Overview
Healthcare providers in Kenya must transition from the manual Social Health Authority (SHA) provider portal to a fully integrated, Digital Health Agency (DHA)-certified and SHA-compliant Health Management Information System to maintain their contracting status. CareverseHIMS is that system, delivered, implemented, integrated, hosted and supported in Kenya by Turquoise Solutions Limited. It is certified by the Digital Health Agency and fully SHA compliant, so your facility stays contracted, submits claims correctly and gets paid on time. CareverseHIMS is an enterprise-grade digital ecosystem rather than a single application: a multi-tenant, cloud-based and mobile-ready platform built on global interoperability standards (FHIR HL7), with fully integrated ERP capabilities so clinical, administrative, financial and operational workflows all run in one environment. It is configured to your Kenya Essential Package for Health (KEPH) level — from Level 2 dispensaries and clinics, through Level 3 health centres and Level 4 primary care hospitals, to Level 5 large private hospitals and Level 6 private tertiary and specialised hospitals — so the modules, claims workflows and reports match what your facility is licensed to do. Paper trails slow the patient journey, manual billing and weak reconciliation delay reimbursement, management lacks real-time visibility, and regulatory, data-protection and interoperability obligations keep rising. CareverseHIMS addresses all of these in one place, while Turquoise Solutions handles the surrounding infrastructure, networking, cybersecurity and end-user devices that make a hospital deployment succeed.
Key Capabilities
- Patient management — registration, scheduling, reminders, referrals and journey tracking
- Clinical management — triage, structured EMR, clinical alerts, clinical templates, laboratory, medication, diagnostics and theatre workflows
- Billing & finance — unified cash, insurance, corporate, mobile money and card billing with real-time reconciliation
- SHA-compliant eClaims — pre-authorisation, service mapping, claim submission and validation
- Pharmacy & inventory — dispensing linked to prescriptions, stock levels, expiry and reorder alerts
- Integrated ERP — human resource management, inventory tracking, financial accounting and resource planning
- Reporting & analytics — role-based dashboards, daily/weekly/monthly reports and a custom report builder
- Compliance & security — role-based access control, audit trails, consent-driven data sharing and licence tracking
- Integration & HIE — DHA-certified health information exchange integration with FHIR/HL7 interfaces, payer platform APIs and diagnostic equipment connectivity
- Cloud scale — multi-tenant, multi-site, mobile-ready operations on secure cloud hosting
Business Benefits
Protected SHA contracting status through a DHA-certified, SHA-compliant system
No disruption from non-compliance or manual provider-portal workflows
Faster patient movement and coordinated care across every service point
Protected revenue through disciplined charge capture and tighter reconciliation
Claims submitted right the first time, reducing rework and payment delays
Real-time, role-based visibility for executives and department heads
Audit-ready governance with system-generated logs and exportable reports
One platform for clinical, administrative and financial operations — no parallel systems
Cloud scalability that grows with new branches and service points
Certified and compliant
CareverseHIMS is certified by the Digital Health Agency (DHA) and fully compliant with Social Health Authority (SHA) requirements. SHA eClaims are handled end to end inside the system — pre-authorisation, service and tariff mapping, claim submission and validation — instead of through the manual provider portal, where re-keying, missing documentation and reconciliation gaps put both revenue and contracting status at risk. The result is faster claim processing, fewer errors and improved financial turnaround. On the DHA side, the platform is compliant with Health Information Exchange standards, supporting secure, structured and interoperable data exchange across the healthcare ecosystem for continuity of care, alongside the access control, consent handling and audit trails expected of a certified system under Kenya's digital health and data-protection framework.
Why facilities choose CareverseHIMS
Seamless integration across systems
Connects with the platforms you already run, enabling interoperability and participation in the wider healthcare ecosystem instead of another data island.
Collaboration and continuity of care
Secure information sharing across providers and service points improves coordination, reduces repeat work and lifts patient outcomes.
Built for real healthcare environments
Designed around national healthcare frameworks and the way facilities actually work, so it is relevant from day one rather than after months of reshaping.
Continuous innovation
Cloud, AI, blockchain and IoT capabilities are applied progressively to keep improving the quality and delivery of care.
The platform — more than a system
Built in compliance with global interoperability standards (FHIR HL7), CareverseHIMS enables seamless integration with Health Information Exchanges and real-time data exchange. With fully integrated ERP capabilities it goes beyond clinical management, optimising administrative, financial and operational workflows in a single cloud-based platform suited to facilities of every size.
Unified clinical & administrative modules
Integrated patient management, clinical alerts, laboratory, medication and billing modules that eliminate duplicate data entry and improve operational efficiency.
Cloud-based & mobile-ready
Multi-tenant, mobile-ready architecture hosted in a secure cloud environment, enabling flexible workflows and scalable deployment across facilities.
Integrated ERP operations
Human resource management, inventory tracking, financial accounting and resource planning consolidated within a single platform.
Real-time analytics & insights
Instant access to clinical and operational data for informed, evidence-based decision-making and performance optimisation.
Change management & capacity building
Structured training and onboarding programmes that secure smooth adoption and long-term system success.
Secure data sharing & consent management
Strong access controls and consent-driven data sharing aligned with data privacy and compliance requirements.
Kenya's health facility levels (KEPH)
Kenya's health system is organised into six Kenya Essential Package for Health (KEPH) levels, from community health services up to national tertiary and specialised hospitals. Each level has defined service expectations, staffing and infrastructure requirements, and referral relationships, and the Kenya Medical Practitioners and Dentists Council (KMPDC) categorisation rules gazetted in December 2021 further split the middle levels into sub-classes. CareverseHIMS is configured to the service mix, claims profile and reporting obligations of your level rather than installed as one generic system, so use the table below to locate your facility, then read the Solution tiers section that follows.
| Level | What it covers | Typical facilities | CareverseHIMS fit |
|---|---|---|---|
| Level 1 — Community health services | Promotive and preventive care, health education, early detection and screening, referral and adherence or defaulter tracing delivered at community level. | Community health units led by community health extension workers and community health promoters. | Community and outreach registration, screening and referral capture that feeds the facility record. |
| Level 2 — Primary care (basic outpatient) | Basic outpatient services without inpatient admission, typically operating limited daily hours. | Dispensaries, health clinics, dental clinics, eye clinics, mobile clinics, home-based care services and standalone funeral facilities. | Core tier — outpatient only (OPD). |
| Level 3B / 3C — General clinics and basic health centres | 3B General medical and dental clinic: the basic level run by a medical or dental officer. 3C Basic health centre: a gazetted health centre offering mainly ambulatory preventive and curative services for local needs. Both operate without inpatient admission. | General practice medical clinics, general dental practice clinics and basic health centres. | Core tier — outpatient only (OPD). |
| Level 3A — Comprehensive health centre (inpatient) | Comprehensive curative, preventive, diagnostic, promotive and rehabilitative services with inpatient beds and a maternity theatre. Deployment is sized by bed capacity: under 20 beds for lower patient volumes, and 20 beds or more for higher volumes. | Comprehensive health centres, nursing homes, cottage hospitals and maternity homes. | Advanced tier — inpatient (IPD), configured by bed capacity. |
| Level 4 — Primary care hospitals and specialist centres | 4A Primary care hospital: the principal primary referral hospital, complementing primary health care with inpatient wards, theatres, radiology and imaging, laboratory services, resident specialists, mortuary and both basic and advanced life support referral capability. 4B Specialist standalone medical, surgical, diagnostic or laboratory centre. 4C Specialist health clinic offering limited outpatient and day-care specialty services. | Private primary care hospitals, standalone specialist and diagnostic centres, and specialist outpatient or day-care clinics. | Advanced tier — inpatient (IPD). |
| Level 5 — Large private and multi-specialty hospitals | Broad specialist inpatient and outpatient care across multiple disciplines, receiving referrals from smaller facilities and referring complex cases onward. | Large private general hospitals, private multi-specialty hospitals, private medical centres and faith-based hospitals. | Enterprise tier. |
| Level 6 — Private tertiary and specialised hospitals | The most advanced private care, concentrated either across a broad tertiary service line or on specific specialist disciplines. | Private tertiary hospitals and private specialised oncology, ophthalmology, renal, cardiac, orthopaedic, dental and mental health hospitals. | Enterprise tier. |
Why your facility level matters for your HMIS
Categorisation and re-categorisation of health institutions in Kenya follow the KMPDC health facility categorisation rules; the summary above is provided for guidance and your licensed level as recorded by the regulator always takes precedence.
Licensable service scope
Your level defines the services you may offer and the infrastructure, staffing and quality systems expected of you — so it defines which clinical, theatre, laboratory and pharmacy modules your system must run.
SHA benefits and tariffs
Level determines the Social Health Authority benefit packages and tariffs a facility can claim against, which shapes service and tariff mapping, pre-authorisation rules and eClaims validation in the system.
Statutory reporting
Reporting obligations to the Ministry of Health and national health information systems differ by level, so dashboards and periodic reports are configured to the indicators your facility must submit.
Referral relationships
Level 1 refers into Level 2 and 3, Level 3 into Level 4, Level 4 into Level 5 and Level 5 into Level 6 — captured as structured referral records with continuity of care through DHA-aligned health information exchange.
Right-sized deployment
A Level 2 dispensary claiming primary healthcare services and a Level 6 referral hospital running theatres and oncology need very different configuration, integrations and support depth.
Room to grow
Facilities that upgrade their level scale within the same platform: additional modules, service points and integrations are enabled without changing systems.
Solution tiers
CareverseHIMS is structured to support health facilities at different stages of operational maturity, mapped directly onto the KEPH levels above. The dividing line is how you deliver care: Core is for facilities offering outpatient services only, Advanced is for facilities that admit inpatients, and Enterprise is for large private and specialised private hospitals. Scope, implementation effort, support model and commercial structure scale with your needs, and final tier selection should reflect your service mix, bed capacity, patient volumes, claims environment and integration requirements.
Core — outpatient-only facilities
Level 2 dispensaries and clinics, Level 3B general medical and dental clinics, and Level 3C basic health centres
For facilities that run outpatient services only, with no inpatient admission: OPD patient flow, basic revenue capture, pharmacy and stock visibility, and SHA primary healthcare (PHC) readiness.
Advanced — facilities with inpatient care
Level 3A comprehensive health centres, whether under 20 beds or 20 beds and above, and Level 4 primary care hospitals and specialist centres
For facilities that admit patients: multi-department clinical operations, inpatient (IPD) patient flow with bed and ward management, theatre and maternity workflows, diagnostics, insurance workflows and financial control.
Enterprise — large private hospitals
Level 5 large private and multi-specialty hospitals, Level 6 private tertiary and specialised hospitals, and private hospital groups
Complex care delivery, advanced revenue assurance, theatre and procedure management, extensive integrations and analytics-driven management across one or many private facilities.
Operational complexity drivers
The table below shows how each tier maps to the operational realities of your facility. Talk to us and we will confirm the right fit.
| Driver | Core | Advanced | Enterprise |
|---|---|---|---|
| Patient volume | Low | Medium | High |
| Service lines | Few, OPD-focused | Multiple | Extensive, including theatre |
| Claims complexity | Low, PHC-oriented | Moderate, SHA and private insurance | High, multi-payer and audit-heavy |
| Financial control needs | Basic | Structured | Advanced governance |
| Integration needs | Minimal | Moderate | High, including devices and external systems |
| Decision-making needs | Operational | Managerial | Executive and strategic |
How it is delivered
CareverseHIMS is delivered as a managed cloud service by Turquoise Solutions: we provision and monitor the environment, handle performance monitoring and security updates, and deliver enhancements through scheduled release cycles. Subscription packages are aligned to facility level and billing cycle, and scope, capabilities and support scale with facility maturity — from primary care clinics through to referral hospitals — so you only pay for the depth you need.
A structured six-step path to go-live
- Requirements and workflow review — confirm departments, users, reports and prerequisites
- Environment setup — provision the application environment, roles and service points
- Master data setup — load charge items, service catalogues, stock and payer mappings
- Workflow and integration configuration — align the platform to agreed processes
- Testing and user validation — functional testing, walkthroughs and user acceptance
- Training and go-live — role-based training, then transition into live operations and support
90-day Proof of Value
Early adopters can start with a three-month Proof of Value in a department selected with your team, with full feature access. It is a low-risk way to validate workflows in live operation and confirm fit before scaling facility-wide, with a structured feedback loop into the product roadmap.
What Turquoise Solutions brings
- Implementation, configuration and data migration led by our healthcare delivery team
- Role-based training programmes for confident day-one adoption
- Local, responsive technical support after go-live
- Hosting options, network readiness and structured cabling for clinical areas
- Cybersecurity: encryption, access control, monitoring and regular audits
- HMIS-optimised endpoint devices — tablets, printers and biometric readers
Ideal For
Level 2 dispensaries and clinics, Level 3B and 3C outpatient clinics and health centres, Level 3A comprehensive health centres with inpatient beds, Level 4 private primary care hospitals and specialist centres, Level 5 large private and multi-specialty hospitals, Level 6 private tertiary and specialised hospitals, diagnostic centres, faith-based facilities, multi-branch private health groups, and any facility still on the manual SHA provider portal that must move to a DHA-certified HMIS to keep its contracting status.
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