Currently submitted to: JMIR Formative Research
Date Submitted: Jul 21, 2026
Open Peer Review Period: Jul 21, 2026 - Sep 15, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Eliminating Patient Queues for Payment via Asynchronous Mobile Money Integration: Architecture and an Eight-Month Performance Evaluation at a Rwandan Tertiary Hospital
ABSTRACT
Background:
Patient payment queuing at hospital cashier desks is a persistent operational challenge in resource-limited healthcare settings. In October 2025, the University Teaching Hospital of Butare (CHUB), a public tertiary referral centre in Rwanda, integrated an asynchronous Mobile Money payment module with its OpenClinic GA hospital management information system (HMIS) through the Irembo payment gateway, as an unfunded quality improvement initiative.
Objective:
To describe the integration architecture and quantify its impact on patient payment cycle time, channel adoption, and transaction reliability over eight months of routine operation.
Methods:
The architecture is described from direct analysis of the deployed production source code. Performance was evaluated by retrospective analysis of all closed invoices for prepaid services (laboratory, imaging, pharmacy) from 1 October 2025 to 31 May 2026. Payment cycle time was defined as the interval from bill creation to payment confirmation; transactions exceeding 24 hours were excluded.
Results:
The integration implements a fully asynchronous, non-blocking model with dual trigger pathways (patient-initiated SMS and staff-initiated HMIS form) and a four-step Irembo API workflow. Across 146,203 invoiced episodes, Mobile Money adoption grew from 3.8% to 20.9%. Among 131,037 within-24-hour transactions, median payment cycle time was 5 minutes for Mobile Money versus 72 minutes for cash, a 93.1% reduction. The system processed 44,216 transactions with a 97.9% success rate; all failure causes were identified and resolved. Insurer paper-documentation requirements were the principal structural ceiling on adoption.
Conclusions:
Asynchronous mobile money integration delivered large, sustained reductions in patient payment waiting time and provides a reproducible reference model for sub-Saharan African hospitals.
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