Indonesia, the world's fourth populous nation, has been leveraging digital technologies to advance its healthcare system. During the "Building a Successful Digital Transformation Roadmap in Indonesia" webinar on 10 June, three hospital leaders in the country shared their strategies and blueprints in implementing digital initiatives.

PT Siloam Hospitals CIO Ryanto Marino Tedjomulja, Mandaya Hospital Group President Director Dr Ben Widaja and Dr Fathema Djan Rachmat, president director of Pertamina Bina Medika (Pertamedika) talked about the challenges and the insights they gathered in the digital health journey of their hospitals.

Dr Joanna Pang, chief manager for Information Technology and Health Informatics at Hong Kong's Hospital Authority (HA), also contributed to the discussion with her experience in helping develop Hong Kong's digital health ecosystem.

Dedicated teams to lead digital transformation

The first step in the digital transformation of Siloam Hospitals was the consolidation of data. Tedjomulja said they created a sole department to oversee this process which has led to the connection of all its 40 hospitals through one single system.

During this phase, all available data were brought together, such as those from patients, medications and service expenses, in a single database to encourage clinicians and staff to use data in decision making. "We use this data to drive culture transformation in Siloam; to be more data-driven," he said.

A dedicated IT team was behind Pertamedika's latest integrated hospital service system called One Solution System, according to Dr Rachmat.

She recalled that all 73 state-owned hospitals under the Indonesia Healthcare Corporation (IHC), the network operated by Pertamedika, used to run their own separate apps. Now, they are working with one solution that is user-friendly for doctors and includes an end-to-end module from the dashboard to EMRs.

Dr Rachmat said she would not mind having an audience with their IT team to discuss, for instance, the latest software they are developing. She said the hospital leadership would provide the space they need.

In their digital health journey, she underscored the importance of getting everyone on board. "We make sure everyone understands the concept of digitalisation and IT as well as the business processes of our hospital services".

Also lately, the IHC tried out drone technology in delivering remote care and evaluating its capacity to do long-distance implementations. In trying out such an innovative practice, not a lot of people were needed, Dr Rachmat said. "We just need to have a strong team making sure that everybody can implement this in their hospitals. We also make sure that a digital mindset is grown in the hospital".

The trouble with systems integration

The Mandaya Hospital Group is set to open its newest digital hospital in West Jakarta this year. The construction of Mandaya Royal Hospital Puri (MRHP) started in 2018. It will be a 16-floor general hospital with centres of excellence in cardiovascular services, neurology and oncology.

According to Dr Widaja, one of the challenges in opening a greenfield hospital is the lack of a base data set. "We have a brand-new team with zero data migration. This means [we] do not have an initial set of data. We need to build a lot of new things, [like] establishing a new database".

Aside from starting from scratch, it will need multiple software which not a single vendor can all provide, he claimed. MRHP will need 13 software systems – seven for medical use and six for non-medical operations. These, including an EMR, had to be sourced from different vendors abroad, such as in Europe, Malaysia and Indonesia.

Still, what is important down the line is systems integration. "How do we combine and collaborate all 13 software systems down to a single system for patient and family experience, making sure that their experience is seamless, making sure that they're not aware that we have 13 software systems in our system," Dr Widaja said. The unified system must also be predictive, proactive, personalised, robust and useful, he added.

In the case of public hospitals in Hong Kong, Dr Pang also thought that integrating a closed-loop system with clinical workflow was "really a challenging task". It is one of those areas the HA is focusing on to support the network's clinical operations. HA manages about 43 hospitals and a hundred more clinics that serve 90% of all in-patients in the region.

"Us and our IT colleagues, we spent quite a lot of time and resources in establishing and also expanding the mobile capability, the cloud service, [and resolving] data issues because these are all interconnected, such that we can support our clinical operation and the administration".

In choosing the right systems, Dr Widaja said they have to weigh their options especially with vendors whose solutions require the adoption of their standard operating procedures. "Do those procedures match our needs? Can they customise according to our needs, the patients and our clinicians' needs?"

With having multiple systems, issues with communications arise. MRHP has set up a dedicated team to control communication.

Echoing Dr Rachmat, he also said: "We need to have a strong, internal IT team to lead these implementation and integration phases".

'Mindset of innovation'

Tedjomulja said they had to go "back to the drawing board" during the second phase of Siloam's digital transformation – the digitalisation phase. In entering this stage, they had to consider patients' expectations first.

Digital initiatives during this phase include the launch of a mobile application for patients; a new clinical system to streamline administrative tasks; and the use of robotics process automation technology to automate routine work, especially in their finance department, as well as analytics to draw insights.

Siloam's digital transformation does not entirely end at the final stage. "We know that technology is always changing; it's always updating," Tedjomulja said. There also lies the challenge of encouraging people to adapt to changes.

That is why a "mindset of innovation" is needed to drive digitalisation, he stressed. "We need to be innovating at all times. We have to make sure that we are not left behind." Among the present innovations at Siloam Hospitals is the application of remote patient monitoring to assist diabetic patients.

Dr Pang also agreed with Tedjomulja's call. On its end, the HA has established its own AI lab where projects are made following an AI innovation process. Despite this effort, the hospital network has to deal with clinicians' considerations, such as medical-legal concerns, safety issues, and patient outcomes, in adopting the latest AI-powered solutions. "We [found] that it's not easy to adopt AI solutions in clinical settings because clinicians will have their own considerations".

But Dr Pang is certain about one thing: "AI will be one of the areas that we should look into because of the rising demand from patients, limited resources and manpower issues. We have to think about how to properly adopt AI to manage the upcoming healthcare challenges".

For Dr Rachmat, digitalisation is not just "creating an app".

"It means, in healthcare, we are changing everything. We are transforming our organisation through innovation, [changing] the culture and the people by using technology," she said.

One of the missions of Pertamedika's IHC network is digital transformation, which for Dr Rachmat, also meant human transformation. "We don't change just the media from paper to digital, but we're actually changing people's mindset and culture and how they work," she said.

In 2019-2020, the IHC made efforts to consolidate its network and ensure digital, business and cultural transformations. For this year, they are seeking or adjusting existing EMR models across the hospital network so, by 2022 they can have a single EMR.

Dr Rachmat noted that the rate of digital adoption in Indonesia's healthcare system is 10%, which represents a "large opportunity" for expanding digital transformation in domestic hospitals. COVID-19, she said, is one of those factors driving digital adoption.

Last year, the IHC implemented data integration and interoperability to capture logistics data from all hospitals as the network worked to meet the needs of COVID-19 patients. This year, IHC plans to build a data infrastructure ahead of instituting business analytics and optimisation in 2022. In 2023, IHC will expand its digital ecosystem to include state-owned pharmaceutical firms via API sharing, and the following year, it will focus on robotics development.

On his end, Dr Widaja said what is crucial in building a digitally-enabled hospital is the concept and leadership, "making sure we have the right concept, how to plan it, we set the deadline and target, how do we execute it. And we have to make sure leadership is able to drive implementation".