Ethiopian-Health-Insurance-Service / openimis-be-medical_py

The openIMIS Backend Medical reference module
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🚀 Feature : Health Facility Hierarchical link - Adding objects Backend #1

Open mngoe opened 3 months ago

mngoe commented 3 months ago

To be able to make the link between these HealthFacilities and then assess whether the referral is "normal" or should be subject to a Malus, it is first necessary to make the link between different Health Facilities.

The Health Facilities modification form must therefore be modified to add a list of Health Facilities linked to a Health Facility.

It is not possible to select the same Health Facility linked to a Health Facility several times (the list of selectable Health Facilities must therefore be modified each time a health facility is added, modified or deleted).

In order to keep track of these referrals and the premium calculation in the future, a history of these values (based on the ValidityTo / ValidityFrom mechanics) on the link between two healthFacilities will have to be set up.

On backend you will have to add new elements in the healthFacilities object to do a recursive link to Health Facilities.

You have to manage it as a configuration in the core module to be sure you activate this functionnality only if configuration is true in the Module Configuration.

You will also need to manage GQL Mutations to manage adding multiple HF to a HF. Please implement rules on backend to check if HF are present just one time in the list of hierarchical. Please also implement update of those fields correctly in order to be sure

Lishaneticha commented 2 months ago

We implemented a similar functionality on the Meso platform. Here is how it was designed. • During claim preparation if the patient needs to be refered the claim preparer selects the referal date and the health facility that the patient needs to be refered to. • Here we link the claim with a health facility (we have claim to health facility relationship here) • After the patient arrives at the referred health facility the clerk selects a referred visit reason and enters the referral date. • Then the system creates a referral linkage to the new claim (claim at the referred health facility) using the insuree number, the referred facility and referral date. • Here we link the old claim to the new claim (claim at the referred health facility)

mngoe commented 2 months ago

Ok , Good to Know. We will almost implement something like this in openIMIS for Ethiopia.

The thing is that Ewnetu told me there is a bonus / malus system if an insuree comes directly in a Health Facilities he shouldn't. In order to achive that, we need to manage this HealthFacilities structure to check if a HF is logically linked to another one to evaluate if we have to implement a bonus or malus on invoice.