Tinjauan aspek Teknologi dalam peningkatan mutu pelayanan kesehatan : Perkembangan e-health

Tinjauan aspek Teknologi d l dalam peningkatan i k t mutu t pelayanan l kesehatan : Perkembangan e-health di Indonesia dan didunia Tati .R . Mengko Pusat Teknologi Kesehatan dan Keolahragaan Teknik Biomedika -Sekolah Teknik Elektro dan Informatika

Institut Technologi Bandung

Outline

E-Health : definition, platform infrastuctur Information, Information products products, services services, technology Current Situation Future Planning Research activities

Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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1 E h lth : d E-health definition fi iti , overview i


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eHealth Components Gov. Policy (Piramida Level)

Definition (What)

eHealth Information Stakeholder (Who)

eHealth Benefit (Why)

eHealth P d t Products

eHealth S Services i

International Standard Current Situation


……………

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Future Electronic Health Record

Integrated-longitudinal-and-sharable medical record Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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Distance Services Telemedicine Ubiquitous e-Health Network


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Many Medical Devices and Body Sensors are Already Undergoing Wireless Integration

Portable Medical Devices

BP Monitors

Body Sensors

Adhesive

Glucometers Implants ECG Monitors Subcutaneous Peak Flow Meters

Pulse Oximetry Monitors


Body-Worn

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HealthPia – LG Diabetes Phone (Korea, US trials)


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VitaPhone (Germany)

The patient takes an ECG by holding phone to chest


The patient is automatically connected to VitaPhone call-center

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eHealth - definition eHealth is an emerging field in the intersection of medical informatics informatics, public health and business, business referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, locally regionally regionally, and worldwide by using information and communication tec o ogy technology Source: What is e-health?, Journal of Med Internet Research 2001;3(2):e20


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eHealth - definition A systemic review of 358 published definitions for eHealth has been done in 2004 Associating eHealth with activities such as managing, educating, arranging, connecting, obtaining, providing, redefining, assisting, accessing, supporting First def. mentioned improving and increasing the cost effectiveness of health care ad making process efficiently Second def. solve problems related to access to care, cost, quality, and portability of health care services Third def. suggested distance and place no longer remain barrier (telemedicine?)


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eHealth - Code of Ethics The goal of eHealth Code of Ethics is to ensure that people worldwide can confidently and with full understanding of known risk realize the potential of the internet in managing their own health and the health of those in their care In formulating eHealth code of ethics ethics, it is necessary to envisage the definition of eHealth, the component component, and the framework activities


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eHealth Information It includes information for staying well, preventing and managing disease, and making other decision related to Health and health care It includes information for making decision about health product and health services It may be in the form of data, text, image, audio, and video It may involve enhancements through programming p g g and interactivity y


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eHealth Products

Include drugs, medical devices and other goods used to diagnose and treat illness or injuries or to maintain health Some must be approved by regulator


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eHealth Services Includes specific, personal medical care or advice, management of medical records, communication between health care provider and/or patient and health plans or insurers, or health care facilities regarding treatment decisions, claim, billing for services It may be in the form of data, text, image, audio, and video It may involve enhancements through programming i and d iinteractivity i i


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eHealth Guiding Principles

Candor Honesty H t Quality Informed Consent Privacy Profesionalism P f i li iin O Online li H Health lth C Care Responsible Partnering Accountibility Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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eHealth Stakeholders Provider of care Physicians, hospital, nursing home, rehabilitation center Influencer IDI YLKI IDI, Policymakers G Government t Consumers Patient, family member, caregivers, clinician Provider of infrastructure developer, manufacturer of electronics and telecommunication system Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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Kolaborasi Bersama (stake holder) DEPKOMINFO

REGULATOR

DEPKES

SIKNAS ONLINE

IDI

LAYANAN ANGGOTA UNTUK SERTIFIKASI

ASPILUKI

Aplikasi RS Daerah Daerah, bersama ARSADA Supply Chain Management (Hulu-hilir)

TELKOMGroup

IT S, Payment Swith

ARSADA

Info RS untuk layanan masyarakat


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Telemedicine - definition

Application of electronics, telecommunication, information & computer technology (in Biomedical Engineering) • To transfer medical information from one site to another • To support medical personnel in conducting the Medical Procedures community healthcare & Education Procedures, Ultimate Goal: to improve the quality of life through existing technology


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The Earliest Telemedicine Ever Record in Indonesia The earliest telemedicine activities ever record in Indonesia is done at the year 1927 by Willem Einthoven 1924 Medicine Nobel Laureate The activity is to send and ECG (electrocardiograph) signal from Bandung to Leiden (about 12.000 km)

String galvanometer recording made in Leiden of wireless signals from Bandoeng String-galvanometer Netherlands Indies Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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Medical Information Medical information: (alphanumeric) e.g.: e g : patient records • Text (alphanumeric), • Physiological signals, e.g.: ECG, EEG, EMG signals g & Biometrics features • Medical images • static images, e.g. X-ray thorax images, X-ray bone images; biometric features, e.g. fingerprint/irisprit… • dynamic images images, e.g. e g USG dynamic heart images

• Sound, e.g. heart sound & Voice • Combination of the above information


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Examples of Physiological Signals

Physiological signals, e.g.: Electrocardiogram


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Examples of Physiological Signals

Physiological signals, e.g.: Electro-encephalogram

γ

Gamma mm ((22 – 30 Hz & higher) g )

β Beta (13 – 22 Hz) α Alpha (8 – 13 Hz) θ Theta (4 – 13 Hz) δ

Delta (0,5 (0 5 – 4 Hz)

D Deep sleep l

Spikes Epilepsy – Petit mal


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Examples of Medical Images

Static images, e.g.: X-ray image, thorax X-ray image, retina & iris patterns


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Medical Standar Medical record and messaging standard? (HL7v3/HL7 Messaging, g g, CEN,, ISO)) Disease classification standard? (ICDx) PACS (Picture Archiving and Communication System)?

National N ti l standard t d d which hi h has h a capability bilit to t exchange h data with another international standard is needed !


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2 C Current Situation Si i in i Indonesia I d i


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Government Regulations Kepmenkes No. 511 Tahun 2002 Kebijakan dan Strategi Sistem Kesehatan Nasional Kepmenkes No. 932 Tahin 2002 Juklak Pengembangan Sistem Kesehatan Daerah di Kabupaten/Kota


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Komunikasi Data Terfragmentasi DIT JEN

DIT JEN

SET/IT JEN PUSDA TIN

Data yang dikirimkan ke tingkat di atasnya memiliki format yang berbeda-beda Munculnya peluang perbedaan data pada berbagai tingkat kelembagaan

DINKES PROV.

Sulit melihat gambaran kesehatan nasional secara keseluruhan

DINKES KAB/KOTA

PUSK

BADAN

RS


Sumber: Bambang Hartono, Pengembangan Jaringan Komputer Online Sistem Informasi Kesehatan Nasional, 2007, Pusdatin, www.depkes.go.id 28

Existing Telecommunication Infrastructure Fiber O Fib Optic ti N Network t k connecting Sumatera, Jawa, Kalimantan and Sulawesi. The rest are relied on satellite network. Focused for business purpose Internet Service Provider (ISP) across Indonesia were still focused i JJava iisland in l d Source: APJII Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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Pendayagunaan Teknologi Informasi dan Komunikasi unt Komunikasi Data PUSDATIN UNIT2 DI DEPKES

MASYARAKAT

BANK DATA

INTRANET & INTERNET CLOUD ??? DINKES PROV

BANK DATA PUSKESMAS

BANK DATA

BANK DATA DINKES KAB/KOTA

BANK DATA RUMAH SAKIT

BAMBANG H


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Arsitektur Antar Domain


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Integrasi E-health dengan SIM lain SIM Profesi (SDM)

SIM Asuransi

B

• ID & Data record • Payment

•ID Pelaksana Medis

A

SIM Was Obat & Mkn • ID Institusi •ID Produk

SIM Penddk • ID Nasional

G

SIM Industri Kesehatan

C D

E-Health Nasional •SIKNAS •Portal IDI •SIM RS, SCM, •Asuransi •Payment System

F

• SCM hulu-hilir

E

Portal Komunitas • Standar Profesi • Akses informasi • Layanan Publik

I tit i finansial Institusi fi i l • Payment & Setlement

Pilar Utama Integrasi E-health

dB ID & Data rec

Aksesabilitas national


Kolaborasi antar komunitas 32

Sistem eHealth yang diharapkan Harus mencakup eHealth guiding principles dan ditambah beberapa prinsip lain yaitu: accesibility, availibility, reliability, affordibility, acceptibility Penggunaan standar medis untuk rekam medis dan pertukaran data di lingkungan nasional/internasional Berada pada infrastruktur jaringan nasional yang baik (reliable) Kebijakan dari pemerintah untuk mendukung eHealth dan aktivitas penelitian yang mendukung eHealth pentarifan khusus bagi penggunakan jasa telekomunikasi untuk kegiatan eHealth, terutama akses komunikasi satelit Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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Kondisi saat ini Belum terdapat rekam medis personal yang bersifat l longitudinal it di l ((mencatat t t riwayat i t kkesehatan h t d darii llahir hi hingga mati) secara terintegrasi Layanan kesehatan masyarakat belum dicatatkan dalam sebuah rekam medis elektronik Program pemerintah: menuju Indonesia sehat 2010


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Data Fragmentation on Medical Record


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Solusi Yang Diusulkan

Implementasi rekam medis terpusat dan t i t terintegrasi i berbasis b b i standar t d tterbuka, b k yaitu it openEHR Pengembangan sistem informasi kesehatan masyarakat yang bermuara pada rekam medis


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openEHR OpenEHR memanfaatkan TIK untuk mendukung healthcare secara efektif Merepresentasikan semantik yang mensyaratkan knowledgeoriented computing framework → arti yang kompleks dapat direpresentasikan dan digunakan bersama (sharable) Adaptable health computing system Patient-centric electronic health record


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Rekam Medis Terintegrasi

Server Pusat/Nasional Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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ASPEK BISNIS : e-Commerce

Kerjasama kemitraan dalam pemanfaatan contentecontente Health: Telkom/Finnet – ASPILUKI- vendor content – pengelola bisnis – bank Public Domain: portal e-Health – Info Sehat – Info Dokter, RS, pendaftaran Pasien viainternet, ponsel, ATM (epayment) penerapan teknologi BREW pada ponsel payment), Emergency call (EMS 119) Pelayanan on line 24 jam g ((medical g guide/ info untuk kasus kegawat-daruratan &ambulatory) Pengembangan Asuransi Kesehatan, Medical Audit (AMO)


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Manfaat Penelitian e-Health Manfaat untuk masyarakat: memiliki riwayat kesehatan yang lengkap dan mendapatkan informasi kesehatan dengan mudah Manfaat untuk lembaga kesehatan: data statistik, peningkatan pelayanan masyarakat, dan kredibilitas Manfaat untuk pemerintah: • mendapatkan data yang lengkap untuk menghasilkan data statistik yang lebih akurat (menunjang pengambilan keputusan)) • Deteksi KLB dapat dilakukan dengan cepat


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3 N i National lH Health l h IInformation f i System y : Future Plan


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Road Map Menuju e-Health (dari blueprint rencana Depkes)

2008 TAHAP INISIASI -Penyusunan Kerangka Konsep & cetak Biru -Standarisasi St d i i Terminologi Medis -Standarisasi identifikasi Unik Kesehatan -Standarisasi sistem informasi kesehatan -Pembentukan Basis Data Kesehatan -Koordinasi diantara Instansi Terkait -Sosialisasi Program Standarisasi sistem -Standarisasi informasi kesehatan -Implemenasi awal pada program kesehatan nasional proyek y -Pilot p

2009

2010

TAHAP PENGEMBANGAN

TAHAP

-Pembangunan ehealth Hub & Pusat data

-Penetapan Sistem sebagai standar informasi kesehatan nasional

-Penerapan awal integrasi & inter operabilitas p awal -Penerapan telemedicine & Rekam Medis -Pembentukan Komunitas

-Penerapan awal eHealth pada rumah sakit tertentu Sosialisasi -Sosialisasi -Perluasan Pilot Proyek


PEMANTAPAN

-Penerapan Telemedicine dan telehealth secara nasional

E-Health E Health Mendukung Indonesia Sehat 2010

-Penerapan e-Health secara nasional

-Perluasan penerapan e-health -Penerapan e-Health bagi sistem jaminan sosial nasional

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SIM P Profesi f i (SDM) ID PelaksanaMedis

SIM Industri Kesehatan SCM hulu-hilir

SIM Asuransi ID & Data record Payment

E-Health Nasional Portal Komunitas Standar Profesi Akses informasi Layanan Publik

SIM Was Obat & Makanan ID Institusi ID Produk


Institusi finansial Payment P t & Setlement S tl t SIM Penduduk ID Nasional

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Data Integration

UPT PST

JARINGAN G ONLINE O SISTEM INFORMASI KESEHATAN NASIONAL (SIKNAS ONLINE)

Pus Datin

DITJEN BINKESMAS

SEKJEN ((BIRO+PUSAT)) & ITJEN

Bank Data UPT PST

DITJEN YANMED BADAN

UPTD

DEPKES

RS

DITJEN PP & PL

DITJEN BINFAR & ALKES UPT PST

DINKES PROV (Bank Data) UPT UPT PST

Sumber: Bambang g g Hartono,, Pengembangan Jaringan Komputer Online Sistem Informasi Kesehatan Nasional, 2007, Pusdatin, www.depkes.go.id

PUSK

UPTD BAMBANG H


DINKES KAB/KOTA (Bank Data)

UPT PST

RS

SWAS TA

DIBANGUN DEPKES (APBN) DIBANGUN DAERAH /SUMBER LAIN

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Rural Network Infrastructure Can be reached by radio communication, such as WiMax and celullar technology

Satelite

Ethernet Switch

Satelite Disc / VSAT

Ethernet Cable Hospital/Puskesmas

Internet Backbone

Very remote area, using satellite communication Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

Local Government Office INTERNET

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Future National Network Infrastructure

Palapa Ring Project : Connecting every big city in Indonesia by means of wide bandwidth fiber optics Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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5 E-Health related Research Activities in Biomedical Engineering -ITB


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Research Activities (done in BME – STEI ITB) eHealth Medical Informatics • • • • • •

Open e-Health Record Mobile telemedicine Safe Motherhood Disaster Mitigation Management System Primaryy Healthcare Telehomecare monitoring

Application and Digital Content • • • • • •

Blood Vessel Segmentation Ultrasound Tomography Imaging System Early Detection for Osteoporosis & Osteoarthritis Diabetic Retinopathy early detection Medical Image Compression Video Communication for Teleophthalmology

eLearning for Medical Education /Information • Pengajaran ANFIS di Universitas Udayana • Informasi Kesehatan Puskesmas Tati Rajab Mengko IHQN Forum Grand Aquila Bandung 19 November 2008

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Research Results (example)

Osteoporosis Early Detection Osteoarthritis Early Detection

Medical Image Compression


Ultrasound Imaging System

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The openEHR Development Methodology


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Arsitektur Sistem Informasi Kesehatan

Posyandu


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Posyandu Over The System Domain Specialist Posyandu Knowledge e.g: marasmic, Immunization, etc

Web Based UI

Posyandu App

Middleware App Svr

Posyandu Biz Rule

OpenEHR Based EHR

Archetype Editor

Other DB, e.g GIS and Administration

Template Query Engine

Template Editor Archetype

PACS

Knowledge Development Tools Knowledge


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Sistem Informasi Posyandu


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References R. Wootton, J. Craig, V. Patterson: Introduction to Telemedicine, Royal y Society y of Medicine Press, 2006 J.H. van Bemmel, M.A. Musen: Handbook of Medical Informatics, Springer-Verlag, 1997 Proceedings BME Days 2006, Bandung Proceedings BME Days 2008, Surabaya Penelitian Open EHR Insentif Ristek 2007 2007,2008 2008 http://www.ieee.org http://www.itb.ac.id http://www itb ac id http://biomed.ee.itb.ac.id http://www.ptkk.itb.ac.id p p


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Tinjauan aspek Teknologi dalam peningkatan mutu pelayanan kesehatan : Perkembangan e-health

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