e-Health Surabaya
Surabaya City Health Department

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
First, hospital patients have to queue since early in the morning to get earlier services. The queue often takes a long time and uncomfortable, and sometimes there are panders for earlier queue numbers. Second, patient administration data used to be recorded manually. It contributes to the poor quality of services. The services for referral patients especially cannot be optimized due to the lack information of patient’s medical history. Third, the delivery of health data cannot be obtained realtime. The needs of policy makers to get valid information about health crysis, analyze, and make a right decision in early warning system against disease hasn’t been optimal

B. Strategic Approach

 2. What was the solution?
Surabaya e-health is the solution of those problems. This platform is included with 3 (three) excellent features ; Online Queuing System, Online Referral System, and Online Medical Record System from Primary Health Care to Referral Hospital, and also Health Information System for the policy makers. These 3 (three) features proved capable in overcoming the problem of 2 (two) Regional Hospitals and Primary Health Care in Surabaya.

 3. How did the initiative solve the problem and improve people’s lives?
Patient can do online registration through various outlets, such as personal computer or smartphone with internet connection, while patient who has no knowledge about internet, there are eKios at the Kelurahan (Villages) or Kecamatan (Districts). Then patient could come to health care facilities at the estimation time of arrival which has been recorded by eHealth. Thus, they don’t need to come early in the morning to wait in line and wasting time. On The Referral Online System patient could directly come to the purposed specialist clinic and no need to go to admission counter. The eHealth application online form have been included with medical resume service given by previous health facilities (primary health care). This helps medical personnel in making appropriate decisions and actions for the patient. The health data and information collected from this system to be a treasure for policy makers in the field of health. Those data can be used in decision making interventions to prevent the spread of disease resulting appropriate policies to improve public health status

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
- eHealth is the first online health care registration, admission, and referral system in Indonesia which self developed by Surabaya City Government. - eHealth can be accessed anywhere through smartphone or personal computer with internet connection to register in any Surabaya’s Primary Health Care Centre and 2 (two) Surabaya Regional Hospitals. - People who has no internet connection can be registered at the nearest Kelurahan or Kecamatan using eKios which facilitated with 3 (three) different languages, Bahasa Indonesia, English, and Madurese. - Single identity medical recording enable patient to register by using finger print and one pass card of eKTP utilization. - Dashboard menu provision for health policy makers.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Surabaya Health District as a leading sector of this inovation, cooperated with Primary Health Care and Regional Hospitals in Surabaya, supported by Surabaya City Government. The population coverage of this innovation is all of Surabaya Citizen inside or outside who access health care facilities in Surabaya.Total population coverage in eHealth during 2016 is 116.278 visitors for Online Registration and 59.125 visitors for Online Referral, and also 2.554.495 visitors for services data from Primary Health Care Information System (SIMPUS) which utilize promotive, preventive, and curative services.
 6. How was the strategy implemented and what resources were mobilized?
eHealth is implemented gradually. Since 2010, we start to build the system called SIMPUS (Sistem Informasi Manajemen Puskesmas) or Information Management System for Health Data in 5 of 53 Primary Health Care in Surabaya. At 2011, developed into 15 of 58 PHC in Surabaya. And at 2012 all of PHC in Surabaya have used and developed eHealth (Beta Version). In 2013, we do the bridging between eHealth for PHC and for Hospital Information System at 2 Regional Hospitals in Surabaya (Dr. Moh. Soewandhie Hospital and Bhakti Dharma Husada Hospital). We also create the dashboard menu for the health policy maker. In 2014, we completed the bridging so the online referral system was started. At the same time, we also integrated the population data, synchronized with eKTP, so that single identity for medical history recording and the used of eKTP as a one pass card can be applied to access any health care facility in Surabaya PHC and Hospitals. The integration with population data was creating The Online Registration or Admission System in eHealth that can be accessed anywhere with internet connection by simply clicking ehealth.surabaya.go.id/pendaftaran. The interactive website is facilitated with 3 (three) different languages, Bahasa Indonesia, English, and Madurese, thus making it easier for the resident to understand. Besides, there are eKios at the Kelurahan (Villages) or Kecamatan (Districts) for the resident who has no knowledge about internet. In 2015, eHealth have another bridging system with Indonesia’s National Health Insurance system called Primary Care (P-Care) which is developed by BPJS. Due to this integration, the person in charge only entry the health data once through eHealth then directly recorded in P-Care. By the year 2016, we develop android based eHealth application to facilitate peoples demand which mostly are using android based phones.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
- Surabaya City Major has the first idea to build an online patient registration/admission system. - Surabaya City Health Department as the developer and cross sectors coordinator. - The cross sectors consist of departments in Surabaya City Government, such as Dinkominfo (Communication and Informatics Department), Dispendukcapil (Demographic Departments), and many more. - Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan) /National Social Health Insurance Agency - All of Surabaya citizens who has contributed in developing this system.

 8. What were the most successful outputs and why was the initiative effective?
a. Waiting time of the patient who has been using eHealth is much faster. It used to be 25 minutes, now they only need to wait 5 minutes for admission. Referral patient also no need to wait inefficiently and can directly go to the specialist outpatient clinic by only give some required documents at the certain counter for referral patient online provided by hospitals. b. Increasing access and utility of eHealth every month show people’s need and demands about eHealth are enhancing also. c. The use of single identity number as patient medical record recall number enable the health providers to understand patient’s previous medical treatments, medications, and diagnosis, then help them decide the appropriate medical treatment next. The use of identity number can also be done through finger print and RFID reading on eKTP card. d. Decision making of program and intervention in health sector always based on data and health information obtained from monitoring dashboard which can be accessed by policy makers at eHealth. Monitoring of high risk disease, incidence rate of deathly disease, such as Dengue or Diarrhea, can be done through eHealth, so they can determine a rapid and effective prevention policy

 9. What were the main obstacles encountered and how were they overcome?
- Giving the understanding to the people/society that has been used to with the manual system. It takes time to socialize so that people can accept the change. - Internet Connection Problem. The internet disruption in Surabaya is unpredictable. While the Communication and Information Department of Surabaya have tried to minimize it, they also create an operating procedure if this problem occurred. - Power failures. At the mean time, yes sometimes we are still facing an electricity problem. While it is intolerant for the server to get power failures. Thus we provide generator set (genset) which always ready if the problem exist.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
- Admission time efficiency for the health care users in Surabaya. - Patients should be more discipline in estimating the time of visiting their health care providers. Thus there will be no more over visitors and the health care situation should be more comfortable. - For the healthcare providers, eHealth facilitate them in creating the right policies based on data and information at the dashboard menu. The valid data is highly valuable in planning and decision making of health intervention. The right intervention of preventing, promoting, healing, and rehabilitating in health will lead to the improvements of community health status.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Before the implementation of eHealth online registration, there were panders who used to come early in the morning to get the manual queue numbers and sell them to the hospital patients. Patients used to be waiting for long time before being examined. Thus the situation at hospital waiting room was incomfortable. Since eHealth was implemented, there are no more panders so the queue system is more accountable. Patient can estimates their own schedule to see the doctor. Recorded medical history at the system was enable the doctor provides more integrity services. Biridging system with P-Care application (BPJS Kesehatan) provides clarity on the utilization of financial guarantees in accordance with the National Health Insurance Program.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
eHealth online registration enable elderly and pregnant women to access healthcare services without long time waiting and early morning queue. By simply come at their own estimation schedule, they won’t get exhausted waiting for the services. Meanwhile, online registration for the elderly and special needs patients could be accompanied with healthcare workers who is ready to help.

Contact Information

Institution Name:   Surabaya City Health Department
Institution Type:   Local Government  
Contact Person:   drg. Febria Rachmanita,MA
Title:   Head of Department of Health  
Telephone/ Fax:   +62318438836
Institution's / Project's Website:  
E-mail:   dinkes.surabaya@gmail.com  
Address:   Surabaya City Health Department, Jemursari Street - 197
Postal Code:   60237
City:   Surabaya
State/Province:   Jawa Timur

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