Telkom-Rancangan Ina Integrated EHealth

The world in your hand
Kongres XII PERSI Kongres XII PERSI
PPlenary Hall, Jakarta Convention Center lenary Hall, Jakarta Convention Center
Jakarta Jakarta , , 99November November 201 2012 2
SAIFUL HIDAYAT
EHealthProject Director
PT. Telekomunikasi Indonesia . Tbk
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
Corporate Strategic Planning
: 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
National eHealth Implementation Benchmark
Information System for Healthcare
TELKOM Initiatives for eHealthcare
Indonesia Integrated eHealth Challenges & 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
Employer
Pharmacy
Benefit
Managers
Private Insurers
Hospitals
(Inpatient, Out
patient, ED)
Diagnostic
Services
(Lab, Rad)
Clinic/
Specialist
GP
CRO
Pharmaceuticals
Health
Information
• Wide EMR penetration
• Automated referrals
• Automated coding and
claim submission
• CPOE and EMR
• Referral
• Remote health
monitoring
• Automated coding &
claims submission
: Private
: Public
: Public & private
Legend:
Healthcare Ecosystem in Indonesia
Private Insurers
State Owned
Insurer (e.g.
ASKES, JAMSOS
TEK)
Regulatory
Agencies
MOH
Province/
District Health
Offices
Other
Healthcare (e.g.
Dental)
NursingCare
Mobile Clinic/
Home Care
Pharmacies
Suppliers
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
• Population health database
• Disease detection & analysis
• Pharmaceutical supply chain optimization
claims submission
Improving Stakeholders Interactions & Benefits
Healthcare Trend & Platform
Corporate Strategic Planning
MOH Ensure Quality of Care and Patient Safety Ensure Quality of Care and Patient Safety
Profil solusi e-Health di Indonesia masih
parsial:
• Implementasi silo-silo
• Tidak terstandarisasi:
• Interoperabilitas, sulit dikembangkan
• Konsolidasi data sulit dilakukan (multi
format dan standrat)
Hospital (2.066)
(BUK)
Asuransi J iwa (54)
(Bapepam)
Solusi eHealth Parsial
Solusi eHealth di Indonesia Saat Ini
Corporate Strategic Planning
format dan standrat)
• Kelengkapan data lemah karena
jangkauankecamatans.d pusat masih
terbatas
• Akses Informasi Publik terbatas: atas
indikator dan informasi kesehatan.
MembutuhkanIntegrated Shared Service
Platform
Puskesmas (9.005)
Bankdata Pusdatin
Apotek (21.852)
IAI
Industri Farmasi (260)
Praktek Dokter(115.155)
69%
55% 50%
Section 1 -e-health
Foundation Actions
Section 2 -mHealth
Section 7 -
Organization and
support for e-health
•Average score is around 52%
•The lowesteHealthreadiness
dimension is Section 3 -
Telemedicine. Which requires
infrastructure, connectivity and
advanced application of
eHealth
World Health Organization Global
Observatory for e-health in Indonesia –
Year 2009
1
Key Observations
Developing Stage
eHealth Readiness di Indonesia
Corporate Strategic Planning
55%
31%
63%
46%
53%
50%
Section 3 -
Telemedicine
Section 4 -eLearning
in health sciences
Section 5 -
Management of
patient information
Section 6 -Legal and
ethical frameworks
for e-health
•The highest eHealthreadiness
dimension is Section 1 –
eHealthFoundations. This is
indicative of the guidelines
being put in to facilitate better
communication and
collaboration and also form the
eHealthfoundation
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
Healthcare ecosystem is complex and often fragmented, eHealth benefits
both public and private stakeholders by improving communications and
information-sharing
Trend eHealthcare di Indonesia
Corporate Strategic Planning
National eHealth Implementation Benchmark
Singapore
Corporate Strategic Planning
Canada
Corporate Strategic Planning
Corporate Strategic Planning
INFORMATION SYSTEM FOR HEALTHCARE
Corporate Strategic Planning
Information System Support
forHealthcare Services Business Process
Insurance/Payors
Loket/UGD/Admin
Laboratoium
Suppliers
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
Corporate Strategic Planning
Loket/UGD/Admin
RS Rujukan
Apotek
Diagnosa Poli
Rawat Inap
Warehouse
Pasien
Rawat J alan
• 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
Need Of Healthcare Organization
Corporate Strategic Planning
Source : SKT
Note : HIS (Hospital Information System) is fundamental of digitalization in medical sector,
and enables hospitals to meet the needs of “Efficiency, Quality Service & Capability”
KompleksitasSistemAplikasi Saatini
Contoh : Proses Bisnis Rumah Sakit
Pendaftaran
Marketing
Rawat Inap
Kesusteran
RuangOperasi
Apotik
Administrasi
Laboratorium
DBF
MySQL
MSAcc
ess
Paper
MySQL
MySQL
MySQL MySQL
In House Development
Heavy Infrastructure
Corporate Strategic Planning
ArsipMedis
Kepegawaian
Keuangan
Poli B Poli A Pelaporan
IGD Billing & Claim
Fas. Penunjang
Fasilitas
Penunjang
GL
SpreadSheet
MSSQL
MSAcc
ess
Oracle
Paper
Paper
Paper
Oracle
MSSQL
MySQL
MySQL
MySQL
*.xls
Difficult to integrate
Integration : Simplify The System
E-Health
Corporate Strategic Planning
E-Health
Cloud Services
Cloud Computing : Definition & Key Characteristics
Corporate Strategic Planning
References : Gartner Research
• Cost Pressure, CAPEX to OPEX: Metered by
Used, Accelerate Speed to Value
New Economics
• no patching /maintenance, faster
development, robust multi layer
security, reliability & fault tolerance
Reduce
Management
Why Cloud Now ? --Demand Side
Efficient Effective Innovation
Corporate Strategic Planning
• 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
Cloud Security Implementation
1.Secure Access into the Cloud
2.Secure Access to Web Apps
3.Server Virtualization
• Mitigate risk towards the hypervisor
• Secure the OS
• Inter-VM traffic visibility and security
• Secure (shared) file systems
VM
VM VM
Security In The Cloud
Corporate Strategic Planning
• Secure (shared) file systems
4.Secure Standard Operation & Procedures
5.Secure System Development Life Cycle Procedures
Security implemented everywhere …
not just on a firewall somewhere.
“Healthcare's Future Is
Partly Cloudy: External
Service Provider Options for
Healthcare Delivery
Organizations”
“Healthcare's Future Is
Partly Cloudy: External
Service Provider Options for
Healthcare Delivery
Organizations”
“By 2012, 20% of
businesses will own
no IT assets.”
“By 2012, 20% of
businesses will own
no IT assets.”
Cloud Based Healthcare System Trend …
Corporate Strategic Planning
“Cloud spending will grow
3X to $42B by 2010.
Cloudsourcing takes the
cloud to the next step”
“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”
“Cloudsourced
delivery…will
comprise ~25% of the
total BPO market by
2012”
“Every enterprise
should be road
mapping their
adoption of the cloud”
“Every enterprise
should be road
mapping their
adoption of the cloud”
76% of hospitals have failed in the 76% of hospitals have failed in the
implementation of HIS
(TELKOM-Probis eHealth riset, 2011)
Corporate Strategic Planning
Successful
Process
• Standardization of Hospital
BusinessProcess
• Compliance with International
Standard/ Accreditation
(ICD9CM, ICD!), CCD/KARS, ISO
9001, JCI)
• Good IT Governance (RACI on
everyProcess)
from C’s Level / • Strong Commitment from C’s Level /
High Level Management
• Acceptance & Technology Adoption
• Change Agent and Continuous
Mentoring
• Continuous HR Training and
Development
Implementation Credential
Key Lesson Learn
Corporate Strategic Planning
Successful
E-Hospital
Implementation
Technology
People
• 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
TELKOM INITIATIVES FOR eHEALTHCARE
eHR
e
R
e
f
e
r
r
a
l
DKB
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. 3. Modernisasi Sistem elektronik klaim Modernisasi Sistem elektronik klaim
Nasional, termasuk administrasi Nasional, termasuk administrasi
rujukan rujukan
 Pilot Medical eReferral Pilot Medical eReferral Sragen Sragen
((Puskesmas Puskesmas–– RSUD RSUD –– Dinkes Dinkes))
3
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TELKOM eHealth Development Activities
TELKOM HIE-EHR
1
2
2
Corporate Strategic Planning
HIE
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DKB: Data KepesertaanBersama
EHR: Electronic Health Record
HIE: Health Information Exchange
BPJ S: Badan Pelaksana J aminanSosial
((Puskesmas Puskesmas–– RSUD RSUD –– Dinkes Dinkes))
 JAMKESDA JAMKESDA (RS (RSUD UD –– Dinkes Dinkes
Kab Kab/Kota /Kota –– Dinkes DinkesProv Prov) )
 Pengembangan Pengembangan Sistem SistemPenanganan Penanganan
Gawat Gawat Darurat Darurat Terpadu Terpadu, , termasuk termasuk
pengembangan pengembangansistem sistemjejaring jejaringRumah Rumah
Sakit Sakit, , sistem sistemrujukan rujukanelektronik elektronikdan dan
sistem sistemcontact center (SPGDT S/B) contact center (SPGDT S/B)
1. Pengembangan aplikasi vertikal untuk
kesehatan
(eGP, eClinic, ePuskesmas, HIS, eClai
m)
4
K
E
M
K
E
S
D
I
N
K
E
S
5
5
1
Tel komHI E ( Heal t h I nf or mat i on Exchange)
I T Secur i t y I nf r ast r uct ur e
Pr ovi der
Di r ect or y
PKI Ser ver
Cer t i f i cat e
Aut hor i t y
Uni ver sal
Pat i ent
I dent i f i er
SEHR
I nt er net & Mobi l e
Emai l & SMS
Gat eway
GOV &
I nst i t ut i ons
TPA &
Pr i vat e I nsur ance
Per sonal Heal t h
Web Por t al
Routing &
Payor’s(GOV’t) will benefit by
an interoperability and
Hospitals will provided the
interoperability with Payers
Solusi eHealth Terintegrasi Menggunakan TELKOM HIE
TELKOM Group eHealth Solution
Tel komHI E ( Heal t h I nf or mat i on Exchange)
( e- Heal t h Hub)
Web Ser vi ce Adapt er
Phar maci es
Hi sys e- Apot i k
Suppl i er s Fi nance
HI MBARA Li nk &
52 ot her Banks
Gover nment
I nsur ance & SOE’ s
ASGARA & 141 SOE’ s
Heal t hcar e Pr ovi der s
Doct or s /
Speci al i st
Cl i ni cs &
Hospi t al s
Labor at or i es EMR
Hi sys e- Hospi t al
Routing &
Transformation
Services
Workflow Services
TELKOMeHospital (HIS), eclinic, epuskesmas, eGP, eApotek , eSCM, eClaim
an interoperability and
integrated EHR and online
reporting of Health Claim to
reduce fraud
eReferralsfrom primary to
secondary to tertiary
healthcare (e.g.
ePuskemsasto District
and Vertical Hospitals)
Expansion to eBilling
and eSettlement
perpetuates end-to-end
paperless & efficient
claims processing
interoperability with Payers
and Medical Supplier
Pharmacies Will Provide
Interoperabilitieswith
Healthcare Provider thru
ePrescribeand eSCM to
Pharceutical Company
The world in your hand
Example of EHR (Electronic Health Record)
LaporanKasus Penyakit – J awa Barat
Integration of Existing Applications
Cek
Kepesertaan
Administrasi Koder
Verifikator
INADRG / CBG VERIFIKATOR
Claim
Proses
Verifikasi
Web
Service
Rekam medis
Distribusi Pasien BerdasarkanKelompok Usia
Processing and Reporting of National Health Data:
JAMKESMAS Integrated Reporting Jamkesmas(INACBG Based)
Corporate Strategic Planning
Verifikator
Reporting & Analytic
Server
Batch
Report
Processing
Online
report &
analytic
MendapatkanPelayanan
Kemenkes
TOP 10 Diagnosa Utama – BerdasarkanJ umlahPasien danJ umlahKasus
• SPGDT sistemyang
menekankan pada time
saving untuk
menyelamantkan
nyawa dan mencegah
cacat.
Sistem Penanggulangan Gawat Darurat Terpadu
TELKOM SPGDT
Corporate Strategic Planning
HIE
(future0)
• SPGDT terdiri atas pre
hospital, intra hospital
dan inter hospital
IntegrasiLayananPre Hospital +JejaringRumahSakit=SPGDT
TELKOM eHospital merupakan solusi terpadu untuk sistem informasi rumah sakit, yaitu sistem
terkomputerisasi yang mengintegrasikan seluruh alur proses bisnis layanan kesehatan di dalamrumah
sakit dalambentukkoordinasi, pelaporan, danprosedur administrasi mulai dari fungsi front officedanback
office. Disampingitu, TELKOMeHospital jugaterintegrasi denganentitaskesehatanlaindi luar rumahsakit
secaraelektronikmelalui HealthInformationExchange(HIE).
 Dokumentasi auditable & accountable
(mendukung audit & proses akreditasi)
 Percepatan proses klaim Jamkesmas
 Meningkatkan citra RS
RSUD
Pemkab/Dinkes
 Monitoring performansi RSUD
secara realtime
 Monitoring kondisi penyakit &
Solusi Sisitem Informasi Rumah Sakit Terintegrasi
TELKOM EHOSPITAL
Corporate Strategic Planning
 Pelayanan regristrasi cepat & mudah
 Kepastian biaya pelayanan RS
 Jaminan Keamanan Pasien
 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
Pasien
 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
Pendaftaran
IRJ
Penunjang
Lab, Rad
IGD
FARMASI
Back Office
INA-CBG
ASKES
IRNA
Ekosistem Interaksi
Kolegium  Uji kompetensi Dokter
[UKDI]
KKI  Surat Tanda Regeristasi [STR]
IDI  Keanggotaan IDI/profesi
 Kompulasi SKP
Dinkes  Surat Ijin Praktekbaru [SIP]
Perpanjangan SIP
KKI
Solusi Ekosistem Kesehatan bagi Dokter Praktek
TELKOM EGP INITIATIVES
Corporate Strategic Planning
 Perpanjangan SIP
Farmasi
[Pabrikan]
 Peresepan obat
 Data penggunaanobat
Apotek  Peresepan obat [penebusan
obat]
Asuransi  Pelayanan medis Pasien
Asuransi
 Prosesadministrasi
penghitungan jasa dokter
RumahSakit  Proses rujukan
Laboratorium  Proses rujukan
Pasien  Pelayananmedis Pasien
Apotek
Indonesia Integrated eHealth Challenges & Key Succes Factors
The challenges
that must be addressed
Corporate Strategic Planning
People
Agreement from Hospital
Executive to provide data
Consensus on coding
Determine
ownership, governance, and
residency of data &
information
KEY SUCCESS FACTOR
Corporate Strategic Planning
Successful
HIE-EHR
Implementation
Process
Techno
logy
Informa
tion
Consensus on coding
Standard (ICD, SNOMED, etc.)
and Exnchange Protocols
(HL7, CDA, CCD, etc.)
Right Adaptor for complex
and heterogenous apps. in
the hospitals
Key Lesson Learnt
• SelfSustainablesystems Right sustainable business models
• Economically viablefor All Stake Holder
• Costeffective 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
Corporate Strategic Planning
We use what has been work
Only Innovate when necessary
Example: ICD9CM, ICD10, CCD works – used it
• Involve regulators, doctors, pharmacies, health & IT
consultantsin the team
Its should be business case driven
Business Heavy VS Engineering Heavy