OpenHIE Architecture Specification
5.2-en
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  • Architecture Specification
    • Architecture
    • Architectural Principles
    • Standards and Profiles
  • OpenHIE Component Specifications
    • Non-Functional Requirements
    • Client Registry (CR)
    • OpenHIE Facility Registry (FR)
    • OpenHIE Finance and Insurance Service (FIS)
    • OpenHIE Health Management Information System (HMIS)
    • OpenHIE Health Worker Registry (HWR)
    • OpenHIE Interoperability Layer (IOL)
    • OpenHIE Logistics Management Information System (LMIS)
    • OpenHIE Product Catalogue (PC)
    • OpenHIE Shared Health Record (SHR)
    • OpenHIE Terminology Service (TS)
    • Point-Of-Care Systems
  • Data Exchange Specification
    • Aggregate Reporting Workflows
      • Export Aggregate Data
      • Validate and Save Aggregate Data
    • Alerting / Sending Reminders or Information
      • Send Client Alert Workflow
      • Send Health Worker Alert Workflow
    • Care Services Discovery
      • Query Health Worker and/or Facility Records Workflow
      • Query Care Services Records Workflow
      • Search Care Services Workflow
      • Request Care Services Updates Workflow
    • Laboratory Work Flows
      • Order Laboratory Test
      • Report Lab Results
    • Patient Identity Management Workflows
      • Create Patient Demographic Record Workflow
      • Update Patient Demographic Record Workflow
      • Query Patient Demographic Records by Identifier Workflow
      • Query Patient Demographic Records by Demographics Workflow
    • Shared Health Record
      • Save Patient-level Clinical Data Workflow
      • Query Patient-level Clinical Data Workflow
    • Terminology Service Workflows
      • Expand Value Set
      • Translate Code
      • Verify Code Existence
      • Verify Code Membership
      • Query Value Set
      • Query Code Systems
      • Query Concept Maps
      • Lookup Code
    • Vaccine Workflows
    • OpenHIE Finance and Insurance Services Workflows
      • HFW-001: Enroll Beneficiary
      • HFW-002: Query Beneficiary
      • HFW-003: Check Coverage Eligibility
      • HFW-004: Claiming
      • HFW-005: Claim Tracking
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  • Interaction Description
  • Technical Details
  1. Data Exchange Specification
  2. OpenHIE Finance and Insurance Services Workflows

HFW-002: Query Beneficiary

PreviousHFW-001: Enroll BeneficiaryNextHFW-003: Check Coverage Eligibility

Last updated 2 years ago

The PoS system is searching for beneficiary master data in the FIS based on a specific query (e.g. by name, ID, age etc …). The FIS returns all master data from the CR and adds FIS specific master data .

Example use case: An insurance agent is looking for information about a beneficiary to respond to a service desk call.

Workflow Maturity

  • Workflow is defined and ARB approved

  • Initial implementations are underway

Standards

Assumptions & Prerequisites

None

Actors

Validations

The IOL should validate the FHIR resources being submitted.

Interaction Description

Source Code

title HFW-002: Query Beneficiary

participant PoS
participant IOL
participant FIS
participant CR

opt
  note over PoS, CR
	Assumes that querying of CR is done here
    
	PoS->HIE: [1] Fetch patient (CRWF-3,4)
  end Note
end opt
PoS->IOL: [2] Submit Patient/Beneficiary Query (Demographics / ID)
IOL->FIS: [3] Forward Query details

FIS->FIS: [4] Process query

FIS->IOL: [5] Return Beneficiary Details response

IOL->PoS: [6] Forward Beneficiary Details response

Technical Details

Ref
Interaction
Endpoint
Data
Transaction Spec

1

Fetch / Register patient

CR

(CRWF-1,3,4)

2

Submit Patient/Beneficiary Query

IOL

3

Forward Query details

FIS

FHIR Patient

4

Process query

internal

5

Return Beneficiary Details response

IOL

FHIR Patient

6

Forward Beneficiary Details response

POS

Newly Defined

HL7 FHIR Financial Module:

- The point of service system that captures a patient clinical encounter, it is responsible for sending this encounter on to the HIE.

- Mediates the transactions between the PoS system and the infrastructure services to facilitate easier interoperability.

- The source of truth for patient demographic and identifier detail. It is able to be queried using an identifier to find the enterprise identifier for a particular person.

- Financing and Insurance System that manages data on beneficiaries and their coverage.

(link to permanent text in )

https://www.websequencediagrams.com/
http://hl7.org/fhir/financial-module.html
PoS
IOL
CR
FIS
http://hl7.org/fhir/patient.html
http://hl7.org/fhir/patient.html