By: Tri Siwi Agustina,
Center for Entrepreneurship and Industrial Relations, Faculty of Economics and Business, Universitas Airlangga
Amidst this second wave of Covid-19, last week, the government, through the Ministry of Health, intended to trial free telemedicine services for asymptomatic and mildly symptomatic Covid-19 patients who are self-isolating using 11 telemedicine applications.
Telemedicine is expected to help the government break the chain of Covid-19 transmission because people who are undergoing self-isolation can consult with doctors without having to go through a face-to-face meeting. Not only that, patients can also directly purchase medication based on a digital prescription sent by the doctor after the consultation session because various telemedicine applications are also connected to pharmaceutical installations that are ready to provide medication according to the patient's condition.
The presence of this healthcare innovation is certainly very beneficial for the community, considering the current surge in COVID-19 cases, which has overwhelmed hospitals with confirmed COVID-19 patients. Therefore, it's not surprising that several government and private hospitals are seizing the opportunity of telemedicine, targeting people undergoing self-isolation. These include creating their own applications to store patient data, from registration for antigen or PCR tests, both walk-in and home services, to providing self-isolation service packages, including 24-hour teleconsultation with specialists and general practitioners, and clinical monitoring by a pharmacy team.
Telemedicine covers many areas in the health system, such as teleconsultation (providing consultations provided by competent health workers); Telepharmacy, namely providing prescriptions and medication; and the most recent is patient referral services through the National Integrated Referral Information System (SISRUTE) owned by the Ministry of Health of the Republic of Indonesia.
In general, the telemedicine business opportunity is wide open in Indonesia, firstly due to Indonesia's large population. Quoted from Bisnis.com (2020), Caroline Clarke, Market Leader and EVP of Philips Asia Pacific, stated that the telemedicine business has great potential in countries with large populations such as Indonesia. Currently, Indonesia is the 4th largest in the world. Secondly, Indonesia is an archipelagic country, the existence of this business will certainly bring great benefits to the 269 million Indonesians spread across 17,504 islands. Telemedicine services can help the government improve health services to its citizens, especially reaching areas that are difficult to reach and have limited access. Thirdly, telemedicine applications can narrow the gap in the distribution of health facilities in Indonesia, because with a population of 267 million, Indonesia only has 10,168 community health centers, 2,877 hospitals, 9,205 clinics and 30,260 pharmacies. Given the distribution of healthcare facilities in Indonesia, the need for telemedicine in Indonesia for COVID-19 treatment is undeniable. Telemedicine service provider Halodoc recorded a doubling in downloads of its app in 2020 compared to 2019. It now has 18 million registered active users. Furthermore, the number of readers of articles on the app has also doubled. The most popular services include online consultations with doctors, psychological consultations, and COVID-19 testing (Kompas, 2021)
Besides opportunities, there are challenges facing the telemedicine business during the Covid-19 pandemic in Indonesia, including changing community habits, the availability of facilities and infrastructure, the legal framework for implementing telemedicine in Indonesia, and administrative culture in reducing paper use.
It's undeniable that many people still seek self-medication by concocting concoctions believed to be medicinal for generations. While this isn't entirely wrong if it's intended to boost immunity, if their health worsens during self-isolation, it's often too late to seek medical attention. Another factor is the culture of people who prefer to listen to what others say rather than medical advice. Furthermore, not all Indonesians are technologically literate, especially the elderly, who are accustomed to interacting directly with medical professionals when experiencing health problems.
The surge in the number of confirmed COVID-19 patients over the past month has not matched the availability of medical personnel, especially doctors. This presents a challenge: how telemedicine operations can continue to serve the public amidst a shortage of doctors. Furthermore, the availability of infrastructure, such as internet access and a widespread electricity supply, is absolutely essential to ensure that people self-isolating in remote and border areas can still access telemedicine services. Similarly, with regard to electricity availability, telemedicine services should not be accessible only when the power is on at night.
From the legal protection perspective for Telemedicine application business stakeholders, namely medical personnel and patients, the government, through Minister of Health Regulation (Permenkes) No. 20 of 2019, appears to be ambiguous in several respects. Referring to Rifa Fauziyah's (2020) article entitled Telemedicine during the Covid-19 Pandemic: Obstacles in Adaptation Efforts, the obstacles encountered are related to, first, the confidentiality of patient-doctor conversations. The confidentiality of patient data must be maintained because it is prone to data misuse. Second, there are no official regulations that clearly define various aspects of electronic medical records. Third, the limitations on medications that may be administered online (without examining the patient) are prone to misuse. Fourth, protection or insurance for medical personnel. Fourth, protection or insurance for medical personnel in online practice is currently unavailable. For example, to protect doctors from certain lawsuits even though they have worked according to standard procedures. These four matters need to be regulated immediately to maintain data security and patient safety, as well as to maintain the quality of health services provided by medical personnel.
The administrative culture of relying on physical documents needs to be minimized. Even if patient data is stored in a telemedicine application, when a doctor issues a referral to a hospital, that data should be integrated across all hospital facilities. Patients will no longer need to manually enter the same information, which also aims to break the chain of COVID-19 transmission through paper.
Law of the Republic of Indonesia Number 36 of 2009 concerning Health mandates that everyone has equal access to healthcare resources. Considering the challenges faced in implementing telemedicine, the government's efforts to reduce the number of daily positive Covid-19 cases by providing a number of telemedicine platforms deserve appreciation, although much work remains to be done. Collaboration between various parties is essential. The seriousness and good faith of the government and the legislature as policymakers are also crucial. May Indonesia recover quickly and be free from Covid-19.