In 1976, Dr Lawrence Weed developed the world’s first electronic health record. This allowed healthcare institutions to store data more efficiently and retain patient information that might have been destroyed if kept in physical form. While many healthcare institutions today are familiar with this practice, the challenge lies in integrating health data that exists in silos under a common platform.

Digital Transformation Office (DTO), a unit under Indonesia’s Ministry of Health, is making moves to tackle this issue. It’s just over a year old and has already been dubbed the nation’s “catalyst for healthcare innovations” by health minister Budi Gunadi Sadikin.  The unit is led by Setiaji, former digital advisor for West Java and Jakarta Smart City chief.

Farzikha Soerono, Chief of Product Officer at DTO, shares the team’s work on making electronic health records more accessible across the country and coping with health demands in the pandemic.

An integrated health information system

The DTO is working on a scalable, secure, and interoperable platform to enable all healthcare providers in the country to exchange medical records across a single network. More than 3000 hospitals, 15,000 primary health care facilities, and 30,000 pharmacies will soon be able to push their electronic medical records to MOH’s data platform, known as Indonesia Health Services (IHS).

Healthcare workers no longer need to navigate multiple data systems with IHS, which reduces their time spent keying in information.

Currently, healthcare providers are not able to share information across a common network. Every institution operates on a separate patient database, resulting in the ministry “managing around 400 overlapping systems,” Farzikha says.

But for the IHS to work, Indonesia first needs to tackle another challenge – bringing data from small healthcare providers online.

Secondary healthcare facilities such as large hospitals have their own electronic medical record systems and only need to migrate data onto IHS. But most primary healthcare facilities record patient data on pen and paper. “We cannot build a data exchange platform effectively if healthcare facilities do not go digital,” Farzikha shares.

This gap has led to “high hospital visitation rates,” he adds. Most people skip visiting primary healthcare facilities, known as Puskesmas in Bahasa Indonesia. They go straight to hospitals when they are sick because they perceive them to be more efficient in providing healthcare services.

To overcome this gap, the DTO is working on a health information system for smaller healthcare providers so they can track patient records digitally. The platform, known as Sehat Indonesiaku, will allow smaller, rural healthcare facilities to record data digitally even if they have no internet access. That will open up more options for citizens seeking medical care.

“We want them to be able to input data first whenever a patient arrives,” Farzikha says. After updating Sehat Indonesiaku, IHS will automatically receive this data when it detects an internet connection.

Telemedicine

The DTO has also developed an app, PeduliLindungi, to support Indonesia’s efforts to speed up Covid-19 testing, tracing, and treatment. The app includes a telemedicine feature and connects 17 providers to patients from the convenience of their homes. It also offers drug delivery to Covid patients.

Those who test positive for the virus will receive a WhatsApp message from the health ministry to get teleconsultation services. MOH will provide them with a voucher code, which they can use to book teleconsultation services and order medicine to their doorstep for free.

“These services have managed to serve hundreds of thousands of patients in Indonesia and significantly reduced the burden on hospitals as patients do not need to make unnecessary trips,” Farzikha says.

Estimating Covid-19 spread across Indonesia’s provinces 

DTO has also worked on a model that can estimate the spread of Covid-19 in each Indonesian province.

The DTO determines the severity of the virus in each region based on a few metrics. They look at indicators such as hospital bed occupancy rate, percentage of vaccinated population, percentage of the population that received booster shots, and contact tracing adoption rate.

The level of Covid-19 severity gives the provinces an indication of whether they can reopen their economy. This could mean relaxed social distancing requirements or making mask-wearing non-mandatory.

“This model has been very impactful in driving the vaccination rate,” Farzikha says. In regions with low vaccination rates, their economy is not likely to open up anytime soon. This serves as an impetus for more people to get vaccinated so they can enjoy these eased measures as soon as possible.

Digital contact tracing 

Aside from telemedicine, the PeduliLindungi app is also capable of digital contact tracing. It has three main functions.

First, Indonesians use the app to check into public places. “This ensures that only those who are fully vaccinated and healthy are allowed to roam around,” Farzikha shares.

Second, upon exposure to infection, the app will alert individuals of their close contact status and urge them to undergo self-testing.

Third, the app features an electronic Health Alert Card that reflects whether a person is eligible for domestic travel. It also informs individuals of the additional tests they need to take before they can travel, according to their vaccination status.

For example, if an individual has received only two doses of the vaccine, the app notifies that they need to have a negative ART test result before they can leave their province.

So far, DTO has launched several tools to keep the spread of the virus in Indonesia under control. But as the pandemic gradually becomes endemic, DTO will shift its priority to simplifying data systems for health workers so that they can focus on what really matters – saving lives.

Special thanks to Maria Rara, Aulia Zahrina, Hansen Wiguna (Product Managers), and Karina Kusumawardani (Head of Communications) at DTO for sharing additional information for this article.