How to cite:
Benedict Sulaiman, Adang Bachtiar (2024) Challenges of Digital Transformation of Healthcare
Industry in Indonesia, (06) 06, https://doi.org/10.36418/syntax-idea.v3i6.1227
E-ISSN:
2684-883X
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Ridwan Institute
CHALLENGES OF DIGITAL TRANSFORMATION OF HEALTHCARE INDUSTRY
IN INDONESIA
Benedict Sulaiman, Adang Bachtiar
Universitas Indonesia, Indonesia
Email: [email protected], ada[email protected]
Abstract
Digital transformation in healthcare is needed to continuously enhance healthcare services in
Indonesia, but all the changes happened especially after the Covid-19 pandemic has made
many healthcare facilities to face difficulties on prioritizing development and their operational
services. The Government thru the Ministry of Health have already defined the direction of
where the transformation is expected to be, but to fulfill that expectation will still be a huge
challenge for all healthcare facilities, both government and private. This research is intended
to bring perspective on the situation and challenges for private healthcare facilities on facing
digital transformation. The research method is conducted using cross sectional survey and
literature study to several private hospitals. From the results it can be seen that there are
various levels of readiness between the hospitals in order to face these challenges, which in
some cases still supported by skepticism of the stakeholders on the need for digital
transformation. But, at the end it can be concluded that digital transformation is needed and
eventually it will come, therefore all hospitals must be ready to face the transformation and
changes. All of this are happening for the good of healthcare in Indonesia
Keywords: Healthcare Digital Transformation; Hospital Information System; Electronic
Medical Record; Technology Disruption; Data Integration; Information Technology
INTRODUCTION
Before the Covid-19 pandemic, the development of information technology (IT) in
hospitals was not too significant. IT is only used to support the process of health services and
is difficult to innovate due to several things such as strict government regulations, the priority
of developing hospitals that prioritize medical services, limited funds and limited IT human
resources in the world of health (He, Zhang, & Li, 2021; Layne & Lee, 2001). The process in
hospitals that is also long and tends to be 'outdated' is also one of the factors in the lack of
innovation and system development, especially for integration with other hospital
stakeholders such as insurance, BPJS, vendors, banking and others.
However, during Covid-19 and now, IT development is very rapid and needed, causing
a lot of 'disruption' in hospitals which causes hospitals to transform in the IT and digital fields
in particular. Clarke, (2020) The government also formed a DTO (Digital Transformation
Office) at the Ministry of Health to form, provide the direction and purpose of health
transformation to be addressed, namely increasing digital capabilities in hospitals (Clarke,
JOURNAL SYNTAX IDEA
p–ISSN: 2723-4339 e-ISSN: 2548-1398
Vol. 6, No. 06, Juni 2024
Challenges of Digital Transformation of Healthcare Industry in Indonesia
Syntax Idea, Vol. 6, No. 06, Juni 2024 2729
2020). Starting from Peduli Lindungi which evolved into SATU SEHAT inevitably the
hospital must improve and develop (Dunleavy, Margetts, Bastow, & Tinkler, 2006; Vial,
2021).
Starting primarily is the adoption of RME (Electronic Medical Record) or what we have
known as EMR (Electronic Medical Record), which must be owned and used by every Health
Service Facility (Fasyankes) to then be able to report the results of services every day to
SATU SEHAT, but besides that many other things need to be prepared and developed, such
as the ability to integrate between systems or commonly known as EMR interoperability with
The government is still immature so that it can cause integration difficulties. This makes it a
challenge for all hospitals in Indonesia (Widiyanto, Sulistyati, & Zahroh, 2023).
The security aspect is also one of the most important factors that cannot be forgotten
and must be prioritized. The Government has established Law No. 27 of 2022 concerning
Personal Data Protection as the basis for protecting personal data, including medical record
data included in specific personal data stated in Article 4 (Fahmi, Pasaribu, Theodora, &
Wangdi, 2022). However, it is feared that the lack of time and speed of the transformation
process must be carried out will cause the potential for data leakage to be higher. But will
health facilities be able to face and secure data to ensure that the law can be fulfilled and
medical data is maintained? Currently there is no specific safety standard that is a reference
for health institutions, there are only general and international standards which if used as a
reference for application for health facilities will cause challenges and even their own burdens
that are difficult to meet (BIOTEKNOLOGI, 2016).
The government through the Ministry of Health has established 6 pillars of health
transformation where the 6th pillar is Health Technology Transformation (Dhawan, Rao,
Ambekar, Pusp, & Ray, 2017; Handayani, 2023). Health Technology Transformation has a
role in utilizing information technology and bio-technology around health (Tjandrawinata,
2016). Thus, it will make the world of health in Indonesia more adaptable and make good use
of the development of digital technology, so that the digitalization process around health can
grow more. The establishment of this pillar is a challenge for health facilities that have been
far behind in technology and now have to catch up very quickly (Nurfitria, Rania, &
Rahmadiani, 2022). The difference in the focus and objectives of the RS strategy with the
government's plan is not easy. There are still many hospitals that have not adopted EMR, and
within 2 years (since the information of SATU SEHAT was submitted) they will have to use
EMR and be ready for integration with SATU SEHAT.
The inadequate readiness of hospital infrastructure also adds to this problem. Coupled
with the readiness of hospital human resources both from medical, non-medical and IT
personnel themselves (Nurfitria et al., 2022; Sunindijo, Lestari, & Wijaya, 2020). Changing a
process from manual to EMR is not an easy change management challenge, especially many
senior health workers who are not used to using EMR. Differences in class and size of
hospitals will also determine and affect the ability of hospitals to determine strategies to adapt
digitally (Safi, Thiessen, & Schmailzl, 2018). It is not impossible that RS must change the
prioritization of development and projects to focus on this transformation process, thus
Benedict Sulaiman, Adang Bachtiar
2730 Syntax Idea, Vol. 6, No. 06, Juni 2024
massive disruption will occur. Apart from the cost and investment factors that must be
allocated for IT development, this may change priorities from previous planning.
These things are a problem to be able to see the readiness of hospitals in transforming to
support their operational processes. Through this paper, it is expected to provide an overview
and answers to questions about the health industry in Indonesia in welcoming the digital
transformation of health, such as how the readiness of hospitals to meet the demands of the
government and the digital ecosystem that is running today. How hospitals can balance their
general hospital strategy and IT strategy with the government's digital transformation. Get
predictions for the success of digital transformation of the Health industry in Infonesia.
RESEACRH METHOD
The author identifies the main factors that play a role in influencing the health
transformation process, namely the availability of electronic medical records in hospitals, IT
human resources, IT investment and funding in hospitals. Then the author conducted a
literature study conducted on these factors and then became the basis for the formation of a
descriptive survey questionnaire with a quantitative approach that will be disseminated to
several selected hospitals, especially at the hospital management level (Tarsito, 2014).
The questionnaire was distributed in February-April 2024 to hospital management in the
Greater Jakarta area (Jakarta, Bogor, Depok, Tangerang and Bekasi). Obtained 40 respondents
with the composition of class B (14 hospitals), class C (18 hospitals) and class D (8 hospitals)
The analysis of the questionnaire results will prove and answer the questions that have been
submitted previously (Noor, 2020). The collected data were analyzed using descriptive
statistics to describe the frequency and percentage distribution of each variable studied. Data
analysis is performed using Microsoft Excel software to facilitate data processing and ensure
accurate results.
RESULTS AND DISCUSSION
The survey results show that the majority of hospitals in the Jabodetabek area rate
themselves quite highly in terms of health digital transformation. Based on the Likert scale of
1-10, 70% of respondents ranked themselves below 7-10 and 30% of respondents rated
themselves below 6. This assessment distribution shows a disparity in the level of digital
transformation in Jabodetabek hospitals. This signals the need for further interventions to
ensure that all hospitals can achieve optimal levels of digital transformation.
Figure 1.
Respondents' Self-Assessment of Health Digital Transformation that has been carried out.
Challenges of Digital Transformation of Healthcare Industry in Indonesia
Syntax Idea, Vol. 6, No. 06, Juni 2024 2731
Electronic Medical Record (RME) Standards and Interoperability
One of the factors of hospital readiness and maturity in undergoing digital
transformation is the availability of RME (Electronic Medical Record). Based on the Digital
Maturity Report of Hospitals in Indonesia in 2023 (Ministry of Health, 2024)(Ministry of
Health, 2024) the survey results of the Indonesian Hospital Association show that 772
hospitals have adopted RME. There are 15% of hospitals that have fully implemented EMR,
39% have only partially implemented EMR, and the rest have not implemented EMR.
Meanwhile, from the survey conducted by the author, it was found that 90% (36 RS) have
adopted RME and only 10% (4 RS) have not done RME. This can be because the respondents
come from Jabodetabek which is more mature and developed. This can also be caused by a
push from the Ministry of Health by the end of December 2023 which requires the process of
adopting RME and integrating SATU SEHAT to be completed by December 2024.
The survey results also show that there are 75% of hospitals that have been completed
integrated in SATU SEHAT, 17.5% of hospitals are in process and only 10% have not done
so by April 2024. One of the difficulty factors encountered in the field is the difference
between Hospital Management Information Systems and EMRs applied. In an effort to
harmonize data and information systems, the government has taken appropriate steps since
2022 by issuing KMK 01.07/Menkes/1423/2022 concerning Guidelines for Variables and
Metadata in the implementation of Electronic Medical Records (Kementerian Kesehatan
Republik Indonesia, 2022)(Kementerian Kesehatan Republik Indonesia, 2022)
Figure 2.
Proportion of Number of Hospitals that have used electronic medical records
Figure 3.
Percentage of RME adoption in hospitals
Benedict Sulaiman, Adang Bachtiar
2732 Syntax Idea, Vol. 6, No. 06, Juni 2024
IT Human Resources
The adequacy factor of the number of IT human resources per hospital is one of the
things that is quite important in assessing hospital readiness. From the survey, it was found
that the number of IT workers was still insufficient. Class C and D hospital groups on average
only have 1-2 IT workers. There are 25% (10 hospitals) of respondents have 2 IT human
resources, 7.5% (3 hospitals) have 1 IT human resource, and there are several class C
hospitals that have also increased the number of IT human resources to 3 (2.5%). As for the
class B hospital group, the majority already have 3-5 IT human resources (50%) and there are
even hospitals that have up to 8 human resources (2.5%).
A different approach is taken by several class B hospitals that are known to have more
than 1 hospital, where IT HR has been centralized and uses the concept of shared services, so
that IT HR can support several hospitals at once. This is very good for the efficiency and
standardization of IT HR. In the Digital Maturity Report, the assessment carried out is not on
the number of IT human resources, but on the presence / absence of IT human resources who
manage SIMRS, but the author assesses based on experience, the number and role of IT HR is
very significant and can be assisted by third parties as IT service providers. The number of IT
human resources is also closely related to the focus of development and also the risk aspects
of SIMRS. With a sufficient and qualified number of IT human resources, hospitals will be
able to develop and also improve supported by other parties including SIMRS providers.
IT Investment and Funds
In terms of investment or funds allocated, the survey found that 82.5% of respondents
have allocated special funding to carry out digital transformation. But unfortunately when
asked about how much it is, 37.5% (15 RS) did not want to answer the amount of funds
allocated. 20% allocates IT funding between Rp 1,000,000,000-1,500,000,000, 12.5% (5 RS)
allocates Rp 1,500,000,000-2,000,000,000, 10% (4 RS) allocates Rp 5,000,000,000-
10,000,000,000 and 10% (4 RS) above Rp 10,000,000,000.
Budget is important and cannot be separated from hospital operations. The budget for
digital transformation is not cheap. The aspects of technology that must be protected as well
as the operational costs of technology such as the internet, device maintenance and device
modernization will also consume funds that may have originally been allocated to other
priorities in hospitals.
In the question of what important factors need to be considered in carrying out health
digital transformation, it was found that the security factor is the most important at 72.5% or
29 respondents, and 62.5% (29 respondents) ranked integration with third parties as a factor
that needs attention. The government itself asks all SIMRS providers to have high and easy
interopability. Especially now that there has been a lot of cooperation and integration carried
out between SIMRS with companies and health service providers such as BPJS and other
insurance. Followed by the factor of ease for patients in accessing the system by 42.5% (17
respondents). All of these factors require a lot of investment and affect how hospitals
prioritize budget management that is right, correct and efficient. Hospital management is
faced with the dilemma of prioritizing IT investment or prioritizing investment in medical
Challenges of Digital Transformation of Healthcare Industry in Indonesia
Syntax Idea, Vol. 6, No. 06, Juni 2024 2733
services such as equipment or other resources. But in this case, the fulfillment of IT is very
important and unavoidable because all directions of the goal lead to technology and SATU
SEHAT initiatives from the government that must be met. This process is not easy and must
be ensured security so that data leakage does not occur.
Figure 4.
Influencing Factors in Health Digital Transformation
Digital Maturity Index
Since October 2022 after the COVID-19 pandemic, the Ministry of Health, in
collaboration with hospital associations such as PERSI, has held a Self-Assessment Digital
Maturity Index. Digital maturity assessment consists of 7 components of technical and non-
technical aspects, namely (Indonesia, 2017):
1. Hospital strategic
2. Capability Technology Hospital
3. Interopability
4. Governance and Management
5. Patient-centered Health Services
6. Skills, Behaviours and Digital Literacy
7. Data Analysis
The assessment of these aspects aims to identify priority challenges and
recommendations to answer the needs of digital transformation in Indonesia. In the future,
individually, hospitals can see which aspects are the weakest and can plan and strengthen
digital capacity according to the results of the assessment independently. The Ministry of
Health expects all hospitals to adapt to the use of digital technology as well as compliance
with regulations in Indonesia (Kementerian Kesehatan, 2024).
The digital maturity self-assessment was attended by 3,075 hospitals in Indonesia
(HASIBUAN, 2022). There are 1,552 hospitals conducting complete digital maturity
assessments. However, only 1,549 (50.37%) met the criteria for digital maturity analysis
(DMI level), and only 1,366 hospitals (44.42%) met the criteria for the assessment of
electronic medical record adoption (RME) rate. The rest are not ready. The results of the DMI
(Digital Maturity Index) level assessment show that the majority of hospitals are at DMI level
3 (39%) and DMI level 2 (28%). Hospitals in the Java-Bali area have a higher average level
of digital maturity than other regions.
Benedict Sulaiman, Adang Bachtiar
2734 Syntax Idea, Vol. 6, No. 06, Juni 2024
The independent digital maturity assessment shows several challenges. The complexity
of digital maturity assessment instruments requires the involvement of staff from technical
backgrounds in related and health units so as to have a correct understanding of the
operational definition of each component measured. Technical constraints on the use of
electronic surveys may have an impact on the completeness of filling, especially in areas with
difficult geographical locations. The involvement of the health office is needed to facilitate
communication and technical support in increasing the response rate and completeness of the
hospital's digital maturity survey.
CONCLUSSION
This research succeeded in providing a comprehensive picture of the readiness of
hospitals in the Jabodetabek area in facing the demands of health digital transformation
launched by the government. The survey results show that the majority of hospitals rate
themselves quite highly in digital transformation. This indicates a significant step that has
been taken by hospitals in adopting digital technology. However, some respondents who rated
themselves below 6 showed a significant gap in the implementation of digitalization in these
hospitals.
Second, the study reveals how hospitals are trying to balance their general and IT
strategies with government digital transformation initiatives. Challenges such as the limited
number of IT human resources and the need for significant investment are major obstacles.
However, some hospitals have implemented the concept of shared services to improve the
efficiency and standardization of IT human resources.
Third, the benchmark for the success of the digital transformation of the health industry
in Indonesia can be predicted from the results of an independent assessment of the level of
digital maturity of hospitals. The digital maturity assessment shows that the majority of
hospitals are at DMI levels 3 and 2, with hospitals in Java-Bali having higher digital maturity
than other regions. Factors such as security, integration with third parties, and ease of access
for patients were identified as keys to successful digital transformation. In the future, this
assessment process must continue to be carried out continuously and the role of the Ministry
of Health is not only to assess the level of digital maturity of hospitals, but also to provide
assistance, direction to the journey of each hospital.
To ensure successful digital transformation in hospitals across Indonesia, several
strategic steps need to be taken. First, upgrading technology infrastructure is a top priority,
with further investment in a stable internet network and adequate hardware. In addition,
strengthening IT human resources through training and certification should also be a focus,
including special recruitment programs and collaboration with educational institutions to
provide a ready-made workforce. Standardization of hospital management information
systems (SIMRS) and electronic medical records (RME) needs to be strengthened to address
interoperability issues, with the Ministry of Health implementing guidelines and regulations
related to variables and metadata by the Ministry of Health(Kementerian Kesehatan, 2022)
Adequate funding and investment should be allocated by hospitals for digital
transformation, covering operational costs and technology maintenance, as well as increased
Challenges of Digital Transformation of Healthcare Industry in Indonesia
Syntax Idea, Vol. 6, No. 06, Juni 2024 2735
transparency in IT fund management to ensure efficient and effective use of budgets. The
focus on data security and privacy should also be increased to prevent leakage of patient
information, through the implementation of strict security protocols and regular audits.
Support from the government through policies, regulations, and incentives needs to continue
to be provided to encourage hospitals in the digital transformation process, including technical
and financial assistance programs for hospitals that are still left behind.
In addition, regular monitoring and evaluation through digital maturity assessments and
regular audits is essential to monitor progress and identify areas that require improvement.
Data from these assessments should be used to adjust existing strategies and policies. With
these steps, it is expected that digital transformation in the Indonesian healthcare industry can
run faster, more effectively, and more evenly, thereby improving the overall quality of
healthcare.
BIBLIOGRAFI
Bioteknologi, D. A. N. (2016). Industri 4.0: Revolusi Industri Abad Ini Dan Pengaruhnya
Pada Bidang Kesehatan.
Clarke, Amanda. (2020). Digital Government Units: What Are They, And What Do They
Mean For Digital Era Public Management Renewal? International Public Management
Journal, 23(3), 358–379.
Dhawan, Anju, Rao, Ravindra, Ambekar, Atul, Pusp, Amal, & Ray, Rajat. (2017). Treatment
Of Substance Use Disorders Through The Government Health Facilities: Developments
In The “Drug De-Addiction Programme” Of Ministry Of Health And Family Welfare,
Government Of India. Indian Journal Of Psychiatry, 59(3), 380–384.
Dunleavy, Patrick, Margetts, Helen, Bastow, Simon, & Tinkler, Jane. (2006). New Public
Management Is Dead—Long Live Digital-Era Governance. Journal Of Public
Administration Research And Theory, 16(3), 467–494.
Fahmi, Fahmi, Pasaribu, Ayodhia Pitaloka, Theodora, Minerva, & Wangdi, Kinley. (2022).
Spatial Analysis To Evaluate Risk Of Malaria In Northern Sumatera, Indonesia. Malaria
Journal, 21(1), 241.
Handayani, Anastasia Susilo. (2023). Implikasi Permenkes Nomor 24 Tahun 2022 Terhadap
Pelaksanaan Rekam Medis Elektronik Melalui Sistim Informasi Puskesmas
(Simpus)(Studi Kasus Di Puskesmas Temanggung). Universitas Katholik Soegijapranata
Semarang.
Hasibuan, Santi Fahrima. (2022). Dampak Pembelajaran Dalam Jaringan (Daring) Terhadap
Interaksi Sosial Anak Usia 5-6 Tahun Di Tk Islam Fatimah Pekanbaru. Universitas
Islam Negeri Sultan Syarif Kasim Riau.
He, Wu, Zhang, Zuopeng Justin, & Li, Wenzhuo. (2021). Information Technology Solutions,
Challenges, And Suggestions For Tackling The Covid-19 Pandemic. International
Journal Of Information Management, 57, 102287.
Indonesia, Pemerintah Republik. (2017). Kementerian Kesehatan Republik Indonesia.
Republic Of Indonesia Law Number 36 Of 2014 Concerning Health Workers.
Layne, Karen, & Lee, Jungwoo. (2001). Developing Fully Functional E-Government: A Four
Stage Model. Government Information Quarterly, 18(2), 122–136.
Noor, H. R. Zulki Zulkifli. (2020). Metodologi Penelitian Kualitatif Dan Kuantitatif:
Petunjuk Praktis Untuk Penyusunan Skripsi, Tesis, Dan Disertasi: Tahun 2015.
Deepublish.
Benedict Sulaiman, Adang Bachtiar
2736 Syntax Idea, Vol. 6, No. 06, Juni 2024
Nurfitria, Bunga, Rania, Firna, & Rahmadiani, Nur Wahyu. (2022). Literature Review:
Implementasi Rekam Medis Elektronik Di Institusi Pelayanan Kesehatan Di Indonesia.
Researchgate (October), 1–16.
Safi, Sabur, Thiessen, Thomas, & Schmailzl, Kurt J. G. (2018). Acceptance And Resistance
Of New Digital Technologies In Medicine: Qualitative Study. Jmir Research Protocols,
7(12), E11072.
Sunindijo, Riza Yosia, Lestari, Fatma, & Wijaya, Oktomi. (2020). Hospital Safety Index:
Assessing The Readiness And Resiliency Of Hospitals In Indonesia. Facilities, 38(1/2),
39–51.
Tarsito, Sugiyono. (2014). Metode Penelitian Kuantitatif, Kualitatif Dan R&D. Alfabeta.
Bandung.
Tjandrawinata, Raymond R. (2016). Industri 4.0: Revolusi Industri Abad Ini Dan
Pengaruhnya Pada Bidang Kesehatan Dan Bioteknologi. Jurnal Medicinus, 29(1), 31–39.
Vial, Gregory. (2021). Understanding Digital Transformation: A Review And A Research
Agenda. Managing Digital Transformation, 13–66.
Widiyanto, Wahyu Wijaya, Sulistyati, Hanifah Shobri, & Zahroh, Salsabila Ummu. (2023).
Analysis Of Readiness For Implementation Of Electronic Medical Records Using Doq-It
Method. International Journal Of Computer And Information System (Ijcis), 4(4), 158–
164.
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