3] Validate FHIR resources
IOL->FHIR Server: [4] Persist FHIR resources
CQL Engine->CQL Engine: [5] Trigger / external request for report
CQL Engine->FHIR Server: [6] Evaluate FHIR Measure(s) / Measure Report(s)
CQL Engine->IOL: [7] Submit to DHIS2
IOL->IOL: [8] Validate FHIR Measure(s) / Measure Report(s)
IOL->IOL: [9] Transform report (e.g. FHIR Measure Report to ADX)
IOL->HMIS: [10] Submit to HMIS
HMIS->HMIS: [11] Evaluate and persist report / indicators

Other HF Workflows

  • Policy lookup and query – know who is associated to which policy | Stems from a use case in India where 1 family gets a single card / policy number and all members are associated to that policy.

Other HIE Workflows

  • 'Patient leaves treatment setting' workflows
    • Explanation of benefit and payment reconciliation
  • Client Registry (CR) interactions
    • Beneficiary enrolment
    • Beneficiary verification
  • Terminology Services (TS) and Product Registry (PR)
    • Terminology and product code sync
  • ...