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 |
🔧 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 |
👤 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
🔍 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:
- Verify eligibility
- Initialize SHA visit
- Capture required parameters
- 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
🏥 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
👨⚕️ 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
💼 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:
- Validate claim data completeness
- Submit claim to HIE
- Receive and process response
- Store claim ID for tracking
- 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 |
🚀 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
✅ 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)
📊 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.
📞 Support
For technical support or clarification, contact the HIE Integration Support Desk.
Document maintained by the HIE Integration Team