The initial set of draft workflows are FHIR-based workflows leveraging Health Financing and FHIR workflows and ongoing work on Integrating openIMIS into the OpenHIE Landscape.
Beneficiary Enrollment
Query Beneficiary
//query for beneficiary - should come close to mirror CR workflow.
Check enrollment status
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
Enrol beneficiary
title Enrol beneficiary PoS->PoS: [1] Fetch / Register patient PoS->IOL: [2] Submit FHIR EnrollmentRequest resource IOL->IOL: [3] Validate FHIR resource IOL->openIMIS: [4] Submit enrollment details openIMIS->openIMIS: [5] Process enrollment openIMIS->IOL: [6] Return enrollment response IOL->PoS: [7] Return FHIR EnrollmentResponse resource PoS->PoS: [8] Add details to patient record
Claim Submission
Check beneficiary validity
title Check beneficiary validity PoS->PoS: [1] Fetch claims data PoS->IOL: [2] Submit FHIR EligibilityRequest resource IOL->IOL: [3] Validate FHIR resource IOL->openIMIS: [4] Query patient eligibility openIMIS->IOL: [5] Return patient eligibility details IOL->PoS: [6] Return FHIR EligibilityResponse resource PoS->PoS: [7] Process response
Check beneficiary balance/treatment options
title Check beneficiary balance/treatment options
PoS->PoS: [1] Fetch claims data
PoS->IOL: [2] Submit FHIR Claim {use=exploratory} resource
IOL->IOL: [3] Validate FHIR resource
IOL->openIMIS: [4] Query patient balance/treatment options
openIMIS->IOL: [5] Return treatment options/reimbursement details
IOL->PoS: [6] Return FHIR ClaimResponse resource
PoS->PoS: [7] Process response
Preauthorization of claim
title Preauthorization of claim
PoS->PoS: [1] Fetch claims data
PoS->IOL: [2] Submit FHIR Claim {use=proposed} resource
IOL->IOL: [3] Validate FHIR resource
IOL->openIMIS: [4] Submit claim to reserve funds
alt Acknowledgement of preauthorization
openIMIS->IOL: [5] Return acknowledgement of preauthorization
IOL->PoS: [6] Return FHIR ClaimResponse resource
PoS->PoS: [7] Process response
else Additional information requested
openIMIS->IOL: [5] Request for additional information
IOL->PoS: [6] Return FHIR CommunicationRequest resource
PoS->PoS: [7] Process response and fetch claims data
PoS->IOL: [8] Submit FHIR Communication resource
IOL->IOL: [9] Validate FHIR resource
IOL->openIMIS: [10] Submit supporting information
openIMIS->IOL: [11] Return adjudicated response
IOL->PoS: [12] Return FHIR ClaimResponse resource
PoS->PoS: [13] Process response
end
Track status of claim
title Track status of claim
PoS->PoS: [1] Fetch claims data
alt Check claim status
PoS->IOL: [2] Submit FHIR ProcessRequest {action=status} resource
else Poll on claim status
loop text
PoS->IOL: [2] Submit FHIR ProcessRequest {action=poll} resource
end
end
IOL->IOL: [3] Validate FHIR resource
IOL->openIMIS: [4] Submit claim status check
openIMIS->IOL: [6] Return claim status
IOL->PoS: [7] Return FHIR ProcessResponse resource
PoS->PoS: [8] Process response
Submit claim
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
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
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 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
- ...