adalah materi presentasi yang samaya sampaikan pada acara ASM (Annual Scientific Meeting) Fakultas Kedokteran Universitas Gajah Mada Yogyakarta Maret 2012 Dengan Topik bagaimana kesiapan dunia kesehatan untuk implementasi Rekam Medis secara Elektronik dengan menggunakan teknologi Cloud Computing

1. The
world
in
your
hand
SAIFUL
HIDAYAT
EHealth
Project
Director
PT.
Telekomunikasi
Indonesia
.
Tbk
Annual
Scien3fic
Mee3ng
2012
Yogyakarta,
10
Maret
2012
SICP
Corporate
Strategic
Planning

2. 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
Corporate
Strategic
Planning

3. The
world
in
your
hand
Digital
Trend
&
EHealth
Issues
EHealth
Trend
&
Expectation
Information
System
For
EHealth
Telkom
Cloud
For
EMR
SICP
Corporate
Strategic
Planning

4. DIGITAL
TREND
&
EHEALTH
ISSUES
SICP
Corporate
Strategic
Planning

5. TODAY THE WORLD IS GETTING NARROW
AND THINGS ARE CONNECTED, CLOSER,
MOBILE AND PERSONAL
SICP
Corporate
Strategic
Planning

6. WWW: WHOEVER AND WHEREVER WE ARE
SICP
Corporate
Strategic
Planning

7. Now
:
Almost
Everything
is
in
the
cloud
Corporate
Strategic
Planning

8. 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 ….?
SICP
Source: The Future of Media, Gerd Leonhard, 2009
Corporate
Strategic
Planning

9. HOW’S HEALTH
GOES
DIGITAL?
SICP
Corporate
Strategic
Planning

10. EHEALTH IS
A CARING BUSINESS
NO MATTER HOW
HIGH-TECH YOU ARE
SICP
Corporate
Strategic
Planning

11. HEALTH IS ONCE ABOUT CARING.
NOW IT WILL BE MORE CARING USING TECHNOLOGY
FOR BETTER & EASIER APPLICATION
SICP
Corporate
Strategic
Planning

12. 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
Corporate
Strategic
Planning

13. Solusi
e-­‐Health
Indonesia
:
Saat
ini
masih
parsial
Profil solusi e-Health di Indonesia masih
parsial:
• Implementasi silo-silo
• Tidak terstandarisasi:
Hospital (1.722) Asuransi Jiwa (46) • Interoperabilitas, sulit dikembangkan
(BUK) (Bapepam)
• Konsolidasi data sulit dilakukan (multi
format dan standrat)
• Kelengkapan data lemah karena
jangkauan kecamatan s.d pusat masih
terbatas
Puskesmas (9.005) Apotek (21.852)
Bankdata Pusdatin IAI • Akses Informasi Publik terbatas: atas
indikator dan informasi kesehatan.
è Membutuhkan
Integrated
Shared
Service
Industri Farmasi (260) Pla`orm
Praktek Dokter(115.155)
Corporate
Strategic
Planning

14. Corporate
Strategic
Planning
Source :

15. E-­‐HEALTH
TREND
&
EXPECTATION
SICP
Corporate
Strategic
Planning

16. Healthcare
Trend
:
Improving
Stakeholders
Interac3ons
and
Benefits
MOH
Ensure Quality of Care and Patient Safety
Corporate
Strategic
Planning

17. Healthcare
Trend
Corporate
Strategic
Planning

18. Basic
Management
Expecta3on
of
Healthcare
System
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”
Corporate
Strategic
Planning
Source : SKT

19. Informa3on
System
Support
for
Healthcare
Services
Business
Process
Healthcare
services
business
process
required
Informa3on
Insurance/Payors Suppliers System
Support
:
• E-­‐PMS
(Pa3ent
Management
System)
• EMR
(Electronic
Medical
Record)/EHR
(Electronic
Health
Record)
Laboratoium • E-­‐Claim
(Insurance
Applica3on)
Pasien Loket/UGD/Admin • E-­‐Referral
System
• E-­‐Prescrip3on
• E-­‐Pharmacy/e-­‐Apotek
• E-­‐Laboratory
• CRM
(Customer
Rela3onship
Diagnosa Poli Rawat Inap Warehouse Management)
Rawat Jalan • Telemedicine
• E-­‐SCM
(Supply
Chain
Management)
• HRIS
(Human
Resource
Informa3on
System)
RS Rujukan Apotek • Accoun3ng/Financial
System
• EIS
and
CDSS
Corporate
Strategic
Planning
• etc

20. Key
Success
Factors
For
Successful
Healthcare
System
Implementa3on
• Strong
Commitment
from
C’s
Level
/
High
Level
Management
• StandardizaEon
of
Healthcare
• Acceptance
&
Technology
AdopEon
Business
Process
• ConEnuous
HR
Training
and
• C o m p l i a n c e
w i t h
Development
I n t e r n a E o n a l
S t a n d a r d /
Process
AccreditaEon
(KARS,
ISO
9001,
JCI)
Successful
E-­‐Health
Technology
People
ImplementaEon
• 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
Corporate
Strategic
Planning

21. Implementa3on
Creden3al
:
Lesson
Learn
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
Corporate
Strategic
Planning

22. INFORMATION
SYSTEM
FOR
E-­‐HEALTH
SICP
Corporate
Strategic
Planning

23. Kompleksitas
Sistem
Aplikasi
Saat
ini
Contoh
:
Proses
Bisnis
Rumah
Sakit
MarkeEng
Kesusteran
Ruang
Operasi
Administrasi
Paper
MySQL
MySQL
MySQL
In
House
Development
Pendakaran
ApoEk
Rawat
Inap
Laboratorium
MSAcc
DBF
MySQL
MySQL
ess
Heavy
Infrastructure
Difficult
to
integrate
Arsip
Medis
IGD
Fas.
Penunjang
Billing
&
Claim
Paper
MSSQL
MySQL
MySQL
Fasilitas
Poli
A
Poli
B
Pelaporan
Penunjang
Oracle
Paper
Paper
MySQL
Keuangan
SpreadSheet
Kepegawaian
GL
MSSQL
MSAcc
*.xls
Oracle
ess
Corporate
Strategic
Planning

24. Integra3on
:
Simplify
The
System
E-Health
Cloud Services
Corporate
Strategic
Planning

25. Cloud
Compu3ng
:
Defini3on
&
Key
Characteris3cs
Corporate
Strategic
Planning
References : Gartner Research

26. Why
Cloud
Now
?
-­‐-­‐Demand
Side
Efficient
àEffec3ve
à
Innova3on
• Cost
Pressure,
CAPEX
to
OPEX:
Metered
by
New
Economics
Used,
Accelerate
Speed
to
Value
Reduce
• no
patching
/maintenance,
faster
development,
robust
mul3
layer
security,
Management
reliability
&
fault
tolerance
Redifining
• latest
so_ware,
internet
collabora3on,
Produc3vity
anywhere
access,
instant
self
provisioning
…
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)
Corporate
Strategic
Planning
References : Microsoft, Gartner Research, Forrester

27. Cloud
Security
Implementa3on
Security In The Cloud
1. Secure
Access
into
the
Cloud
2. Secure
Access
to
Web
Apps
3. Server
VirtualizaEon
• MiEgate
risk
towards
the
hypervisor
• Secure
the
OS
VM VM VM
• Inter-­‐VM
traffic
visibility
and
security
• Secure
(shared)
file
systems
4. Secure
Standard
OperaEon
&
Procedures
5. Secure
System
Development
Life
Cycle
Procedures
Security implemented everywhere …
not just on a firewall somewhere.
Corporate
Strategic
Planning

28. Cloud
Based
Healthcare
System
Trend
…
“Healthcare's
Future
Is
“By
2012,
20%
of
Partly
Cloudy:
External
businesses
will
own
Service
Provider
OpEons
for
no
IT
assets.”
Healthcare
Delivery
OrganizaEons”
“Cloud
spending
will
grow
“Every
enterprise
“Cloudsourced
3X
to
$42B
by
2010.
should
be
road
delivery…will
Cloudsourcing
takes
the
mapping
their
comprise
~25%
of
the
cloud
to
the
next
step”
adopEon
of
the
cloud”
total
BPO
market
by
2012”
Corporate
Strategic
Planning

29. TELKOM
CLOUD
FOR
EMR
SICP
Corporate
Strategic
Planning

30. Introducing
Telkom
Group
Our
business
por;olio
(T.I.M.E)
Product
Media
Telecom
Poreolio
n Fixed
Wireline
n Mul3
Channel
TV
n Fixed
Wireless
n Mobile/Cellular
Informa3on
n Broadband
Access
n Satellite
n IT
Services
&
BPO/
KPO
n Tower
n E-­‐Money
Edutainment
n Premises
Integra3on
n Portal
n E-­‐Commerce
n Content
*)
Geography
coverage
Customers
Poreolio
BPO:
Business
Process
Outsourcing
for
interna3onal
KPO:
Knowledge
Process
investment
is
basically
all
n SME
n Enterprise
n Wholesale
over
the
world,
however
n Consumer
Outsourching
for
the
ini3al
investment,
Asia
and
Middle-­‐East
will
be
the
priority.
Domes3c
Geography*
Interna3onal
Corporate
Strategic
Planning

31. Telkom’s
Healthcare
Vision
Corporate
Strategic
Planning

32. Telkom
Group
e-­‐Health
Complete
Solu3on
Telkom
HIE
as
a
Na3onal
e-­‐Health
Shared
Service
Plaeorm
HIMBARA
MOH
who
will
benefit
by
an
Hospitals
will
provided
the
interoperability
and
interoperability
with
Payers
ASGARA
integrated
EHR
and
online
reporEng
of
Jamkesmas
HIE – Health Information Exchange
eReferrals
from
primary
to
Expansion
to
eBilling
secondary
to
terEary
and
eSewlement
healthcare
(e.g.
perpetuates
end-­‐to-­‐end
ePuskemsas
to
District
paperless
&
efficient
and
VerEcal
Hospitals)
claims
processing
TELKOM
e-­‐Hospital
(HIS),
e-clinic, e-puskesmas, e-GP, e-Apotek , e-SCM, e-Claim
Corporate
Strategic
Planning

33. TELKOM
Group
e-­‐Health
Services
:
e-­‐Clinic
For
General
Prac33oner
(Cloud
–
SaaS
Model
–
Pay
per
Use)
Module and
Cloud Computing
Configuration
1. Registrasi 11. Laboratorium
2. Poli umum 12. Rawat inap Kebidanan
3. Poli Gigi & Mulut 13. IGD
4. Poli Anak 14. Apotik
5. Poli Internis 15. Kasir
6. Poli Kulit & Kelamin 16. Keuangan
7. Poli THT 17. Inventory
8. Poli Mata 18. Rekam Medis
9. Poli Paru & Alergi 19. EIS
10. Poli Kebidanan 20. SMS
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
Corporate
Strategic
Planning
Telkom
Group
Services
(eq,
e-­‐Payment,
e-­‐Procurement,
SAP)
•
Integrated
with
other

34. Telkom
Group
E-­‐Health
Services
:
EMR
Standardiza3on
TELKOM EMR Standardization
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.
HL7 CCD and XML
HL7 Reference Information Model
v HL7 CCD is a XML-based high-level
standard for clinical document exchange.
Basically CCD is:
§ Specification of record and HL7 CCD
communication of patient examination <levelone>
<clinical_document_header>
HL7 V3 Message
<document_information>
§ “Human Readable” <encounter_data>
<observation> <service_actors>
<service_cd V="6298-8" S="LOINC"
§ XML exchange format technology DN="POTASSIUM:SCNC:PT:BLD"/>
<service_targets>
</clinical_document_header>
<result_dttm V="2000-05-22"/> <body>
v RIM of HL7 Version 3.X is a standard for <value V="4.5" U="mg/dl"/>
</observation>
...
</body>
</levelone>
XML message development process.
Corporate
Strategic
Planning

35. Telkom
E-­‐Health
Development
Ac3vi3es
3 2 1
1. Pengembangan platform HIE
(Health Information Exchange)
2
2. Pengembangan Sistem Mini
Dashboard
eReferral
Analityc
EHR
eClaim
3
3. Modernisasi Sistem elektronik
eHR
DKB
klaim Nasional, termasuk
administrasi rujukan
4
4. Pengembangan aplikasi
vertikal untuk kesehatan
1
HIE
4
Praktek
Dokter
Rumah
Sakit
Puskesmas
Asuransi
Klinik
BPJS
DKB: Data Kepesertaan Bersama
EHR: Electronic Health Record
HIE: Health Information Exchange
Corporate
Strategic
Planning
BPJS: Badan Pelaksana Jaminan Sosial

36. Considera3on:
EMR
on
the
Cloud
-­‐ EMR
definiEon
&
rule
-­‐ EMR
data
retenEon
-­‐ EMR
data
integraEon
&
Regula3ons
exchange
-­‐ EMR
data
content
-­‐
-­‐
EMR
data
format
EMR
data
store
Cloud
-­‐ EMR
data
exchange
For
EMR
Standard
Security
-­‐ ConfidenEality
-­‐ Authority
-­‐ Integrity
-­‐ Non
RepudiaEon
Corporate
Strategic
Planning

37. Q
&
A
SICP
Corporate
Strategic
Planning

38. SICP
Corporate
Strategic
Planning