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The world in your hand
Pengembangan Platform Health Information Exchange sebagai Pusat Pertukaran Data Healthcare Sistem di Indonesia
Rancangan Indonesian Integrated eHealth
Kongres XII PERSIPlenary Hall, Jakarta Convention Center
Jakarta , 7 November 2012
SAIFUL HIDAYATEHealth Project Director
PT. Telekomunikasi Indonesia . Tbk
Corporate Strategic Planning
Curriculum Vitae :
SAIFUL HIDAYAT
Education :- MT in Information System and Technology, ITB- S1 in Telecomunication, Unibraw
Working Experiences :- 2004-2006 : PT. Telekomunikasi Indonesia, Tbk
: Manager e-Solution Divisi Multimedia
- 2006 – 2007 : PT. Finnet (Telkom Group): General Manager of Operation
- 2007 – 2010 : PT. Telekomunikasi Indonesia, Tbk: Head of IT Service Strategy
- 2010 – 2011 : PT. Admedika (Telkom Group): Director Of Business Development
- 2011 – Now : PT. Telekomunikasi Indonesia, Tbk: Project Director Of Ehealth Business Project
The world in your hand
Indonesia eHealth Ecosystem Overview
Information System for Healthcare
TELKOM Initiatives for eHealthcare
National eHealth Implementation Benchmark
Indonesia Integrated eHealth Challengges & Key Succes Factors
INDONESIA EHEALTH ECOSYSTEM OVERVIEW
The world in your hand
Healthcare ecosystem is complex and often fragmented, eHealth benefits both public and private stakeholders by improving communications and information-sharing
Healthcare Ecosystem
EmployerPharmacy
Benefit Managers
Private Insurers
State Owned Insurer (e.g.
ASKES, JAMSOSTEK)
Regulatory Agencies
MOH
Province/District Health
Offices
Other Healthcare (e.g.
Dental)
Nursing Care
Mobile Clinic/ Home Care
Pharmacies
Hospitals (Inpatient,
Outpatient, ED)
Diagnostic Services (Lab,
Rad)Clinic/SpecialistGP
CRO
Pharmaceuticals
Suppliers
Health Information
Exchange
Patient/Consumers
• Members database maintenance
• Automated eligibility/ claims processing
• Claims rating• Effective case/
disease management
• Medical records storage
• Portable PHR• Personalized Portals• Patient Education• Remote health
monitoring
• Wide EMR penetration• Automated referrals• Automated coding and
claim submission
• Population health database• Disease detection & analysis• Pharmaceutical supply chain optimization
• CPOE and EMR• Referral• Remote health
monitoring• Automated coding &
claims submission
: Private
: Public
: Public & private
Legend:
Healthcare Ecosystem in Indonesia
Corporate Strategic Planning
MOHEnsure Quality of Care and Patient Safety
Improving Stakeholders Interactions & BenefitsHealthcare Trend & Platform
Corporate Strategic Planning
Profil solusi e-Health di Indonesia masih parsial: • Implementasi silo-silo• Tidak terstandarisasi:
• Interoperabilitas, sulit dikembangkan• Konsolidasi data sulit dilakukan (multi
format dan standrat)• Kelengkapan data lemah karena
jangkauan kecamatan s.d pusat masih terbatas
• Akses Informasi Publik terbatas: atas indikator dan informasi kesehatan.
Membutuhkan Integrated Shared Service Platform
Hospital (2.066) (BUK)
Puskesmas (9.005)Bankdata Pusdatin
Apotek (21.852)IAI
Industri Farmasi (260)
Asuransi Jiwa (54) (Bapepam)
Praktek Dokter(115.155)
Solusi eHealth ParsialSolusi eHealth di Indonesia Saat Ini
Corporate Strategic Planning
Section 1 - e-health Foundation Actions
Section 2 - mHealth
Section 3 - Telemedicine
Section 4 - eLearning in health sciencesSection 5 - Management of patient information
Section 6 - Legal and ethical frameworks for e-health
Section 7 - Organization and support for e-health
69%
55%
31%63%
46%
53%
50%
•Average score is around 52%
•The lowest eHealth readiness dimension is Section 3 - Telemedicine. Which requires infrastructure, connectivity and advanced application of eHealth
•The highest eHealth readiness dimension is Section 1 – eHealth Foundations. This is indicative of the guidelines being put in to facilitate better communication and collaboration and also form the eHealth foundation
Note: (1) The WHO Global Survey for eHealth provides a secondary analysis of Indonesia e-readiness based on WHO e-health framework Source: WHO, SME Input, Deloitte Consulting Analysis
World Health Organization Global Observatory for e-health in Indonesia –
Year 20091
Key Observations
Developing StageeHealth Readiness di Indonesia
Corporate Strategic Planning
Healthcare ecosystem is complex and often fragmented, eHealth benefits both public and private stakeholders by improving communications and information-sharing
Trend eHealthcare di Indonesia
National eHealth Implementation Benchmark
Corporate Strategic Planning
Singapore
Corporate Strategic Planning
Canada
Corporate Strategic Planning
Corporate Strategic Planning
INFORMATION SYSTEM FOR HEALTHCARE
Corporate Strategic Planning
Information System Support for Healthcare Services Business Process
Insurance/Payors
Loket/UGD/Admin
RS Rujukan Apotek
Diagnosa Poli Rawat Inap
Laboratoium
Warehouse
Suppliers
Pasien
Rawat Jalan
Healthcare services business process required Information System Support :• E-PMS (Patient Management System)• EMR (Electronic Medical Record)/EHR
(Electronic Health Record)• E-Claim (Insurance Application)• E-Referral System• E-Prescription• E-Pharmacy/e-Apotek• E-Laboratory• CRM (Customer Relationship
Management)• Telemedicine• E-SCM (Supply Chain Management)• HRIS (Human Resource Information
System)• Accounting/Financial System• EIS and CDSS• etc
Corporate Strategic Planning
Basic Management Expectation of eHealthcare System
Source : SKT
Need Of Healthcare Organization
Note : HIS (Hospital Information System) is fundamental of digitalization in medical sector, and enables hospitals to meet the needs of “Efficiency, Quality Service & Capability”
Corporate Strategic Planning
Kompleksitas Sistem Aplikasi Saat iniContoh : Proses Bisnis Rumah Sakit
Arsip Medis
Pendaftaran
KepegawaianKeuangan
Poli BPoli A Pelaporan
IGD Billing & Claim
Marketing
Rawat Inap
Kesusteran
Fas. Penunjang
Fasilitas Penunjang
Ruang Operasi
Apotik
GLSpreadSheet
Administrasi
Laboratorium
MSSQL MSAccess
DBF
MySQL
OraclePaper
Paper
Paper
Oracle
MSSQL
MSAccess
Paper MySQL MySQL
MySQL
MySQL
MySQL
MySQL
MySQL
*.xls
In House Development
Heavy Infrastructure
Difficult to integrate
Corporate Strategic Planning
Integration : Simplify The System
E-Health Cloud Services
Corporate Strategic PlanningReferences : Gartner Research
Cloud Computing : Definition & Key Characteristics
Corporate Strategic Planning
• Cost Pressure, CAPEX to OPEX: Metered by Used, Accelerate Speed to ValueNew Economics
• no patching /maintenance, faster development, robust multi layer security, reliability & fault tolerance
Reduce Management
• latest software, internet collaboration, anywhere access, instant self provisioning
Redifining Productivity
… by 2012 80% of Fortune 1000 will use some of cloud computing services, 20% of business will own no IT asset (Gartner)
The bottomline : Early Adopters are finding serious benefits, meaning that cloud computing is real and warrant your scrutiny as a new set of platform for business application (Forrester)
References : Microsoft, Gartner Research, Forrester
Why Cloud Now ? --Demand SideEfficient Effective Innovation
Corporate Strategic Planning
Cloud Security Implementation
1. Secure Access into the Cloud 2. Secure Access to Web Apps3. Server Virtualization
• Mitigate risk towards the hypervisor• Secure the OS• Inter-VM traffic visibility and security• Secure (shared) file systems
4. Secure Standard Operation & Procedures5. Secure System Development Life Cycle Procedures
VM VM VM
Security In The Cloud
Security implemented everywhere …not just on a firewall somewhere.
Corporate Strategic Planning
“Healthcare's Future Is Partly Cloudy: External
Service Provider Options for Healthcare Delivery
Organizations”
“By 2012, 20% of businesses will own
no IT assets.”
“Cloud spending will grow 3X to $42B by 2010.
Cloudsourcing takes the cloud to the next step”
“Cloudsourced delivery…will
comprise ~25% of the total BPO market by
2012”
“Every enterprise should be road mapping their
adoption of the cloud”
Cloud Based Healthcare System Trend …
Corporate Strategic Planning
76% of hospitals have failed in the implementation of HIS
(TELKOM-Probis eHealth riset, 2011)
Top Management Commitment & Change Management Issues
Not having a Master Plan and ICT Roadmap , partial implementation
Resources readiness issues: Policy, Human Resources, Infrastructure
Lack of control in the IT Operation (Poor IT Governance)
The absence of continuous development and improvement
Incompatibility of HIS solution with the Vision, Mission and Business Strategy of Hospital
Fact of HIS Implementation
Failure Factors:
Corporate Strategic Planning
Successful E-Hospital
Implementation
Process
TechnologyPeople
• Standardization of Hospital Business Process
• Compliance with International Standard/ Accreditation (ICD9CM, ICD!), CCD/KARS, ISO 9001, JCI)
• Good IT Governance (RACI on every Process)
• Integrated and Interoperable Solution (eg : support MOH e-Reporting, e-Referral, e-Claim and e-Bill to Insurance, etc)
• Easy to implement, simple, modularity, multiplatform• Security (CIA) • Reliable, Auditable, Manageable• DRC,DRP,BCP• Readiness and Sustainability of Solution Partner
• Strong Commitment from C’s Level / High Level Management
• Acceptance & Technology Adoption• Change Agent and Continuous
Mentoring• Continuous HR Training and
Development
Implementation CredentialKey Lesson Learn
TELKOM INITIATIVES FOR eHEALTHCARE
Corporate Strategic Planning
HIE
eHR
Asur
ansi
Prak
tek
Dok
ter
Klin
ik
Pusk
esm
as
eRef
erra
l
Rum
ah S
akit
DKB
BPJS
DKB: Data Kepesertaan BersamaEHR: Electronic Health RecordHIE: Health Information ExchangeBPJS: Badan Pelaksana Jaminan Sosial
3
1. Pengembangan platform HIE (Health Information Exchange)
2. Pengembangan Sistem Mini eHR : Pilot Project 6 RS Vertikal Jakarta Dashboard Dirjen BUK Dashboard PPJK (JAMKESMAS)
3. Modernisasi Sistem elektronik klaim Nasional, termasuk administrasi rujukan
Pilot Medical eReferral Sragen (Puskesmas – RSUD – Dinkes)
JAMKESDA (RSUD – Dinkes Kab/Kota – Dinkes Prov)
Pengembangan Sistem Penanganan Gawat Darurat Terpadu, termasuk pengembangan sistem jejaring Rumah Sakit, sistem rujukan elektronik dan sistem contact center (SPGDT S/B)
1. Pengembangan aplikasi vertikal untuk kesehatan (eGP, eClinic, ePuskesmas, HIS, eClaim)
3
4
KEM
KES
DIN
KES
eCla
im
SPG
DT
Das
hboa
rd
Anal
ityc
4
5
5
TELKOM eHealth Development ActivitiesTELKOM HIE-EHR
1
2
1
2
Telkom HIE (Health Information Exchange) (e-Health Hub)
IT Security Infrastructure
Provider Directory
PKI Server
CertificateAuthority
UniversalPatient Identifier
SEHR
Internet & Mobile
Email & SMSGateway
GOV & Institutions
TPA &Private Insurance
Personal HealthWeb Portal
Web Service Adapter
Pharmacies
Hisys e-Apotik
Suppliers Finance
HIMBARA Link &52 other Banks
Government Insurance & SOE’s
ASGARA & 141 SOE’s
Healthcare Providers
Doctors /Specialist
Clinics &Hospitals
Laboratories EMR
Hisys e-Hospital
Routing & Transformation
ServicesWorkflow Services
TELKOM eHospital (HIS), eclinic, epuskesmas, eGP, eApotek , eSCM, eClaim
Payor’s (GOV’t) will benefit by an interoperability and
integrated EHR and online reporting of Health Claim to
reduce fraud
eReferrals from primary to secondary to tertiary
healthcare (e.g. ePuskemsas to District and
Vertical Hospitals)
Expansion to eBilling and eSettlement
perpetuates end-to-end paperless & efficient
claims processing
Hospitals will provided the interoperability with Payers
and Medical Supplier
Pharmacies Will Provide Interoperabilities with
Healthcare Provider thru ePrescribe and eSCM to Pharceutical Company
Solusi eHealth Terintegrasi Menggunakan TELKOM HIETELKOM Group eHealth Solution
The world in your hand
Example of EHR (Electronic Health Record)
Corporate Strategic Planning
Laporan Kasus Penyakit – Jawa Barat
Integration of Existing Applications
Cek Kepesertaan
Administrasi Koder
Verifikator
INADRG / CBG VERIFIKATOR
Reporting & Analytic Server
Claim Proses Verifikasi
Batch Report
Processing
Online report & analytic
Mendapatkan Pelayanan
Kemenkes
Web Service
Rekam medis
Distribusi Pasien Berdasarkan Kelompok Usia
TOP 10 Diagnosa Utama – Berdasarkan Jumlah Pasien dan Jumlah Kasus
Processing and Reporting of National Health Data:JAMKESMAS Integrated Reporting Jamkesmas (INACBG Based)
Corporate Strategic Planning
HIE(future0)
• SPGDT sistem yang menekankan pada time saving untuk menyelamantkan nyawa dan mencegah cacat.
• SPGDT terdiri atas pre hospital, intra hospital dan inter hospital
Sistem Penanggulangan Gawat Darurat TerpaduTELKOM SPGDT
Integrasi Layanan Pre Hospital + Jejaring Rumah Sakit = SPGDT
Corporate Strategic Planning
TELKOM eHospital merupakan solusi terpadu untuk sistem informasi rumah sakit, yaitu sistem terkomputerisasi yang mengintegrasikan seluruh alur proses bisnis layanan kesehatan di dalam rumah sakit dalam bentuk koordinasi, pelaporan, dan prosedur administrasi mulai dari fungsi front office dan back office. Disamping itu, TELKOM eHospital juga terintegrasi dengan entitas kesehatan lain di luar rumah sakit secara elektronik melalui Health Information Exchange (HIE).
Pelayanan regristrasi cepat & mudah Kepastian biaya pelayanan RS Jaminan Keamanan Pasien
Dokumentasi auditable & accountable (mendukung audit & proses akreditasi)
Percepatan proses klaim Jamkesmas Meningkatkan citra RS
(mutu, kepastian biaya, kecepatan) Meningkatkan profesionalisme
manajemen RS Meningkatkan akses & pelayanan RSUD
ke pihak ketiga : mitra /PBF, Askes, dll Proses reporting cepat, akurat Optimalisasi pendapatan RS melalui :
minimalisasi fraud & loss opportunity
Benefit
RSUD Pemkab/Dinkes
Pasien
Monitoring performansi RSUD secara realtime
Monitoring kondisi penyakit & maping pasien RSUD
Percepatan pengambilan keputusan secara akurat
Tenaga Medis RSUD Transparasi & akurasi
penghitungan jasa medis
Standar praktek kedokteran yang baik dan benar
SIRSPendaftaran
IRJ Penunjang Lab, Rad
IGD
FARMASIBack Office
INA-CBG
ASKESIRNA
HIE Platform
Solusi Sisitem Informasi Rumah Sakit TerintegrasiTELKOM EHOSPITAL
Corporate Strategic Planning
Ekosistem InteraksiKolegium Uji kompetensi Dokter
[UKDI]KKI Surat Tanda Regeristasi [STR]
IDI Keanggotaan IDI/profesi Kompulasi SKP
Dinkes Surat Ijin Praktek baru [SIP] Perpanjangan SIP
Farmasi [Pabrikan]
Peresepan obat Data penggunaan obat
Apotek Peresepan obat [penebusan obat]
Asuransi Pelayanan medis Pasien Asuransi
Proses administrasi penghitungan jasa dokter
Rumah Sakit Proses rujukan
Laboratorium Proses rujukan
Pasien Pelayanan medis Pasien
Apotek
KKI
eGP
Solusi Ekosistem Kesehatan bagi Dokter PraktekTELKOM EGP INITIATIVES
Indonesia Integrated eHealth Challenges & Key Succes Factors
Corporate Strategic Planning
Determining HIE value preposition
to each stakeholder;Developing
sustainable HIE business models;
GOV more focus on core healthcare infrastructure
investmentand basic care provisioning
Legal and regulatory issues regarding data
sharing and consumer protections
Very low adoption of Healthcare IT
Silos Implementation & Multi data format
(Lack of InteroperableliityLack of data consolidation)
The lack of communication and data
sharing
Many Health Providers treat EHR as a “Gold
Mine”
The challenges that must be addressed
Corporate Strategic Planning
Successful HIE-EHR
Implementation
People
Process
Techno logy
Information
Agreement from Hospital Executive to provide data
Consensus on coding Standard (ICD, SNOMED, etc.)
and Exnchange Protocols (HL7, CDA, CCD, etc.)
Right Adaptor for complex and heterogenous apps. in
the hospitals
Determine ownership, governance, and residency of
data & information
KEY SUCCESS FACTOR
Corporate Strategic Planning
Key Lesson Learnt• Self Sustainable systems Right sustainable business models• Economically viable for All Stake Holder• Cost effective We don’t have tons of cash to wasted• Used proven technology
We don’t have time for R&D and take a risk We use what has been work Only Innovate when necessary Example: ICD9CM, ICD10, CCD works – used it
• Involve regulators, doctors, pharmacies, health & IT consultants in the team
Its should be business case driven
Business Heavy VS Engineering Heavy
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