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Transitioning Indonesia to digital healthcare

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Caroline Clarke
Jun 08, 2020 - reading time 8 mins

Country Leader, Philips Indonesia

 

Pim Preesman is the Country Leader of Philips Indonesia. He is also responsible for the strategic direction of Philips in Indonesia to improve health and wellness through Philips’ innovations.

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As the fourth most populous nation in the world, Indonesia’s unique geographical and population composition presents challenges in bringing healthcare to all. With its population spread across a large archipelago, ensuring accessible, quality healthcare remains a hurdle, particularly for remote communities where seeking healthcare entails days of travel. With the nation embarking on a revamp of its healthcare system, digitalization and tapping on healthcare innovations could help ensure good healthcare for all – whether by bringing portable ultrasound to point-of-care, digitalizing patient records to enhance traceability, or through telehealth to provide and elevate care for communities beyond the physical reach of healthcare institutions.  
Increasing healthcare access to rural communities through telehealth

As the Country Leader of Philips Indonesia, I have made it a priority to familiarize myself with the healthcare industry, including healthcare facilities across the archipelago.  I have visited many public and private hospitals throughout Indonesia. I have also seen the crucial role that puskesmas (community health clinics) play in bringing health services to less affluent areas in the cities and out into rural districts.

 

From this vantage point over the local healthcare landscape, it is apparent that Indonesia’s unique geographical and population composition present challenges in bringing healthcare to all. One obvious challenge is ensuring access to healthcare for those who live in one of the 14,461 officially designated “disadvantaged” villages1, where the nearest hospital could be days away by land or water.

 

The geographic challenge is in overcoming the issue of distance/remoteness – i.e. access to quality care. The population challenge is that there are not enough medical professionals to provide the same quality care to all people of Indonesia, the fourth most populous country in the world.  Indonesia’s ratio of four trained physicians per 10,000 population2 is not yet at a sufficient level to deliver the medical needs of this country of more than 260 million.

 

Even as Indonesia advances its efforts to provide affordable healthcare for all Indonesians, the key is modernizing the delivery of healthcare. By digitalizing healthcare, physicians will be able to use technology to address both the challenges of access (geographic) and the capacity (population). 

Digitalization recognized as need

One of President Joko Widodo’s signature achievements in his first term was to enroll more than 180 million people— nearly 70% of the population—in Jaminan Kesehatan Nasional, the national insurance program administered by the Badan Penyelenggara Jaminan Sosial (BPJS)3, the government agency responsible for administering the Indonesian national health insurance scheme.

 

However, after an evaluation in July 2019 of 2,170 hospitals that had partnered with the BPJS, the Ministry of Health recommended that the class (ranking) of 615 hospitals be downgraded4. The downgrades were mostly due to issues regarding the lack of medical facilities or regarding the number or competence of medical professionals.

 

This action prompted new interest in accelerating wider implementation of accreditation standards from both public and private hospital associations – specifically on the digital front. The on-going discussions around assessment includes the level or degree of digitalization within a facility, which is seen as a key determinant of healthcare quality and/or service. 

 

Pioneer efforts to raise standards

 

One area of assessment is in record keeping, where ‘traceability’ of patient records is an issue. For many healthcare agencies, documentation is still largely completed and stored manually such that staff and facilities are often swamped in paperwork. This is complicated by the lack of legality for electronic medical records, and should any dispute happen, Indonesian courts still require legal documents to be presented.

 

In a pioneering move towards digitization of patient treatment, the Kasih Ibu Hospital in Denpasar, Bali, last year (2019) installed the Philips IntelliSpace Critical Care and Anesthesia (ICCA) system and the Philips IntelliVue Guardian Solution (IGS).

 

This occasion marked the first time both connected care solutions have been installed in the same hospital in Indonesia.  With the digitalized patient monitoring system in ICCA, patient records are automatically documented, while, with the automated early warning scoring and workflow systems of the IGS, clinicians are alerted to subtle warning signs that prompt timely intervention.  Both solutions together have elevated care by integrating seamless tracking of patients across general and ICU wards. 

 

Encouraging telehealth solutions

 

Another example of how digitalization of healthcare will benefit Indonesia is the wider and deeper adoption of telehealth practices. In a country of many volcanic islands, extending the last-mile of healthcare to reach those living in remote regions is a challenge of its own.

 

In particular, maternal and infant mortality rates are higher in these remote areas, due to the lack of access to quality care in hospitals or established clinics. This is where telehealth solutions should come in and help with improving access to – if not quality of – care.

 

Technologies such as Philips’ Lumify, a portable mobile app-based ultrasound solution, enables faster diagnosis by doctors in emergency situations at the point-of-care, and telehealth programs like Philips’ Mobile Obstetrics Monitoring (MOM) program enable healthcare professionals to provide care and consultation to at-risk pregnant women in inaccessible areas and monitor their health remotely.

 

MOM is a scalable, smartphone-based digital health service designed to tackle maternal mortality and bring ultrasound to remote locations. Since its launch, the MOM program has helped to monitor 2,000 expectant mothers in West Sumatra, North Sulawesi, Papua and West Papua.

 

Healthcare opportunities abound in Indonesia

 

The Future Health Index (FHI), Philips’ proprietary global study on the readiness of healthcare systems to meet rising future healthcare challenges, presents a strong case for the digitalization of healthcare. Findings from neighboring countries (such as Singapore) suggest where Indonesia could be headed if it follows the path to digitalization.

 

For example, almost all (89%) of the 201 healthcare practitioners surveyed by the FHI in Singapore use digital record keeping.  The top three positive results from adopting digital record keeping were quality of care provided, professional satisfaction and patient outcomes.  These are all beneficial results that could be expected to be seen in Indonesia, where there is a golden opportunity to reap greater benefits through healthcare’s digitalization.

 

The FHI also found that 49% of the 201 healthcare professionals surveyed in Singapore used telehealth for patient services such as remote patient monitoring and consultations (although a surprisingly high 32% did not use telehealth practices at all).  However, looking ahead five years, 57% of doctors in Singapore considered patient monitoring to have by far the most potential to improve. In the same vein, telehealth programs such as MOM, while already demonstrating impact locally, could reduce the levels of maternal and infant mortality across Indonesia.

 

I am convinced that with the right framework in place, Indonesia’s healthcare practitioners can also make better use of telehealth solutions.  The 9,993 Puskesmas in the country5 provide a physical backbone for access to healthcare but this network must continue to expand.  With just under 900,000 professionals6 engaged in the health sector across the country, Indonesia’s medical practitioners should embrace the use of digital technology whether in record keeping, monitoring or consultations.

 

The path towards digitalization

 

In order to support the transition to digital healthcare, the regulatory framework needs at least to keep pace with, and ideally get ahead of, digital innovation. It should cover diverse aspects such as the protection of patient data, health apps and diagnostics (including AI-based), and ethical health insurance, in order to increase the quality and access of healthcare in Indonesia. Such policy issues need to be tracked and regulations explained thoroughly.

 

Noting the regional trends identified by the FHI survey and observing the need for scalability of health services, there is great opportunity for digital technology to enhance healthcare delivery in Indonesia, whether for arranging a consultation with a specialist at a larger reference hospital, or for reporting the vital signs of an expectant mother in her home 2,000 kilometers away from the capital. 

1Hasil Pendataan Potensi Desa 2018 (Results of Data Collection on Village Potential 2018) by the Indonesian Statistic Agency/BPS.

2According to the World Bank. To note as reference, the World Health Organization (WHO) has promulgated a desirable doctor–population ratio as 1:1,000 or 2.5 times the current ratio in Indonesia.

3BPJS Kesehatan stands for Badan Penyelenggara Jaminan Sosial Kesehatan (the Health Care and Social Security Agency). BPJS administers the Indonesian national health insurance program, Jaminan Kesehatan Nasional or JKN for short.
4Indonesian public hospitals are ranked by Class (A to E) based on quality of service/amenities (quality of healthcare should be same).

5https://databoks.katadata.co.id/datapublish/2020/01/12/berapa-jumlah-puskesmas-di-indonesia

6Attachment 3.1,  Rekapitulasi Sumber Daya Manusia Kesehatan menurut Jenis Tenaga dan Provinsi Tahun 2018 as updated January 2019 by the Sekretariat Badan Pengembangan dan Pemberdayaan Sumber Daya Manusia Kesehatan, Kemenkes RI (Indonesian Ministry of Health).

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