The presentation discusses Telkom's implementation of healthcare IT solutions in Indonesia. It provides an overview of Telkom's business portfolio and status as the largest telecom company in Indonesia. It then discusses Indonesia's current healthcare landscape, including fragmented systems and the government's goal to increase healthcare spending. The presentation outlines Telkom's healthcare information exchange and EHR plans and implementation, and notes challenges that must be addressed. It concludes with lessons learned from Telkom's healthcare IT work.

1. HIMSS ASIAPAC12 CONFERENCE
17-19 SEPTEMBER 2012
MARINA BAY SANDS, SINGAPORE

2. S&I-7
SAIFUL HIDAYAT
INDONESIA MOH EHR
OPPORTUNITIES
CHALLENGES AND EXPERIENCES
9/25/2012 ©2012 Healthcare Information and Management Systems Society 2

3. 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
9/25/2012 ©2012 Healthcare Information and Management Systems Society 3

4. TELKOM’s Highlight
Telkom is the largest telecommunication company and TELKOM is listed at
network provider in Indonesia, majority owned by the Indonesia Stock Exchange (IDX),
Government of Indonesia New York Stock Exchange (NYSE),
(Total shares = 20,159,999,280, including 1 Dwiwarna share series A) London Stock Exchange (LSE) and
also Publicly Offering Without
Listing (POWL) at Tokyo Stock
as of January 2nd , 2012
Exchange (TSE)
Government
53.24%
10,320,470,712 shares
Public
46.76%
9,065,868,068 shares
Treasury Stock
773,659,960 shares
Market cap USD 16.09 Billion or + 4.2% of total
market cap. at IDX Indonesia
9/25/2012 ©2012 Healthcare Information and Management Systems Society 4

5. Telkom Business Portfolio - TIMES
PERSONAL CONSUMER/HOME SME LARGE ENTERPRISE
services
Wholesale
International
Telecommunication Information Media & Edutainment
POTS Premise Integration Services Media
FWA VA, Managed App & Performance/ITO Online Business
Mobile / Cellular E-Payment
International Services ITeS (BPO, KPO, e-health)
Fixed Broadband
Network Services
Tower
9/25/2012 ©2012 Healthcare Information and Management Systems Society 5

6. 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
9/25/2012 ©2012 Healthcare Information and Management Systems Society 6

7. An Illustrative Healthcare Ecosystem
It is complex & often fragmented; eHealth provides benefits to all stakeholders in
Indonesia through improved communication and information sharing
Diagnostic
Services
Clinic/ Hospitals (Lab, Rad)
GP (Inpatient,
Specialist
Outpatient,
ED)
Pharmacy • Wide EMR penetration • CPOE and EMR
Employer Benefit • Automated ref errals • Ref erral Pharmaceuticals
Managers • Automated coding and • Remote health
claim submission monitoring
• Automated coding &
Private Health claims submission CRO
Insurers Information
• Members Exchange
database
maintenance Suppliers
State Owned Pharmacies
• Automated
eligibility/ claims Insurer (e.g.
processing ASKES) Patient/
• Claims rating Consumers
• Ef f ective case/ Mobile Clinic/
disease Home Care
management MOH
• Medical records • Portable PHR
storage • Personalized Portals
Other
• Patient Education
Healthcare
• Remote health
Legend: Regulatory monitoring
(e.g. Dental) Staking share in key
: Private Agencies components of the
: Public Province/ eHealth ecosystem is
Nursing Care
• Population health database District important to ensure
: Public & private • Disease detection & analysis Health growth & viability
• Pharmaceutical supply chain optimization Offices
9/25/2012 ©2012 Healthcare Information and Management Systems Society 7

8. eHealthcare Trend
Improving Stakeholders Interactions and Benefits
Ensure Quality of MOH and Patient Safety
Care
Source : Deloitte Analysis

9. Indonesia eHealthcare Trend
Source: Telkom & SKT 2010

10. 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
Health Care Expenditure
Indonesian GDP and health care expenditure(a)(b)
(GDP, healthcare spending, USD, %, Indonesia, 2000 -
2015)
1,400 1,297 3.0
Portion of GDP (%)
1,200 2.5
USD (B)
1,000
2.0
800 707
1.5
600
1.0
400 286
165 0.5
200 36.3
3.3 8.0 19.8
0 0.0
2000 2005 2010 2015
Source: Deloitte Analysis Healthcare expenditure Total GDP % of GDP
9/25/2012 ©2012 Healthcare Information and Management Systems Society 10

11. Indonesia Healthcare Outlook
Demand Exceeds the Supply
Demand Supply
• Factors such as improving macro economic • Limited players in the market that target the
conditions, incl PPI affluent and middle-up segment
• Currently, the ratio of hospital beds per
• Compelling epidemiology, Indonesian life
100,000 population in Indonesia is 60 beds
expectancy: 74 / 69 years (m/f) with CAGR Unmet per 100,000 population — eighth lowest in the
of 0.5%; 70% chronic diseases are life style Need world
related; 30-50% of everyone over 40 will
• Shortage of healthcare professionals and
have at least 1 chronic disease; represents
quality care facilities in Indonesia; Doctor to
80% of health care cost
patient ratio 1:7700 vs.1:390 in USA vs.
1:1700 average in developing countries e.g.
India, Malaysia, etc.
‘Universal Coverage’ by 2014 will change dynamics
With provision of insurance coverage for the
general public under the ‘Universal Coverage’ 2014 Public Care Providers
Scheme, the population segment that currently
does not have access to cardiac care or is not
aware of the disease condition (lack of
diagnosis), will flood public healthcare facilities
Increased pressure on public
Medical Tourism care facilities will further
increase demand for private
care
Indonesia’s demand for
cardiac care
Post-2014
Affluent to mid-up
segment 150 million people added
to the patient pool
Mid- to lower- strata
Source: Deloitte Analysis of the population
9/25/2012 ©2012 Healthcare Information and Management Systems Society 11

12. 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.
9/25/2012 ©2012 Healthcare Information and Management Systems Society 12

13. Indonesia eHealth
Lanscape & Implication
• Partial used of eHealth Solutions:
• Silos Implementation
2001 plus hospitals 46 private insurers
• Non Standard/ Multi Format Data: (DG BUK Sep 2012) (Bapepam)
• Lack of Interoperability
• Lack of data consolidation
• Lack of communication and data
sharing
• Lack of public information access
• Government plan to have Universal 9,005 Puskesmas 21,852 pharmacies
Health Coverage on Jan 2014 (Bankdata Pusdatin) (IAI)
• Law 24/ 2011 – Executing Agency of Social
Security (BPJS)
• To provide basic healthcare for all
Indonesian
 Integrated eHealth Shared Service
115,155 eGPs 260 pharmaceutical
Platform is a Must industries
9/25/2012 ©2012 Healthcare Information and Management Systems Society 13

14. Telkom Group eHealth Solution
Using Telkom’s HIE (Health Information Exchange)
IT Security Internet & TPA & Personal
GOV &
Infrastructure Mobile Private Health
Institutions
Insurance Web Portal
Provider Certificate SEHR Email &
Directory Authority SMS
Gateway
Universal
PKI Server Patient
Identifier
Routing &
Transformation
Telkom HIE (Health Information Exchange) Workflow Services
Services (e-Health Hub)
Web Service Adapter
Government
Healthcare Providers Pharmacies Suppliers Finance Insurance &
SOE’s
Doctors / Clinics & Laboratories EMR
Specialist Hospitals
HIMBARA Link & ASGARA & 141 SOE’s
Hisys e-Hospital Hisys e- 52 other Banks
Apotik
TELKOM eHospital (HIS), eclinic, epuskesmas, eGP, eApotek , eSCM, eClaim
9/25/2012 ©2012 Healthcare Information and Management Systems Society 14

15. 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
9/25/2012 ©2012 Healthcare Information and Management Systems Society 15

16. HIE-EHR Implementation plan & Roadmap
VALUE-ADD Illustrative Purposes
mHealth
Enterprise- Analytics
Driven
Health
Portal
Tele-med EHR
eOrder
eRefer
eProcure
eClaims
eRe-
minder
eBilling
ePro- Consumer-
motion driven
eShop
eGP CIS/HIS
ePhar
m
TIME
Infrastructure Wide Scale Innovation

17. 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
9/25/2012 ©2012 Healthcare Information and Management Systems Society 17

18. The challenges
that must be addressed
9/25/2012 ©2012 Healthcare Information and Management Systems Society 18

19. 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
9/25/2012 ©2012 Healthcare Information and Management Systems Society 19

20. Key Success Factors
Agreement from
People Hospital Executive to
Determine ownership, provide data
governance, and residency
of data & information
Consensus on coding
Standard (ICD, SNOMED,
etc.) and Exnchange
Successful Protocols (HL7, CDA, CCD,
Informa
HIE-EHR Process etc.)
tion
Implementation
Right Adaptor for
complex and
Techno heterogenous apps. in
logy the hospitals
9/25/2012 ©2012 Healthcare Information and Management Systems Society 20

21. 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
Business Heavy VS Engineering Heavy
Its should be business case driven
9/25/2012 ©2012 Healthcare Information and Management Systems Society 21

22. THANK YOU
9/25/2012 ©2012 Healthcare Information and Management Systems Society 22