saiful hidayat : telkom ehealth cloud, infrastruktur cloud computing untuk rekam medis elektronik

SICP Corporate Strategic Planning

The world in your hand

Annual Scien3fic Mee3ng 2012 Yogyakarta, 10 Maret 2012

SAIFUL HIDAYAT EHealth Project Director

PT. Telekomunikasi Indonesia . Tbk

Corporate Strategic Planning

Curriculum Vitae :

SAIFUL HIDAYAT Educa1on : -‐  MT in InformaEon System and Technology, ITB -‐  S1 in TelecomunicaEon, Unibraw Working Experiences : -‐  2004-‐2006 : PT. Telekomunikasi Indonesia, Tbk : Manager e-‐SoluEon Divisi MulEmedia

-‐  2006 – 2007 : PT. Finnet (Telkom Group) : General Manager of OperaEon

-‐  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

Digital Trend & EHealth Issues

Information System For EHealth

EHealth Trend & Expectation

Telkom Cloud For EMR


DIGITAL TREND & EHEALTH ISSUES


TODAY THE WORLD IS GETTING NARROW AND THINGS ARE CONNECTED, CLOSER,

MOBILE AND PERSONAL


WWW: WHOEVER AND WHEREVER WE ARE


Now : Almost Everything is in the cloud


All Goes Digital Teknologi digital akan banyak mengubah gaya hidup kita melalui berbagai macam

layanan digital, termasuk untuk music, video, games, books, magazine, HEALTH RECORD ….?

Source: The Future of Media, Gerd Leonhard, 2009


HOW’S HEALTH GOES DIGITAL?


EHEALTH IS A CARING BUSINESS

NO MATTER HOW HIGH-TECH YOU ARE


HEALTH IS ONCE ABOUT CARING. NOW IT WILL BE MORE CARING USING TECHNOLOGY

FOR BETTER & EASIER APPLICATION


Challenges : Health Problems & Barrier

Health & Healthcare Problems •  Cost •  Quality of care •  Consistency of care •  ConEnuity of care •  Disaster/Emergency response •  Isolated, piecemeal, inaccessible records • Medical care separated from health, life & prevenEon

Barriers to EMR AdopEon •  Co$t •  Poor usability •  Nerdy GUI (Graphical User Interface) • Workflow disrupEon

•  Poor leadership for innovaEon and change management


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.

è Membutuhkan Integrated Shared Service Pla`orm

Hospital (1.722) (BUK)

Puskesmas (9.005) Bankdata Pusdatin

Apotek (21.852) IAI

Industri Farmasi (260)

Asuransi Jiwa (46) (Bapepam)

Praktek Dokter(115.155)

Solusi e-‐Health Indonesia : Saat ini masih parsial

Corporate Strategic Planning Source :


E-‐HEALTH TREND & EXPECTATION


MOH Ensure Quality of Care and Patient Safety

Healthcare Trend : Improving Stakeholders Interac3ons and Benefits


Healthcare Trend


Basic Management Expecta3on of Healthcare System

Source : SKT

Need Of Healthcare OrganizaEon

Note : HIS (Hospital Information System) is fundamental of digitalization in medical sector, and enables hospitals to meet the needs of “Efficiency, Quality Service & Capability”


Informa3on 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 Informa3on System Support : •  E-‐PMS (Pa3ent Management System) •  EMR (Electronic Medical Record)/EHR

(Electronic Health Record) •  E-‐Claim (Insurance Applica3on) •  E-‐Referral System •  E-‐Prescrip3on •  E-‐Pharmacy/e-‐Apotek •  E-‐Laboratory •  CRM (Customer Rela3onship

Management) •  Telemedicine •  E-‐SCM (Supply Chain Management) •  HRIS (Human Resource Informa3on

System) •  Accoun3ng/Financial System •  EIS and CDSS •  etc


Successful E-‐Health

ImplementaEon

Process

Technology People

•  StandardizaEon of Healthcare Business Process

•  C o m p l i a n c e w i t h InternaEonal Standard/ AccreditaEon (KARS, ISO 9001, JCI)

•  Integrated and Interoprable SoluEon (eg : support MOH e-‐ReporEng, e-‐Referral, e-‐Claim and e-‐Bill to Insurance, etc)

•  Easy to implement, simple, modularity, mulEpla`orm •  Security (CIA) •  Reliable, Auditable, Manageable •  DRC,DRP,BCP

•  Strong Commitment from C’s Level / High Level Management

•  Acceptance & Technology AdopEon •  ConEnuous HR Training and

Development

Key Success Factors For Successful Healthcare System Implementa3on


3 Main Considera3on : 1. Matched between e-‐health soluEon with Vision, Mission and

Business Strategy of Healthcare 2.  Acceptance & Technology AdopEon (Doctors, management,

medical staff and all Stake Holder) 3.  Stages and Success Criteria

5 Cri3cal Components on E-‐Health Implementa3on 1.  Strong Commitment (C’s Level) 2.  Internal Team Readiness 3.  Readiness and Sustainability of SoluEon Partner 4.  OrganizaEonal Readiness and Proper Change Management 5.  Good Project Management

Implementa3on Creden3al : Lesson Learn


INFORMATION SYSTEM FOR E-‐HEALTH


Kompleksitas Sistem Aplikasi Saat ini Contoh : Proses Bisnis Rumah Sakit

Arsip Medis

Pendakaran

Kepegawaian Keuangan

Poli B Poli A Pelaporan

IGD Billing & Claim

MarkeEng

Rawat Inap

Kesusteran

Fas. Penunjang

Fasilitas Penunjang

Ruang Operasi

ApoEk

GL SpreadSheet

Administrasi

Laboratorium

MSSQL MSAccess

DBF

MySQL

Oracle Paper

Paper

Paper

Oracle

MSSQL

MSAccess

Paper MySQL MySQL

MySQL

MySQL

MySQL

MySQL

MySQL

*.xls

In House Development

Heavy Infrastructure

Difficult to integrate


Integra3on : Simplify The System

E-Health Cloud Services

Corporate Strategic Planning References : Gartner Research

Cloud Compu3ng : Defini3on & Key Characteris3cs


•  Cost Pressure, CAPEX to OPEX: Metered by Used, Accelerate Speed to Value New Economics

•  no patching /maintenance, faster development, robust mul3 layer security, reliability & fault tolerance

Reduce Management

•  latest so_ware, internet collabora3on, anywhere access, instant self provisioning

Redifining Produc3vity

… by 2012 80% of Fortune 1000 will use some of cloud compu:ng services, 20% of business will own no IT asset (Gartner)

The boEomline : Early Adopters are finding serious benefits, meaning that cloud compu:ng is real and warrant your scru:ny as a new set of plaJorm for business applica:on (Forrester)

References : Microsoft, Gartner Research, Forrester

Why Cloud Now ? -‐-‐Demand Side Efficient àEffec3ve à Innova3on


Cloud Security Implementa3on

1. Secure Access into the Cloud 2. Secure Access to Web Apps 3. Server VirtualizaEon

•  MiEgate risk towards the hypervisor •  Secure the OS •  Inter-‐VM traffic visibility and security •  Secure (shared) file systems

4. Secure Standard OperaEon & Procedures 5. 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 OpEons for Healthcare Delivery OrganizaEons”

“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

adopEon of the cloud”

Cloud Based Healthcare System Trend …


TELKOM CLOUD FOR EMR


Telecom

Informa3on

Media

n Fixed Wireline

n Fixed Wireless

n Mobile/Cellular

n Broadband Access

n Satellite

n Tower

n Premises Integra3on

n  IT Services & BPO/ KPO

n  E-‐Money

n  Mul3 Channel TV

Edutainment

n  Portal

n  E-‐Commerce

n  Content

Customers Poreolio

n  Consumer n  Enterprise n  Wholesale

Product Poreolio

n  SME

*) Geography coverage for interna3onal investment is basically all over the world, however for the ini3al investment, Asia and Middle-‐East will be the priority. Geography* Domes3c Interna3onal

BPO: Business Process Outsourcing KPO: Knowledge Process Outsourching

Our business por;olio (T.I.M.E) Introducing Telkom Group


Telkom’s Healthcare Vision

Corporate Strategic Planning TELKOM e-‐Hospital (HIS), e-clinic, e-puskesmas, e-GP, e-Apotek , e-SCM, e-Claim

Telkom Group e-‐Health Complete Solu3on Telkom HIE as a Na3onal e-‐Health Shared Service Plaeorm

ASGARA

HIE – Health Information Exchange

HIMBARA

Hospitals will provided the interoperability with Payers

MOH who will benefit by an interoperability and

integrated EHR and online reporEng of Jamkesmas

eReferrals from primary to secondary to terEary

healthcare (e.g. ePuskemsas to District and VerEcal Hospitals)

Expansion to eBilling and eSewlement

perpetuates end-‐to-‐end paperless & efficient claims processing


Module and Cloud Computing Configuration

Benefit Hisys SaaS Business Model : • No Investment •  Capex to Opex •  Pay per Used •  No Operational and Maintenance Cost •  Flexible as Business Need •  Focus on Hospital Business & Service not on IT •  Automatic Update •  Mobility any where, any time, any device •  Integrated with other Telkom Group Services (eq, e-‐Payment, e-‐Procurement, SAP)

TELKOM Group e-‐Health Services : e-‐Clinic For General Prac33oner (Cloud – SaaS Model – Pay per Use)

1.  Registrasi 2.  Poli umum 3.  Poli Gigi & Mulut 4.  Poli Anak 5.  Poli Internis 6.  Poli Kulit & Kelamin 7.  Poli THT 8.  Poli Mata 9.  Poli Paru & Alergi 10.  Poli Kebidanan

11. Laboratorium 12. Rawat inap Kebidanan 13. IGD 14. Apotik 15. Kasir 16. Keuangan 17. Inventory 18. Rekam Medis 19. EIS 20. SMS


Telkom Group E-‐Health Services : EMR Standardiza3on

v  HL7 CCD is a XML-based high-level

standard for clinical document exchange.

Basically CCD is:

§  Speci f icat ion of record and

communication of patient examination

§  “Human Readable”

§  XML exchange format technology

v  RIM of HL7 Version 3.X is a standard for

XML message development process.

HL7 CCD and XML

<levelone> <clinical_document_header> <document_information> <encounter_data> <service_actors> <service_targets> </clinical_document_header> <body> ... </body> </levelone>

<observation> <service_cd V="6298-8" S="LOINC" DN="POTASSIUM:SCNC:PT:BLD"/> <result_dttm V="2000-05-22"/> <value V="4.5" U="mg/dl"/> </observation>

HL7 Reference Information Model

HL7 CCD

HL7 V3 Message

By applying CCD-based standard XML Schema to EMR system, indexing for effective search for electronic medical record between connected health institution is provided, and gateway foundation for document exchange is built.

TELKOM EMR Standardization


Telkom E-‐Health Development Ac3vi3es

HIE

eHR

Asuransi

Praktek Do

kter

Klinik

Puskesmas

eClaim

eReferral

Anality

c

Rumah Sakit

DKB

BPJS

DKB: Data Kepesertaan Bersama EHR: Electronic Health Record HIE: Health Information Exchange BPJS: Badan Pelaksana Jaminan Sosial

Dashbo

ard

1

23

4

1. Pengembangan platform HIE (Health Information Exchange)

2. Pengembangan Sistem Mini EHR

3. Modernisasi Sistem elektronik klaim Nasional, termasuk administrasi rujukan

4. Pengembangan aplikasi vertikal untuk kesehatan

1

2

3

4


Considera3on: EMR on the Cloud

Cloud For EMR

Regula3ons

Security Standard

-‐  EMR definiEon & rule -‐  EMR data retenEon -‐  EMR data integraEon & exchange

-‐  ConfidenEality -‐  Authority -‐  Integrity -‐  Non RepudiaEon

-‐  EMR data content -‐  EMR data format -‐  EMR data store -‐  EMR data exchange


Q & A