Towards Data Exchange between Health Information System and Insurance Claims Management System

Abstract

The advancement of technology observed today has led to the development of many Health Information Systems (HIS) which are cost-effective, reliable, scalable and flexible. Moreover, integrated Health Information System (iHIS) plays a crucial role in the dissemination of information, which helps in decision-making. The care2x HIS in Tanzania does not have a module for exchanging data between Care2x HIS and the National Health Insurance Fund (NHIF) claims management system. The absence of this module in Care2x has resulted into long waiting time for a patient, inaccuracy of the data submitted in claim forms, the consumption of time when processing claims, delay in processing payment and the high costs incurred in printing claims forms. In this paper, we used both qualitative and quantitative methods to gather the requirements for the development of the module. Interviews, questionnaire and document review were employed in data collection. The requirements were gathered with the help of 12 practitioners and one Information Technology (IT) specialist from NHIF headquarters. The results showed that the integration of the data exchange module is very potential in solving the present challenges. The data exchange module between Care2x HIS and NHIF Claims management System will increase the accuracy of claims submitted and reduce the cost for printing claims forms and time spent in filling and processing claims.