Health informatics solution to facilitate health information exchange and verification between health service providers and health insurances. Case study CHUK and RSSB

Abstract

BACKGROUND Information exchange between Health facilities and insurance are two main health system blocks that must work together for a good health service delivery. However, it has always presented problems in terms of delays in the reimbursement process, exchanged information trust between both parties and redundant workload on both sides. CHUK is one of the main referral hospitals in Rwanda with a daily frequency of more than 1000 patients and RSSB/CBHI as a medical insurance that covers 93.1% of the Rwandan population. That is why once this problem is handled between these two institutions it will be a big contribution to the nation. This research investigated HIE challenges and developed detailed requirements for a long-lasting solution that answers found challenges. METHOD In Depth interviews and Questionnaires of 41 employees from both institutions that work on different data exchange points and adjustment data of the fiscal year 2021-2022 documents have been used to collect accurate information from both sides. There has also been the analysis of systems that have been implemented before and all gathered information permitted the development of implementable Requirements Specifications that considered identified gaps. RESULTS Found results are qualitative and quantitative which support qualitative results. Qualitatively I used the qualitative framework analysis and the found theme is “the challenges that hinder the effectiveness of health information exchange between CHUK and RSSB/CBHI are at all interoperability layers, but the institutional layer affects the most the implementation of electronic HIE. ” Quantitatively we found that the human interoperability layer (processes in existing manual and digital systems) is the layer that needs more attention as it contributed at 99% in the deduction of the amount in the year 2021-2022, the results on currently used semi-digital HIE system shows that it is occupying the first place. Now that all challenges are brought out and their high-level respective solutions have been identified, it is time to implement the solution by following all best practices mentioned in the solution and it will require the involvement of all identified stakeholders. v Keywords: HIE, Interoperability, Health Facility, Health insurance, RSSB, CBHI, CHUK