Our Team will start to apply in Cardiology and Dermatology

1. TELEMEDICINE - TELECARDIOLOGY!
PROFESSOR DR HAMED OEMAR, PHD
Senior Consultant Cardiology,
Echocardiologist,
e-Health Supervisor,
Faculty of Medicine UiTM Malaysia

2. TELEMEDICINE:
Medical equipment is one of the basic requirements to set up a
telemedicine station and support an examination. With the right
telemedicine equipment and telemedicine software, new and cutting edge
healthcare can be provided.

3. INTRODUCTION
• Closed the Gap: shutting the breach
between a modern and a rural hospital
• A Golden Bridge: bridging an inadequate of
latest technology on one-to-another
• Inter-connection: linking a hospital to
another hospital
• Education Hub: media for upgrading
knowledge, skill and competence of MD/NR

6. E-HEALTH AND M-HEALTH
Pelayanan kesehatan berbasis elektronik (e-
Health) telah dianjurkan oleh World Health
Organization (WHO) sejak 2005

8. TO SOLVE MANY
PROBLEMS OF
INADEQUATE CONDITIONS
Menyelesaikan
masalah komunikasi
yang paling banyak
dihadapi oleh Rumah
Sakit, Pasien dan
Keluarga pasien

9. TO SOLVE MANY
PROBLEMS OF
INADEQUATE CONDITIONS
Menyelesaikan
masalah kekurangan
tenaga dokter yang
dihadapi oleh Rumah
Sakit dan Pasien/
Keluarga pasien

10. TO SOLVE MANY
PROBLEMS OF
INADEQUATE CONDITIONS
Menyelesaikan
masalah kekurangan
& kelambatan
pelayanan spesialis/
sub-spesialis
terhadap berbagai
penyakit sulit dan
berat

11. RATIO POPULATION AND DOCTOR
• 2012 data shows 30 doctors 100,000
population, ratio is 1:3300
Organisasi Kesehatan Dunia (WHO) tahun 2012,
jumlah dokter dengan penduduk Indonesia tidak
sebanding, sehingga bisa dikatakan hal ini paling buruk
se-ASEAN (Association of South East Asia Nations)

12. KONDISI GEOGRAFI
• Indonesia adalah negara kepulauan (17.000 pulau).
• Penempatkan dokter spesialis di seluruh pulau jelas
memiliki kendala tersendiri.
• Masyarakat yang berada di kabupaten, kecamatan,
atau desa apalagi di daerah perbatasan mau tak mau
harus cukup puas dilayani oleh dokter yang bukan
spesialis atau bahkan mantri dan perawat.

13. FLOW PASIEN BEROBAT KE LUAR NEGERI
• Animo masyarakat Indonesia untuk berobat
keluar negeri juga cukup tinggi.
• Ketua IDI “Dalam setahun hampir 1 juta
orang berobat ke luar negeri dengan uang
yang dibelanjakan ke luar negeri untuk
kepentingan berobat mencapai angka Rp 20
triliun”

14. PEMBANGUNAN KESEHATAN
• Peningkatkan pembangunan kesehatan di
Indonesia akan sulit kalau tidak ada
“terobosan baru”
• Tujuan Pembangunan Nasional:
• Meningkatkan kesadaran, kemauan, dan
kemampuan hidup sehat
• Investasi bagi pembangunan sumber daya
manusia yang produktif secara sosial dan
ekonomis.

15. RUMAH SAKIT YANG MEMILIKI
DOKTER SPESIALIS DI INDONESIA
NO
DOKTER
SPESIALIS
JUMLAH
JUMLAH RS
YANG TIDAK
MEMILIKI
JUMLAH RS
YANG
MEMILIKI
% RS YANG
MEMILIKI DOKTER
SPESIALIS
1 Anak 5,241 511 1,854 78.4
2 Obgyn 6,242 502 1,863 78.8
3 Penyakit Dalam 4,862 596 1,769 74.8
4 Bedah 4,230 654 1,711 72.3
5 Radiologi 2,106 1,096 1,269 53.7
6 Anestesi 3,361 787 1,578 66.7
7
Jantung &
Pembuluh Darah
1,179 1,767 598 25.3
8 Saraf 1,820 1,399 966 40.8
9 Paru 1,093 1,698 667 28.2
10 Mata 2,431 1,215 1,150 48.6
11 THT 2,290 1,214 1,151 48.7
12 Patologi Klinik 1,009 1,615 750 31.7
13 Kes. Jiwa 1,083 1,744 621 26.3
14 Patologi Anatomi 467 2,047 318 13.4
15 Urologi 412 2,094 271 11.5
16 Orthopedi 765 1,905 460 19.5
17 Kulit&Kelamin 902 1,854 511 21.6
18 Forensik 99 2,303 62 2.6
19
Dokter Spesialis
Lainnya
2,233 1,940 425 18
✓
✓
✓
✓
✓
✓
✓
Sumber: KemKes RI, Data 2008
✓ = Tersedia Spesialis <30%

16. WHEN DO WE NEED TELEMEDICINE?
• Many patients find it difficult to travel to clinics,
hospitals, or doctors’ offices for any number of
reasons.
• By using video conferencing and other
telemedicine technology when applicable,
healthcare practitioners and patients can reduce
the costs associated with regular office visits.

17. TELEMEDICINE | WHY USE TELEMEDICINE?
• Remote healthcare services and technology are
quickly becoming common-place for healthcare.
• Telemedicine enables practitioners to evaluate,
diagnose and treat patients remotely using the
latest telecommunications technology.

20. DOCTOR – PATIENT COMMUNICATION IN TELEMEDICINE

21. E-HEALTH OR TELEMEDICINE STATION

26. ECHO Room at
Center or Hospital

27. MANFAAT TELEMEDICINE
• Mendekatkan akses dokter-pasien yang jauh
• Meningkatkan kwalitas pelayanan kesehatan
• Komunikasi konsultasi antara RS dan RS
• Mendapatkan pendidikan spesialis/konsultan dan
provider
• Meningkatkan kepuasan pasien dan RS/provider
• Mengurangi biaya kesehatan secara umum
• Meningkatkan efisiensi pelayanan tertiar

28. INITIATIVE TO BE
SUCCESSFUL!
1. Establishing an incentive-based program.
“sustainable funding is vital”
2. Infrastructure. “Having adequate infrastructures [in place] to
support these initiatives
3. Improved telemed reimbursements.
4. Fostering user acceptance & confidence in telemedIcine.
5. Resources and time. ”programs must have the proper
allocated resources and time necessary to ensure its
widespread adoption”.

29. EQUIPMENT FOR TELEMEDICINE

30. EQUIPMENT IN TELEMEDICINE
• Fiber optics
• Broadband/wireless coverage
• Video
• Computer
• Voice and imaging.

31. BASE STATION
• Echocardiographer Mobile Application
• Web Application
• Network A/V Encoder

33. SPECIAL CAMERA
• Teleconference
equipment enabling
seamless and real-
time face-to-face
collaboration at the
desktop.

34. SAMPLE: Polycom HDX 7000
• HD video conferencing for
high-quality communication
in workplace environments.
• ideal for education,
medical, enterprise & on-
demand collaboration
solutions, expanding the
utility of visual
communications quickly
and easily
.
1
2
3
4
5
VICON

35. TRAINING BY EXPERT
• Class Room versus Teleconference Room and
Laboratorium (Tatap-muka)
• On-line at Far Distance Course
• Self Learning and Assessment Test
• Evaluation

36. STUDY ON-LINE AT CLASS ROOM

37. TELECONFERENCE

41. Seorang MLT melakukan rekaman USG Liver!

42. Workstation at Telemedicine Center

43. TELECARDIOLOGY
Contoh, seorang spesialis sedang membuat intererpretasi dan diagnosis echo LA Myxoma

44. TELE-DERMATOLOGY
Seorang spesialis sedang membuat analisa penyakit kulit penderita dari RS Satelit (Daerah)

45. Use of information and
communication technologies:
i) To provide specialized health care consultation
to patients in remote locations,
ii) To facilitate video-conferencing among health
care experts for better treatment & care,
iii) To provide opportunities for continuing
education of health care personnel.
Objectives of Telemedicine

46. Relevance of Telemedicine
Ø Inadequate infrastructure in rural/district hospitals
Ø Large number of indoor/outdoor patients requiring
referral for specialized care
Ø Low-availability of Health Experts in district/remote
hospitals
Ø Shortage of adequate opportunities for training or
continuing Medical Education for Doctors in Rural/
Remote Health facilities.
IN GENERAL

47. Benefits of Telemedicine (I)
Benefits to Patients:
Ø Access to specialized health care services to
under-served rural, semi-urban and remote
areas,
Ø Access to expertise of Medical Specialists to a
larger population without physical referral,
Ø Reduced visits to specialty hospitals for long
term follow-up care for the aged and terminally
ill patients.

48. Benefits to Physicians:
Ø Improved diagnosis and better treatment
management
Ø Access to computerized, comprehensive data
(text, voice, images etc.) of patients – offline
as well as real time
Ø Quick and timely follow-up of patients
discharged after palliative care
Ø Continuing Education or Training (CME&T)
through video conferencing periodically
Benefits of Telemedicine (II)

49. Hospital and Insurance Benefits:
Ø Significant reduction in unnecessary visits &
hospitalization for specialized care at tertiary
hospitals,
Ø Earlier discharge of patients leading to shorter
length of stay in hospitals,
Ø Increase in the scope of services without
creating physical infrastructure in remote
hospitals
Benefits of Telemedicine (III)

50. ADVANTAGE
Ø Real-time transmission.
Ø Reduction of both patient and physician
transfers.
Ø Scheduling of consultation.
Ø Emergency management.
Ø Clinical record and remote reporting.

51. THE SYSTEM IS BASED ON THREE MAIN
COMPONENTS
• The control station (one per tertiary care
center)
• The base station (one per secondary care
center)
• The data hub (one for the whole system)

52. CONTROL STATION
• Specialized Desktop Application
• The specialist may control pan, tilt and zoom of
the camera through the keyboard or the on-
screen graphical interface
• Web Application
• view the clinical records and create or edit
consultation reports.

53. Sequence of Tele-consultation (I)
PATIENT IN
Patient visits OPD
Local Doctor checks up
Patient receives treatment
and is not referred to
telemedicine system
Patient referred to the Telemedicine system (some
special investigations may be suggested)
Patient visits Telemedicine data-entry console.
Operator enters patient record, data and images of
test results, appointment date is fixed for online
telemedicine session
OUT
OUT
Offline Data
transfer
from Nodal
Centre
StepOne

54. Patient 1
Patient 2
Patient 3
Patient 4
.
.
.
Online video conference & tele-
consultation for patients between
local doctors at the nodal hospital
and specialist doctors at the
referral hospital
Patient Queue
IN OUT
StepTwoSequence of Tele-consultation (II)

55. Connecting the All Health Centers

56. CONNECTING SATELITES HOSPITALS
IN INDONESIA
TELEMEDICINE
CENTER
H9
H7
H6
H10

57. BERBASIS VICON
• Telemedicine berbasis video conference
yaitu pelayanan kesehatan rujukan
antara fasilitas pelayanan kesehatan
yang dilaksanakan secara jarak jauh
melalui media teknologi informasi dan
telekomunikasi, yang memungkinkan
terjadi komunikasi tatap muka antara
tenaga kesehatan.

58. JENIS PERALATAN TELEMEDICINE
BERBASIS VICON
• End-point video confere :2 set (pengampu dan diampu)
• Komputer set/PC : 2 set (pengampu dan diampu)
• Monitor TV 32 inch : 2 set (pengampu dan diampu)
• UPS : 2 set (pengampu dan diampu)
Peralatan tersebut terdiri dari !
!

59. EXPERTS ROLE
(Peranan dan Tanggung-Jawab Pakar Supervisor)
• Kebijakan Program Telemedicine
• Supervisi Pelakasanaan di Lapangan
• Koordinasi lalu-lintas informasi pasien-ke-dokter, vs
• Koordinasi Para Spesialis yang Terdaftar Ikut
Program Telemedicine
• Tanggung-jawab Sistem Pelaporan Kasus, Keakuratan
dan Sekuriti Tranfer ke RS Satelit

60. EXPERT’S STATION & EDUCATIONAL
RESPONSIBILITY
• It is not dependency on one expert or
specialist
• Expert have to do transfer of knowledge
and skill to younger specialist in the team
group
• Expert shall have limit period of tenure, for
instance, 3-4 years

61. EDUATIONAL RESPONSIBLE –
TRAINING CENTER
• Young Specialist (Cardiologist, Dermatologist,
Neurologist, Radiologist, Pediatricians, Psychiatry,
Public Health, etc.)
• MLT (Medical Laboratory Technicians), Radiographer
• Nurses (Male and Female)

62. UU DAN PERATURAN SEBAGAI GUIDELINE
• Undang-Undang No. 36 Tahun 1999 tentang Telekomunikasi
• Undang-Undang No. 36 Tahun 2009 tentang Kesehatan
• Undang-Undang No. 44 Tahun 2009 tentang Rumah Sakit
• Undang-Undang Nomor 11 Tahun 2008 tentang Informasi dan
Transaksi Elektronik
• Keputusan Menteri Kesehatan Nomor 1014 tahun 2008
• Permenkes RI Nomor 780/Menkes/Per/VIII/2008 tentang
Penyelenggaraan Pelayanan Radiologi
• Petunjuk Teknis Sistem Informasi Kesehatan, 2011, KemKes RI

64. CONCLUSION
• Telemedicine, if used to its full extent, has the potential to
cause great and far-reaching effects on the field of medicine.
• The implementation and effective use of Internet, mobile and
video technologies offer hospitals, physician groups and health
plans ways to improve their performance and provide greater
convenience and value to patients.
• As new health care delivery and payment models evolve, and
the systems to support the use of new technologies improve and
become less costly, telemedicine offers the potential to improve
the efficiency, convenience and cost-effectiveness of our health
care system.