HIMSS ASIAPAC12 CONFERENCE 17-19 SEPTEMBER 2012

MARINA BAY SANDS, SINGAPORE

S&I-7 SAIFUL HIDAYAT

INDONESIA MOH EHR OPPORTUNITIES

CHALLENGES AND EXPERIENCES

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Agenda • Telkom Group Business Portfolio • Indonesia Healthcare Current Landscape & Implication • Telkom HIE-EHR Implementation and Plan • The challenges that must be addressed • Key lessons learnt

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TELKOM’s Highlight

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Telkom is the largest telecommunication company and network provider in Indonesia, majority owned by the Government of Indonesia (Total shares = 20,159,999,280, including 1 Dwiwarna share series A)

Government

Public

53.24%10,320,470,712 shares

Treasury Stock

773,659,960 shares

46.76%9,065,868,068 shares

Market cap USD 16.09 Billion or + 4.2% of total market cap. at IDX Indonesia

TELKOM is listed at Indonesia Stock Exchange (IDX),

New York Stock Exchange (NYSE), London Stock Exchange (LSE) and

also Publicly Offering Without Listing (POWL) at Tokyo Stock

Exchange (TSE)as of January 2nd , 2012

Telkom Business Portfolio - TIMES

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TelecommunicationPOTS

FWA

Mobile / Cellular

International Services

Fixed Broadband

Network Services

Tower

InformationPremise Integration Services

VA, Managed App & Performance/ITO

E-Payment

ITeS (BPO, KPO, e-health)

Media & EdutainmentMedia

Online Business

Wholesale

International

PERSONAL CONSUMER/HOME SME LARGE ENTERPRISE

serv

ices

Agenda • Telkom Group Business Portfolio • Indonesia Healthcare Current Landscape & Implication • Telkom HIE-EHR Implementation and Plan • The challenges that must be addressed • Key lessons learnt

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An Illustrative Healthcare Ecosystem It is complex & often fragmented; eHealth provides benefits to all stakeholders in

Indonesia through improved communication and information sharing

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EmployerPharmacy

Benefit Managers

Private Insurers

State Owned Insurer (e.g.

ASKES)

Regulatory Agencies

MOH

Province/District Health Offices

Other Healthcare

(e.g. Dental)

Nursing Care

Mobile Clinic/ Home Care

Pharmacies

Hospitals (Inpatient, Outpatient,

ED)

Diagnostic Services

(Lab, Rad)Clinic/SpecialistGP

CRO

Pharmaceuticals

Suppliers

Health Information Exchange

Patient/Consumers

• Members database maintenance

• Automated eligibility/ claims processing

• Claims rating• Ef fective case/

disease management

• Medical records storage

• Portable PHR• Personalized Portals• Patient Education• Remote health

monitoring

• Wide EMR penetration• Automated referrals• Automated coding and

claim submission

• Population health database• Disease detection & analysis• Pharmaceutical supply chain optimization

• CPOE and EMR• Referral• Remote health

monitoring• Automated coding &

claims submission

Staking share in key components of the eHealth ecosystem is important to ensure growth & viability

: Private: Public

: Public & private

Legend:

MOH Ensure Quality of Care and Patient Safety

eHealthcare Trend Improving Stakeholders Interactions and Benefits

Source : Deloitte Analysis

Indonesia eHealthcare Trend

Source: Telkom & SKT 2010

Indonesia Macroeconomic Outlook Increase Healthcare Spend in Indonesia

• The Indonesian government is encouraging foreign investment in the provider sector to offset health care funding shortages

• Government is planning to increase health care spending from 2.8% to 5% of the gov. budget • ASEAN Free Trade Area (AFTA). • Analysis project 11 percent growth in personal disposable income through 2014 will drive

higher individual health care spending in the country

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Source: Deloitte Analysis

Health Care Expenditure

Porti

on o

f GD

P (%

)

3.3 8.0 19.8 36.3165

286

707

1,297

0.0

0.5

1.0

1.5

2.0

2.5

3.0

0

200

400

600

800

1,000

1,200

1,400

2000 2005 2010 2015

Healthcare expenditure Total GDP % of GDP

Indonesian GDP and health care expenditure(a)(b)

(GDP, healthcare spending, USD, %, Indonesia, 2000 -2015)

USD

(B)

Indonesia Healthcare Outlook Demand Exceeds the Supply

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Source: Deloitte Analysis

Demand• Factors such as improving macro economic

conditions, incl PPI• Compelling epidemiology, Indonesian life

expectancy: 74 / 69 years (m/f) with CAGR of 0.5%; 70% chronic diseases are life style related; 30-50% of everyone over 40 will have at least 1 chronic disease; represents 80% of health care cost

Supply• Limited players in the market that target the

affluent and middle-up segment• Currently, the ratio of hospital beds per

100,000 population in Indonesia is 60 bedsper 100,000 population — eighth lowest in theworld

• Shortage of healthcare professionals and quality care facilities in Indonesia; Doctor to patient ratio 1:7700 vs.1:390 in USA vs. 1:1700 average in developing countries e.g. India, Malaysia, etc.

Unmet Need

Indonesia’s demand for cardiac care

Public Care Providers

Mid- to lower- strata of the population

Affluent to mid-up segment

‘Universal Coverage’ by 2014 will change dynamics

Medical Tourism

With provision of insurance coverage for thegeneral public under the ‘Universal Coverage’ 2014Scheme, the population segment that currentlydoes not have access to cardiac care or is notaware of the disease condition (lack ofdiagnosis), will flood public healthcare facilities

Post-2014

Increased pressure on publiccare facilities will furtherincrease demand for privatecare

150 million people addedto the patient pool

The EHR implementation versus

invest in core healthcare infrastructure and provisioning to basic care

Perhaps unique to Indonesia, the EHR implementation costs is anticipated to be significant public sector investment that competes with raising needs to invest in core healthcare

infrastructure and provisioning to basic care to more than 200 million Indonesians.

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Indonesia eHealth Lanscape & Implication • Partial used of eHealth Solutions:

• Silos Implementation • Non Standard/ Multi Format Data:

• Lack of Interoperability • Lack of data consolidation

• Lack of communication and data sharing

• Lack of public information access

• Government plan to have Universal Health Coverage on Jan 2014

• Law 24/ 2011 – Executing Agency of Social Security (BPJS)

• To provide basic healthcare for all Indonesian

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2001 plus hospitals (DG BUK Sep 2012)

9,005 Puskesmas (Bankdata Pusdatin)

21,852 pharmacies (IAI)

260 pharmaceutical industries

46 private insurers (Bapepam)

115,155 eGPs

Telkom Group eHealth Solution Using Telkom’s HIE (Health Information Exchange)

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

IT Security Infrastructure

Provider Directory

PKI Server

Certificate Authority

Universal Patient

Identifier

SEHR

Internet & Mobile

Email & SMS Gateway

GOV & Institutions

TPA & Private Insurance

Personal Health Web Portal

Web Service Adapter

Pharmacies

Hisys e-Apotik

Suppliers Finance

HIMBARA Link & 52 other Banks

Government Insurance & SOE’s

ASGARA & 141 SOE’s

Healthcare Providers

Doctors / Specialist

Clinics & Hospitals

Laboratories EMR

Hisys e-Hospital

Routing & Transformation

Services Workflow Services

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

Agenda • Telkom Group Business Portfolio • Indonesia Healthcare Current Landscape & Implication • Telkom HIE-EHR Implementation and Plan • The challenges that must be addressed • Key lessons learnt

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eProcure

eClaims

HIE-EHR Implementation plan & Roadmap Illustrative Purposes

eGP

eBilling

CIS/HIS

EHR Tele-med

mHealth

Health Portal

TIME ePhar

m

eShop

ePro-motion

eRe-minder

eRefer

eOrder

Analytics

VALUE-ADD

Enterprise-Driven

Consumer-driven

Infrastructure Wide Scale Innovation

Agenda • Telkom Group Business Portfolio • Indonesia Healthcare Current Landscape & Implication • Telkom eHealth Initiatives and Activities with MOH • Telkom HIE-EHR Implementation and Plan • The challenges that must be addressed • Key lessons learnt

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The challenges that must be addressed

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Agenda • Telkom Group Business Portfolio • Indonesia Healthcare Current Landscape & Implication • Telkom eHealth Initiatives and Activities with MOH • Telkom HIE-EHR Implementation and Plan • The challenges that must be addressed • Key lessons learnt

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Key Success Factors

Successful HIE-EHR

Implementation

People

Process

Techno logy

Information

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Agreement from Hospital Executive to

provide data

Consensus on coding Standard (ICD, SNOMED,

etc.) and Exnchange Protocols (HL7, CDA, CCD,

etc.)

Right Adaptor for complex and

heterogenous apps. in the hospitals

Determine ownership, governance, and residency

of data & information

Key Lesson Learnt • Self Sustainable systems Right sustainable business models • Economically viable for Telkom and Government • Cost effective We don’t have tons of cash to waste • Used proven technology R&D vs. time to market We don’t take unnecessary risk Proven Technology & Processes

• Example: CCD works – used it, MIMS works – used it

• Involve doctors, pharmacies, health consultants in the team

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Its should be business case driven

Business Heavy VS Engineering Heavy

THANK YOU

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