Telkom-Rancangan Ina Integrated EHealth

The world in your hand

Kongres XII PERSIKongres XII PERSIPPlenary Hall, Jakarta Convention Centerlenary Hall, Jakarta Convention Center

Jakarta Jakarta , , 99 November November 20120122

SAIFUL HIDAYATEHealth Project 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


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


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

Hospitals (Inpatient, Out

patient, ED)

Diagnostic Services

(Lab, Rad)Clinic/SpecialistGP

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, JAMSOSTEK)

Regulatory Agencies

MOH

Province/District Health

Offices

Other Healthcare (e.g.

Dental)

Nursing Care

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


MOHEnsure Quality of Care and Patient SafetyEnsure Quality of Care and Patient Safety

Profil solusi e-Health di Indonesia masihparsial: Implementasi silo-silo Tidak terstandarisasi:

Interoperabilitas, sulit dikembangkan Konsolidasi data sulit dilakukan (multi

format dan standrat)

Hospital (2.066)(BUK)

Asuransi Jiwa (54)(Bapepam)

Solusi eHealth Parsial

Solusi eHealth di Indonesia Saat Ini


format dan standrat) Kelengkapan data lemah karena

jangkauan kecamatan s.d pusat masihterbatas

Akses Informasi Publik terbatas: atasindikator dan informasi kesehatan.

Membutuhkan Integrated 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 - mHealthSection 7 -

Organization and support for e-health

Average score is around 52%

The lowest eHealth readiness 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 20091

Key Observations

Developing Stage

eHealth Readiness di Indonesia


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 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 frameworkSource: 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


National eHealth Implementation Benchmark

Singapore


Canada


INFORMATION SYSTEM FOR HEALTHCARE


Information System Support for Healthcare Services Business Process

Insurance/Payors

Loket/UGD/AdminLaboratoium

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


Loket/UGD/Admin

RS Rujukan Apotek

Diagnosa Poli Rawat Inap Warehouse

Pasien

Rawat Jalan

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 PlanningSource : 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

Kompleksitas Sistem Aplikasi Saat iniContoh : Proses Bisnis Rumah Sakit

Pendaftaran

Marketing

Rawat Inap

Kesusteran Ruang Operasi

Apotik

Administrasi

LaboratoriumDBF

MySQL

MSAccess

Paper MySQL MySQL

MySQL MySQL

In House Development

Heavy Infrastructure


Arsip Medis

KepegawaianKeuangan

Poli BPoli A Pelaporan

IGD Billing & ClaimFas. Penunjang

FasilitasPenunjang

GLSpreadSheetMSSQL MSAcc

ess

OraclePaper

Paper

Paper

Oracle

MSSQL MySQL

MySQL

MySQL

*.xls

Difficult to integrate

Integration : Simplify The System

E-Health


E-Health Cloud Services

Cloud Computing : Definition & Key Characteristics

Corporate Strategic PlanningReferences : Gartner Research

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

Why Cloud Now ? --Demand SideEfficient Effective Innovation


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 Apps3. 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


Secure (shared) file systems4. Secure Standard Operation & Procedures5. 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


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

Cloudsourceddeliverywill

comprise ~25% of the total BPO market by

2012

Cloudsourceddeliverywill

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)


Successful

Process

Standardization of HospitalBusiness Process

Compliance with InternationalStandard/ Accreditation(ICD9CM, ICD!), CCD/KARS, ISO9001, JCI)

Good IT Governance (RACI onevery Process)

from Cs Level / Strong Commitment from Cs Level / High Level Management

Acceptance & Technology Adoption Change Agent and Continuous

Mentoring Continuous HR Training and

Development

Implementation CredentialKey Lesson Learn


Successful

E-HospitalImplementation

TechnologyPeople

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

eRef

erra

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 rujukanrujukan Pilot Medical eReferral Pilot Medical eReferral SragenSragen

((PuskesmasPuskesmas RSUD RSUD DinkesDinkes))

3

eCla

im

SPG

DT

Das

hboa

rd

Anal

ityc

4

TELKOM eHealth Development Activities

TELKOM HIE-EHR1

22


HIEAs

uran

si

Prak

tek

Dok

ter

Klin

ik

Pusk

esm

as

Rum

ahSa

kit

BPJS

DKB: Data Kepesertaan BersamaEHR: Electronic Health RecordHIE: Health Information ExchangeBPJS: Badan Pelaksana Jaminan Sosial

((PuskesmasPuskesmas RSUD RSUD DinkesDinkes)) JAMKESDA JAMKESDA (RS(RSUD UD DinkesDinkes

KabKab/Kota /Kota DinkesDinkes ProvProv)) Pengembangan Pengembangan SistemSistem PenangananPenanganan

GawatGawat DaruratDarurat TerpaduTerpadu, , termasuktermasukpengembanganpengembangan sistemsistem jejaringjejaring RumahRumahSakitSakit, , sistemsistem rujukanrujukan elektronikelektronik dandansistemsistem contact center (SPGDT S/B)contact center (SPGDT S/B)

1. Pengembangan aplikasi vertikal untuk kesehatan(eGP, eClinic, ePuskesmas, HIS, eClaim)

4

KEM

KES

DIN

KES

5

5

1

Telkom HIE (Health Information Exchange)

IT Security Infrastructure

Provider Directory

PKI Server

CertificateAuthority

UniversalPatient

Identifier

SEHR

Internet & Mobile

Email & SMSGateway

GOV & Institutions

TPA &Private Insurance

Personal HealthWeb Portal

Routing & Payors (GOVt) will benefit by

an interoperability and Hospitals will provided the interoperability with Payers

Solusi eHealth Terintegrasi Menggunakan TELKOM HIE

TELKOM Group eHealth Solution

Telkom HIE (Health Information Exchange) (e-Health Hub)

Web Service Adapter

Pharmacies

Hisys e-Apotik

Suppliers Finance

HIMBARA Link &52 other Banks

Government Insurance & SOEs

ASGARA & 141 SOEs

Healthcare Providers

Doctors /Specialist

Clinics &Hospitals

Laboratories EMR

Hisys e-Hospital

Routing & Transformation

ServicesWorkflow Services

TELKOM eHospital (HIS), eclinic, epuskesmas, eGP, eApotek , eSCM, eClaim

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 eBillingand eSettlement

perpetuates end-to-end paperless & efficient

claims processing

interoperability with Payersand Medical Supplier

Pharmacies Will Provide Interoperabilities with

Healthcare Provider thru ePrescribe and eSCM to Pharceutical Company


Example of EHR (Electronic Health Record)

Laporan Kasus Penyakit Jawa Barat

Integration of Existing Applications

CekKepesertaan

Administrasi Koder

Verifikator

INADRG / CBG VERIFIKATOR

Claim Proses Verifikasi

WebService

Rekam medis

Distribusi Pasien Berdasarkan Kelompok Usia

Processing and Reporting of National Health Data:JAMKESMAS Integrated Reporting Jamkesmas (INACBG Based)


Verifikator

Reporting & Analytic Server

Batch Report

Processing

Online report & analytic

Mendapatkan Pelayanan

Kemenkes

TOP 10 Diagnosa Utama Berdasarkan Jumlah Pasien dan Jumlah Kasus

SPGDT sistem yang menekankan pada time saving untukmenyelamantkannyawa dan mencegahcacat.

Sistem Penanggulangan Gawat Darurat Terpadu

TELKOM SPGDT


HIE(future0)

SPGDT terdiri atas pre hospital, intra hospitaldan inter hospital

Integrasi Layanan Pre Hospital + Jejaring Rumah Sakit = SPGDT

TELKOM eHospital merupakan solusi terpadu untuk sistem informasi rumah sakit, yaitu sistemterkomputerisasi yang mengintegrasikan seluruh alur proses bisnis layanan kesehatan di dalam rumahsakit dalam bentuk koordinasi, pelaporan, dan prosedur administrasi mulai dari fungsi front office dan backoffice. Disamping itu, TELKOM eHospital juga terintegrasi dengan entitas kesehatan lain di luar rumah sakitsecara elektronik melalui Health Information Exchange (HIE).

Dokumentasi auditable & accountable (mendukung audit & proses akreditasi) Percepatan proses klaim JamkesmasMeningkatkan citra RS

RSUD Pemkab/Dinkes

Monitoring performansi RSUD secara realtimeMonitoring kondisi penyakit &

Solusi Sisitem Informasi Rumah Sakit Terintegrasi

TELKOM EHOSPITAL


Pelayanan regristrasi cepat & mudah Kepastian biaya pelayanan RS Jaminan Keamanan Pasien

Meningkatkan citra RS(mutu, kepastian biaya, kecepatan)Meningkatkan profesionalisme

manajemen RSMeningkatkan 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

PendaftaranIRJ Penunjang

Lab, Rad

IGD

FARMASIBack Office

INA-CBG

ASKESIRNA

Ekosistem InteraksiKolegium Uji kompetensi Dokter

[UKDI]

KKI Surat Tanda Regeristasi [STR]IDI Keanggotaan IDI/profesi

Kompulasi SKPDinkes Surat Ijin Praktek baru [SIP]

Perpanjangan SIP

KKI

Solusi Ekosistem Kesehatan bagi Dokter Praktek

TELKOM EGP INITIATIVES


Perpanjangan SIPFarmasi [Pabrikan]

Peresepan obat Data penggunaan obat

Apotek Peresepan obat [penebusan obat]

Asuransi Pelayanan medis Pasien Asuransi Proses administrasi

penghitungan jasa dokter

Rumah Sakit Proses rujukanLaboratorium Proses rujukanPasien Pelayanan medis Pasien

Apotek

Indonesia Integrated eHealth Challenges & Key Succes Factors

The challenges that must be addressed


People

Agreement from Hospital Executive to provide data

Consensus on coding

Determine ownership, governance, and

residency of data & information

KEY SUCCESS FACTOR


Successful HIE-EHR

ImplementationProcess

Techno logy

Information

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 Self Sustainable systems Right sustainable business models Economically viable for All Stake Holder Cost effective We dont have tons of cash to wasted Used proven technology We dont have time for R&D and take a riskWe use what has been work


We use what has been work Only Innovate when necessaryExample: 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

Documents

Telkom-Rancangan Ina Integrated EHealth