saiful hidayat 09112012 rancangan ina integrated e-health persixii 1.1

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


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


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


MOHEnsure Quality of Care and Patient Safety

Improving Stakeholders Interactions & BenefitsHealthcare Trend & Platform


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


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


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


Singapore


Canada


INFORMATION SYSTEM FOR HEALTHCARE


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


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”


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


Integration : Simplify The System

E-Health Cloud Services

Corporate Strategic PlanningReferences : Gartner Research

Cloud Computing : Definition & Key Characteristics


• 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


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.


“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 …


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:


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


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


Example of EHR (Electronic Health Record)


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)


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


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


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


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


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


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

saiful hidayat 09112012 rancangan ina integrated e-health persixii 1.1

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