By: Tri Siwi Agustina
Center for Entrepreneurship and Industrial Relations, Faculty of Economics and Business, Universitas Airlangga
In the midst of 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.
It is hoped that telemedicine can help the government to break the chain of transmission of Covid-19 because people who are undergoing self-isolation can consult with doctors without having to meet face to face, not only that, patients can also directly buy medicine based on digital prescriptions sent by doctors after the consultation session because of various The telemedicine application is also connected to a pharmacy installation that is ready to provide medication according to the patient's condition.
The presence of this health service innovation is certainly very beneficial for society, considering that there is currently a spike in Covid-19 cases which has resulted in hospitals being overwhelmed in accepting confirmed Covid-19 patients. Therefore, it is not surprising that there are government and private hospitals that are seizing telemedicine opportunities targeting people who are undergoing self-isolation. Start by creating your own application so that patient data is stored from registering when carrying out an antigen or PCR test, either walk-in or home service, to providing independent isolation service packages in the form of teleconsultations with specialist doctors and general practitioners for 24 hours, clinical monitoring by the pharmacy team .
Telemedicine covers many areas in the health system, such as teleconsultation (providing consultations provided by competent health personnel; Telepharmacy, namely providing prescriptions and drugs; and most recently, patient referral services through the National Integrated Referral Information System (SISRUTE) belonging to the Ministry of Health of the Republic of Indonesia.
In general, telemedicine business opportunities are wide open in Indonesia, firstly because of Indonesia's large population. Quoted from Bisnis.com (2020), Caroline Caroline Clarke, Market Leader and EVP Philips Asian Pacific, stated that the telemedicine business has great opportunities in countries with large populations such as Indonesia. Currently Indonesia is the 4th largest in the world. Second, Indonesia is an archipelagic country, the existence of this business will certainly bring benefits to the 269 million Indonesian people 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. Third, the telemedicine application can narrow the gap in the distribution of health facilities in Indonesia, because with a population of 267 million people, Indonesia only has 10,168 community health centers, 2,877 hospitals, 9,205 clinics and 30,260 pharmacies. Looking at the reality of the distribution of health facilities in Indonesia, it seems inevitable that the need for telemedicine in Indonesia for handling Covid-19 is absolutely necessary. Telemedicine service provider Halodoc noted that the number of downloads of their application doubled in 2020 compared to 2019. There are now 18 million registered active users. Apart from that, the number of article readers on the application has doubled. The services most in demand by the public include online consultations with doctors, psychological consultations and Covid-19 tests (Kompas, 2021)
Apart from opportunities, there are challenges to the telemedicine business during the Covid-19 pandemic in Indonesia, including people's habits, availability of facilities and infrastructure, legal umbrella for administering telemedicine in Indonesia, administrative culture in reducing the use of paper.
In society, it cannot be denied that there are still many people who try to treat themselves by concocting their own concoctions which have been believed for generations to be medicine. Indeed, this is not completely wrong if it is aimed at increasing immunity, but if the health condition during isomanism gets worse, of course it will be too late to get medical help. Another thing is the culture of society which listens more to what people say than to explanations from medical personnel. Apart from that, in terms of mastery of technology, not all Indonesian people are "technologically literate", especially the elderly who, if they have health complaints, are used to interacting directly with medical personnel.
The surge in the number of patients confirmed positive for Covid-19 in the last month is not commensurate with the availability of medical personnel, especially doctors. This is certainly a challenge, how telemedicine operations can continue to serve the community amidst a shortage of doctors. Apart from that, the availability of infrastructure such as internet networks and widespread electricity supplies is absolutely necessary to ensure that people who are self-isolating in remote and border areas can still access telemedicine services. Likewise with the availability of electricity, don't let telemedicine services only be accessible when the electricity is on at night.
Judging from the legal protection side for the stakeholders of the Telemedicine application business, namely: medical personnel and patients. The government through the Minister of Health Regulation (Permenkes) No. 20 of 2019 still seems "ambiguous" in several respects, referring to Rifa Fauziyah's (2020) review in her article entitled Telemedicine during the Covid-19 Pandemic: Obstacles in Adaptation Efforts, stating that the obstacles encountered are related firstly to the confidentiality of patient conversations and doctor. The confidentiality of patient data certainly needs to be maintained because it is prone to data misuse. Second, there are no official regulations that clearly determine various things regarding the form of electronic medical records. Third, it is related to restrictions on medicines that can be given online (without examining the patient) which are prone to causing abuse. Fourth. protection or insurance for energy. Fourth, protection or insurance for medical personnel in online practice is not yet available. For example, to protect doctors from certain demands even though they have worked according to standard procedures. The four things mentioned above need to be immediately regulated to maintain data security and patient safety as well as maintain the quality of health services provided by medical personnel.
A culture in terms of administration that still relies on physical documents needs to be minimized. Even though patient data is already stored in the telemedicine application, if a doctor gives a referral to a hospital, the data should be integrated in all hospital installations. Patients no longer need to fill in the same information manually, this is also aimed at breaking the chain of transmission of Covid-19 through paper media.
Law of the Republic of Indonesia Number 36 of 2009 concerning Health, mandates that everyone has the same rights in gaining access to resources in the health sector. Considering the challenges faced in implementing telemedicine, the government's efforts to reduce the number of positive daily cases of Covid-19 by providing a number of telemedicines need to be appreciated even though there is still a lot of homework to be done. Collaboration of many parties is very necessary. Don't forget the seriousness and good faith of the government and legislature as policy makers. Hopefully Indonesia will recover soon and be free from Covid-19.
