| 4. In which ways is the initiative creative and innovative?
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Utilization of information technology may not be separated from many aspect of life, including health. Utilization of information technology is obtained a lot at hospital and primary care in Indonesia, however this innovation is unique because of JCH is the only hospital in Indonesia that brave enough to apply paperless application at all of service unit.
The system is creatively modified by mobile using tablet of electronic device. Hospital data in huge amount can be accessed just only using electronic device which can be carried around easily (tablet). JCH is Hospital on Tablet.
The innovation gets more unique because of service information can be accessed by everyone, everytime, and everywhere based on his/her authority. JCH is borderless hospital.
Jember Chest Hospital introduces new concept, brave enough to become pioneer of medical record paperless application at all service unit by mobile of medical record electronic in Indonesia. Jember Chest Hospital bravely becomes the pioneer of available access of public information that improve worker integrity and prevent corruption/bribe.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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HoT (Hospital on Tablet) motivator is the staff of JCH Information System Unit that consist of : a) information technology programmer with formal education qualification of Bachelor of Informatics Technology (1 person) and qualification of Diploma of Informatics Management (2 persons); b) Information Technology Technisian with formal education qualification of Diploma of Computer or Network Technique (3 persons) and be assisted by Electrics High School Graduate (2 persons); and c) medical record employee with formal education qualification of Diploma of Medical Record (2 persons) and be assisted by High School Graduate employees (5 persons).
All of this innovation motivators receive particular workshop and accompaniment from vendor of information technology consultant. From employees number, formal education obtained, particular workshop and accompaniment that be received from vendor so all innovation motivators have adequate expertise to move the application system that integrated with HoT (Hospital on Tablet).
Improvement of HoT (Hospital on Tablet) gives benefit for, first : health providers take rate and accurate patient medical data. Patient medical data is needed for making decision of medical implementation. Patient medical data rate and accuracy will improve medical service quality.
Second : Jember Chest Hospital Management obtain hospital data rate and accuracy. Hospital data help management to make managerial decision correctly.
Third : Jember Chest Hospital stakeholders obtain information correctly. Correct informations determine stakeholder policy in development of Jember Chest Hospital.
Forth : Jember Chest Hospital consumers receive access to JCH public service information. All of society element receive qualified medical service.
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| 6. How was the strategy implemented and what resources were mobilized?
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The chronology of innovation implementation of digital hospital was: it is started with delivering idea in Jember Chest Hospital Development Symposium on 2005 at Surabaya. Then forming JCH Information System Unit as innovation motivator.
Through tight selection, in choosing information technology vendor. In the same year, vendor developed template billing system. JCH Management provided 20 computer units that integrated with system. After socialization, workshop and accompaniment by vendor, billing system application can be proceeded.
In 2006 vendor developed template inventory system and electronic pharmacy template. After socialization, workshop and accompaniment by vendor, inventory system and electronic pharmacy application can be proceeded.
In 2007 vendor developed electronic medical record and supporting medical template. After socialization, workshop and accompaniment by vendor, radiology and laboratory application can be proceeded. Then it was followed by outpatient electronic medical record and emergency service application. Inpatient electronic medical record was not proceeded yet.
In 2008 JCH digital hospital was sertified with ISO 9001: 2008. However until 2010 JCH Digital hospital was walked in place. Inpatient electronic medical record application still can be proceeded. The aim of digital hospital development was to reach effectiveness and efficiency of service can be fulfilled. Even JCH management had double burden in preparing manual and electronic medical record.
In 2011 the development of electronic medical record application system was adapted as Medical Board wish. In 2012 inpatient electronic medical record system was started. In order to give comfortness in application filling, server capacity renew was held.
In 2013 digital hospital was modified with using computer divice (tablet) and be named HoT (Hospital on Tablet). Digital Hospital was able to proceed completely, accurately, and real time.
In 2013 JCH Management took policy to withdraw manual medical record. In 2013 JCH was the only one hospital in Indonesia who barvely enough to apply paperless system*.
Since 2014, JCH was become learning and comparison study center for electronic medical record. Some of hospitals who visit were : Jember dr Soebandi Government Hospital, Jakarta Persahabatan Government Hospital, Bali Badung Government Hospital, Yogyakarta Lung Health Service, Kertosono Government Hospital, Situbondo Abdul Rohim Hospital, Surabaya Menur Psychiatry Hospital, Bondowoso Koesnadi Government Hospital, Bali Klungkung Government Hospital and Mojokerto Prof Dr Soekandar Government Hospital.
In 2015, JCH enrolled Public Service Innovation Competition and got Top 99. The JCH enrolled m-Health Competition : Innovation for Sustainable Health (sHealth) 2015 and be awarded as the champion for Asian Region.
Through digital hospital, JCH received award as hospital with best public service in East Java region. Besides, JCH also received award as hospital with integrity zone of free corruption in East Java region.
In 2016 the development of application system for public accessibility and application was suitable with KARS accreditation version 2012. Still in progress of development are : electronic accrual accounting system, payment system using magnetic card, self registration system via internet and application integrated website system.
Financing source of HoT (Hospital on Tablet) innovation development, digital hospital promote transparency, accountability and integrity in public service for capital expenditure and maintenance use ex routine APBD fund. Meanwhile for software and hardware development uses functional APBD fund.
For electronic device purchasing as supporting integrated application implementation is facilitated by vendor. HoT (Hospital on Tablet) innovation, has been planned from financial element via APBD, and it was part of Strategic Bussiness Plan and JCH Governance System.
System development is proceeded gradually and continually. The expense that be spent for every system development (billing system, inventory, electronic pharmacy, electronic medical record and public accessibility) is not less than Rp. 200.000.000,-. Routine accompaniment cost by information technology consultant vendor is Rp. 60.000.000,- every year.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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Involved stakeholders in innovation implementation consist of idea initiators, motivator and main characters and also information technology consultant vendor. Idea initiators of HoT (Hospital on Tablet), Digital Hospital Promote Transparency, Accountability, and Integrity in Public Service is Director of Jember Chest Hospital.
Innovation motivator is JCH Information System Unit. Innovation main character is medical doctors. Beside filling in electronic medical record, medical doctor through Medical Board also is involved in application system development along with information technology consultant vendor.
Information technology consultant vendor is consultant of application system developer and routine companion in HoT (Hospital on Tablet) implementation. Information technology consultant vendor was selected through tough selection that involving JCH stakeholders and academic community.
Vendor must have commitment in developing application system based on public access continually and be suitable with JCH local requirement. Innovation motivator and person receive workshop and accompaniment in system implementation gradually by consultant vendor.
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| 8. What were the most successful outputs and why was the initiative effective?
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Public service is proceeded effectively, accountable and transparent (SDGs #16.6). The effectivity of public service before and after innovation can be seen through response time of patient admission service before innovation was done ± 2 hours, after innovation it is shortened to 30 minutes.
Incomplete medical record before innovation was above 10%, after innovation became less than 2%. Another outcome is paper utilization efficiency, one inpatient patient in one day needs minimum 20 paper sheets for manual medical record, after innovation it does not need paper anymore (paperless).
The rate and accuracy of patient data affect improvement of patient safety. Innovation outcome is reduction in the length of hospital stay, before innovation length of stay (LOS) is 14 days, after innovation reduces 3-4 days.
After HoT (Hospital on Tablet) innovation appears openness of public information. The society can control, monitor and give feedback to the service. After innovation, there is certainty of service and tariff.
Reducing corruption and bribe in any form (SDGs 16.5). Before innovation, corruption appears in any towing fees out of procedures, financial data manipulation, tariff discrepancy with service type that be given and payment slip forgery. Bribe appears in gratification form of JCH item purchasing. Corruption and bribe can happen because of financial transaction data was done manually at every service unit and not integrated.
After innovation, financial transaction data is recorded in integrated application system. Corruption and bribe in any forms is not appeared because of JCH or individual worker performances are measured and recorded in digital hospital.
Improving information and communication technology utilization in order to empower women (SDGs #5.b). HoT (Hospital on Tablet) development is a effort to improve information and communication technology utilization. HoT (Hospital on Tablet) empowers society including women to get information access of JCH public service.
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| 9. What were the main obstacles encountered and how were they overcome?
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Generally innovation issues are budgeting and legal assurance, however for JCH, it is not the main issue. Legal regulation is in : UU No. 11/2008 about Information and Electronic Transaction, UU No. 44/2009 about Hospital, UU No. 36/2009 about Health, UU No. 29/2004 about Medical Practice and Health Ministry Regulation No. 269/MENKES/III/2008 about Medical Record. Clause 5 subsection (1) in Regulation of Information and Electronic Transaction mentions that electronic information and/or electronic document and/or its print out are legal evidence.
The main issue of digital hospital implementation at Jember Chest Hospital is doctors unwillingness to fill in electronic medical record application, completely, correctly and on time. The strategy that be done is finding causative factors doctors unwillingness.
It was found 2 causative factors, which are first : doctors were hesitate that electronic medical record have more benefit and whether capable of recording all patient condition. Second : doctors felt that electornic medical record filling in of inpatient patient was difficult.
The effort that be taken by JCH management was convincing that electronic medical record have a lot benefit. Giving facility to ease for the doctors in applying the system. Management facilitate intense communication between Medical Board as user with application composer vendor, together they composed application system that are comfortable and easy to be used by doctors. The easiness of data application filling in was modified by mobile via tablet.
With this strategy, appears doctors willingness to fill in electronic medical record correctly and completely so that electronic medical record can be proceeded.
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