Streamlining Healthcare Delivery and Insurance Claims through interoperability

How can digital technology enable countries to move seamlessly from service delivery to payments - without paperwork, delays, or administrative bottlenecks? This question framed the first Bhela meeting in 2026, featuring a presentation by Maxime Ngoe (Y-Note) and Sunil Parajuli (Tinker Tech), followed by a short Q&A. 

The answer lies in interoperability: digitally connecting hospital information systems with health insurance management so that data from clinical encounters can be transformed into insurance claims through automated data exchange between systems. 

To illustrate both the complexity and the potential of this approach, the presenters focused on Nepal, where Bahmni, a digital public good for the management of hospital information and medical records that is used in rural hospitals and clinics, connects with openIMIS, which manages the country’s national health insurance programs. This means that healthcare workers can enter patient data during consultations that is then automatically used to generate insurance claims and ultimately payments. 

Maxime Ngoe explained that, by automating data flows between different digital systems, interoperability brings important benefits, particularly for countries implementing universal health coverage or national health insurance programs: healthcare workers can focus on patient care rather than paperwork, facilities can receive faster payments, insurance administrators gain access to data for budgeting and fraud detection, and patients receive more timely information about their insurance coverage. 

Sunil Parajuli then demonstrated the interoperability solution in real time. He showed how Bahmni connects to openIMIS via Odoo, an enterprise resource planning (ERP) system that generates hospital billing data, and how the openHIM middleware layer securely transfers this information to openIMIS for claims processing.
 

The solution aligns with international standards such as openHIE, and can be adapted to different national contexts, insurance policies, and service packages. It is particularly relevant for low- and middle-income countries seeking to modernize their health systems while supporting efficient and transparent workflows that advance health financing goals.

Scenarios like this one are being developed within the openIMIS sandbox project, which creates a platform for exploring and teaching interoperability with hands-on demonstrations using meaningful demo-data. Once ready, the solution will also be incorporated into a new landing page, enabling a wider audience to explore how openIMIS connects with other digital public goods, such as openCRVS, DHIS2, OpenHIE, and digital payment platforms.

The session concluded with a brief Q&A reflecting strong interest in this topic. As Konstanze Lang noted in her closing remarks, the resulting interoperability sandbox will be the focus of a forthcoming Bhela - watch this space.

The documentation on the Bhela call, including links to the recording and further resource pages regarding Bahmni interoperability can be found in the openIMIS wiki.