HMIS | HIE Integration Guide

HIE Implementation Guide for HMIS Integration

This implementation guide assists Health Management Information System (HMIS) integration teams in connecting with the Health Information Exchange (HIE). Following these guidelines ensures proper interfacing with the HIE's critical components: Client Registry, Facility Registry, Health Worker Registry, and Claims systems.

Priority Levels

Icon	Level	Description
🔴	Critical	Essential functionality — must be implemented
🟠	Standard	Expected functionality — should be implemented
🟢	Advanced	Enhanced functionality — optional features

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🔧 Core Requirements

Use Official APIs

Priority: 🔴 Critical

Requirement	Details
API Source	Use only APIs provided through the official portal
No Third-Party	Avoid unofficial interfaces or middleware
Data Exchange	All communication through official channels only

Best Practices:

• Maintain up-to-date API documentation
• Implement proper authentication and security
• Monitor API usage and performance

Direct HMIS Integration

Priority: 🔴 Critical

Requirement	Details
Implementation	Direct integration within HMIS itself
No Middleware	No external components or third-party systems
Native Functionality	All features built into the HMIS

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👤 Client Registry Integration

1. Patient Registration

Priority: 🟠 Standard

Feature	Implementation Details
Registration Form	Implement patient registration functionality
ID Search	Search by ID number capability
PIN Management	Set default PIN, enable PIN changes
User Awareness	Inform patients about PIN for Afyayangu login

2. Patient Search

Priority: 🔴 Critical

Search Parameters:

Parameter	Required	Description
ID Number	Yes	National identification number
Full Name	Yes	Complete patient name
Date of Birth	Yes	Patient's date of birth
Phone Number	No	Contact phone number
Other Identifiers	No	As per API documentation

Implementation:

• Enable comprehensive search functionality
• Display accurate results
• Implement error handling for failed searches

3. Patient Data Decryption

Priority: 🔴 Critical

Component	Requirement
Decryption Keys	Use Afyalink-provided keys
Data Security	Encrypt all sensitive information
Key Management	Secure storage with access controls
Audit Logging	Log all decryption activities

4. Patient Data Mapping & Storage

Priority: 🟠 Standard

Mandatory Fields:

Field	Type	Description
CR ID	String	Client Registry identifier
ID Number	String	National ID
Full Names	String	Complete patient name
Date of Birth	Date	Patient DOB
Gender	Enum	Patient gender
Phone Number	String	Contact number

Implementation:

• Store patient details locally after successful search
• Eliminate repeated API calls through local storage
• Map all required fields accurately

5. Update Patient

Priority: 🟠 Standard

Feature	Details
Update Functionality	Enable information updates
Encryption	Send updates with encrypted PIN
Validation	Validate all update requests
Change Tracking	Track all patient modifications

6. Dependents Handling

Priority: 🟠 Standard

Dependent Type	Action
Spouse	Store and display as next of kin
Children	Register as dependents
Relationships	Map family connections clearly

7. Consent Workflow

Priority: 🟢 Advanced

• Capture patient consent before processing requests
• Store consent linked to patient records
• Comply with privacy laws and regulations
• Implement age-appropriate consent mechanisms

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🔍 Eligibility Check

1. Search Patient Eligibility

Priority: 🔴 Critical

Feature	Implementation
Eligibility Search	Implement search functionality
Status Display	Clear visual indicators
Ineligibility Handling	Show reasons and solutions

2. SHA Patient Visit

Priority: 🔴 Critical

Process Flow:

1. Verify eligibility
2. Initialize SHA visit
3. Capture required parameters
4. Confirm visit creation

3. Display SHA Scheme Eligibility

Priority: 🟠 Standard

SHA Schemes:

Scheme	Display Requirements
SHIF	Status, coverage period, benefit limits
ECCIF & PCIF	Active periods, waiting periods
POMF	Eligibility status, coverage details
ECDF	Active coverage, benefit information

Visual Design:

• Color-coded eligibility status
• Easy-to-read benefit displays
• Detailed information on hover/click

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🏥 Facility Registry Integration

1. Search Facility

Priority: 🔴 Critical

Search Parameters:

Parameter	Description
Facility Code	Unique facility identifier
Facility Name	Official facility name
Location	Geographic location
Level	Facility level (primary, secondary, tertiary)

2. Save Facility Details

Priority: 🟠 Standard

Required Data:

Data Field	Purpose
Facility Name	Identification
Facility Level	Service scope
Facility Codes	System identifiers
Location Info	Geographic data
Contact Details	Communication

Implementation:

• Store locally in HMIS database
• Implement caching to reduce API calls
• Ensure proper data mapping

3. Use Facility Details

Priority: 🟠 Standard

• Populate organization resource in claims
• Ensure consistent facility information
• Implement data validation and fallback mechanisms

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👨‍⚕️ Health Worker Registry Integration

1. Search Practitioner

Priority: 🔴 Critical

Search Parameters:

Parameter	Description
ID Number	National identification
Registration Number	Professional registration ID
Name	Practitioner name

2. Save Practitioner Details

Priority: 🟠 Standard

Required Data:

Field	Description
Full Names	Complete practitioner name
License Numbers	Professional licenses
Registration Number	Official registration ID
ID Number	National ID
Specialization	Medical specialty

3. Use Practitioner Details

Priority: 🟠 Standard

• Populate practitioner resource in claims
• Ensure consistent information across claims
• Handle updates and missing data appropriately

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💼 Claims Integration

1. SHA Codes Mapping

Priority: 🔴 Critical

Task	Implementation
Code Addition	Map SHA codes to local database
Consistency	Ensure uniform coding for SHA visits
Validation	Validate codes before submission
Updates	Handle code version changes

2. Map Preauth Services

Priority: 🔴 Critical

Service Handling:

• Flag services requiring preauthorization
• Visual indicators in service selection
• Block service until preauth confirmed

3. Send PreAuth Check

Priority: 🔴 Critical

Process Flow:

Step	Action
1	Identify service requiring preauth
2	Collect required information
3	Submit preauth request
4	Process and store response
5	Proceed based on authorization status

4. SHA Intervention Amounts

Priority: 🟠 Standard

• Display SHA payable amount per intervention
• Use locally stored data
• Update amounts regularly
• Indicate patient vs. SHA responsibility

5. ICD-11 Search

Priority: 🔴 Critical

Implementation Options:

Approach	Benefits
API-based with caching	Always current, minimal storage
Local database	Fast, offline capability
Hybrid	Optimal performance and accuracy

6. Build Claim Bundle (Registries)

Priority: 🟠 Standard

Bundle Components:

Component	Source
Patient Information	Local storage
Facility Details	Local storage
Practitioner Information	Local storage
Visit Details	Current encounter
Claim Metadata	System-generated

7. Build Claim Bundle (SHR, Services & Diagnosis)

Priority: 🔴 Critical

Data Requirements:

Category	Details
Diagnoses	Primary and secondary (ICD-11)
Procedures	All services rendered
Medications	Prescribed medications
Clinical Info	Additional required data

8. Claim Submission

Priority: 🟠 Standard

Submission Process:

1. Validate claim data completeness
2. Submit claim to HIE
3. Receive and process response
4. Store claim ID for tracking
5. Provide status feedback

9. Poll Claim Status

Priority: 🔴 Critical

Feature	Implementation
Status Polling	Regular status checks using claim ID
Status Codes	Handle all status codes appropriately
Visual Indicators	Clear display of claim status
Actions	Enable resubmission for rejections

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🚀 Advanced Features

Facility Level Context

Priority: 🟢 Advanced

• Customize workflows based on facility capabilities
• Display appropriate options by facility level
• Hide unavailable features
• Provide facility-specific guidance

Service Filtering By Facility Level

Priority: 🟢 Advanced

• Filter services by facility level
• Show only relevant services
• Prevent selection of unavailable services
• Implement referral workflows

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✅ Production Readiness Requirements

To be eligible for production deployment, you must complete 100% of all Critical (🔴) and Standard (🟠) components.

Advanced features (🟢) are optional enhancements that improve functionality but are not required for production.

Core Requirements

Component	Priority
Use Official APIs	🔴 Critical
Direct HMIS Integration	🔴 Critical

Required for Production: 2/2 components

Client Registry Integration

Component	Priority
Patient Registration	🟠 Standard
Patient Search	🔴 Critical
Patient Data Decryption	🔴 Critical
Patient Data Mapping & Storage	🟠 Standard
Update Patient	🟠 Standard
Dependents Handling	🟠 Standard
Consent Workflow	🟢 Advanced

Required for Production: 6/6 Critical & Standard components

Eligibility Check Integration

Component	Priority
Search Patient Eligibility	🔴 Critical
SHA Patient Visit	🔴 Critical
Display SHA Scheme Eligibility	🟠 Standard

Required for Production: 3/3 Critical & Standard components

Facility Registry Integration

Component	Priority
Search Facility	🔴 Critical
Save Facility Details	🟠 Standard
Use Facility Details	🟠 Standard

Required for Production: 3/3 Critical & Standard components

Health Worker Registry Integration

Component	Priority
Search Practitioner	🔴 Critical
Save Practitioner Details	🟠 Standard
Use Practitioner Details	🟠 Standard

Required for Production: 3/3 Critical & Standard components

Claims Integration

Component	Priority
SHA Codes Mapping	🔴 Critical
Map Preauth Services	🔴 Critical
Send PreAuth Check	🔴 Critical
SHA Intervention Amounts	🟠 Standard
ICD-11 Search	🔴 Critical
Build Claim Bundle (Registries)	🟠 Standard
Build Claim Bundle (SHR, Services & Diagnosis)	🔴 Critical
Claim Submission	🟠 Standard
Poll Claim Status	🔴 Critical

Required for Production: 9/9 Critical & Standard components

Advanced Features (Optional)

Component	Priority
Facility Level Context	🟢 Advanced
Service Filtering By Facility Level	🟢 Advanced

Required for Production: 0/2 (Optional enhancements)

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📊 Production Readiness Summary

Integration Area	Required Components	Status
Core Requirements	2	☐
Client Registry	6	☐
Eligibility Check	3	☐
Facility Registry	3	☐
Health Worker Registry	3	☐
Claims Integration	9	☐
TOTAL REQUIRED	26	☐

Production Eligibility Criteria

• ✅ Ready for Production: All 26 Critical and Standard components completed
• ⚠️ Not Ready for Production: Any Critical or Standard component incomplete

Note: Advanced features are optional and do not affect production eligibility.