Hospital billing for KenyaEMR, built from scratch, field-tested in 7 facilities and adopted by OpenMRS as its standard billing design
KenyaEMR is the medical record system used in health facilities across Kenya, built on the open-source OpenMRS platform. At Palladium I designed its billing module from scratch: how a cashier finds a patient's bill and takes payment by cash, insurance or mobile money, for outpatient and inpatient care.
Facilities needed to bill patients inside the medical record. Waivers, where a facility lets a patient pay less or nothing, worked differently in every facility we tested.
One payment desk where a waiver is one of four ways to pay. OpenMRS adopted the designs as its standard billing design guide.
A hospital visit builds a bill line by line: registration, consultation, lab tests. Some lines are exempt, some are already paid, some are still pending. The cashier has to see what is owed and take it in whatever way the patient can pay.
Most patients pay by cash, insurance or mobile money. Some can't pay at all, and the facility waives part or all of the bill. That last case is where the real complexity was.
The first version covered everything a cashier's office does: payment points that cashiers clock in to, payment modes, a bill manager, charge items and payment history, across 23 screens.
A waiver was a separate action. The cashier opened a bill, chose Waive Bill from its menu, entered an amount and typed a reason.
We took the cashier module into 7 health facilities and ran it through different case scenarios. The gaps were in waivers, in three ways, and one fixed waiver path couldn't serve every facility.
Version two became the Payment desk: 14 screens running from search to receipt, including what happens when a patient isn't found or the connection times out.
Njeri owes 420 KSH for a consultation and two lab tests. Waive part of it, then pay the rest by mobile money, the way a cashier would on the Payment desk.
Every line on a bill starts somewhere in the patient's journey. Alongside billing, I helped design the inpatient module, starting from early work that Partners In Health shared with the OpenMRS community.
As part of the OpenMRS design community, we tested and shaped it before KenyaEMR adopted it. Follow Njeri from the front desk to the payment desk.
The waiver rules surfaced in the field. A short survey of facility policies before version one would have caught them earlier.
Time from search to receipt, before and after the Payment desk, would turn a strong story into a number.
