Indonesia – Telemedicine Guidelines For Covid-19 Patients In Self-Isolation.

17 September 2021

 

Due to the increasing transmission of Corona Virus Disease (“COVID-19”) in Indonesia, the Minister of Health (“MoH”) has issued Decree of the MoH No. HK.01.07/MENKES/4829/2021 on Guidelines for Telemedicine Healthcare Services during the COVID-19 Pandemic (“MoH Decree 4829/2021”). In essence, MoH Decree 4829/2021 seeks to provide certainty on telemedicine services by allowing the provision of healthcare services remotely through information and communication technologies to enable communication between health service facilities.
 

Previously, MoH Regulation No. 20 of 2019 on Organisation of Telemedicine Services through Health Services Facilities (“MoH Reg 20/2019”) was issued to regulate the use of telemedicine between health service facilities as the providers and recipients. MoH Decree 4829/2021 further sets the guidelines and act as a reference for the Indonesian Government, doctors and other healthcare workers, healthcare facilities, persons in charge of telemedicine applications and related stakeholders in relation to the organisation of telemedicine healthcare services during the period of the COVID-19 pandemic.
 

Under Decree MoH 4829/2021, the healthcare facilities that are permitted to offer telemedicine services during the COVID-19 pandemic are:

 

• Hospitals;

• Public health centers (pusat kesehatan masyarakat – “Puskesmas”);

• Clinics;

• Independent private practices of doctors/dentists and specialists/dental specialists;

• Medical laboratories; and

• Pharmacies
   

collectively referred to as the “Providers”.

 

Any healthcare services offered via telemedicine may be provided using the applications developed by the healthcare facilities themselves or in cooperation with other applications owned by the government or private sector actors. Under MoH Reg 20/2019, the Providers may operate telemedicine applications, either by means of the applications provided by the MoH or by self-developed application that must be registered and integrated into the MoH database.
 

Telemedicine applications must also be registered as a private Electronic Systems Organisers (Penyelenggara Sistem Elektronik – “PSE”) at the Ministry of Communication and Informatics. PSE that manages or processes personal data must develop and maintain an internal data protection procedure or policy for acquiring, collecting, processing, analysing, storing, displaying, announcing, transferring, transmitting, providing access, and deleting personal data.
 

MoH Decree 4829/2021 sets out the scope of services of telemedicine services, as follows:
 

Healthcare Services	Remarks
Communications, information and education (Komunikasi, Informasi dan Edukasi – “KIE”) consultations	Include health promotion efforts aimed at disseminating information about healthy lifestyles, diet, exercise and fitness, COVID-19 and other health-related information.   These services can be offered by doctors and other competent healthcare workers according to their authority.
Clinical consultations	Include healthcare services provided by doctors via telemedicine as follows:   anamnesis; certain physical examinations performed through audiovisual technologies; provision of necessary advice based on the results of supporting examinations and/or the results of certain physical examinations; diagnoses, which should be made based on examination results that are primarily obtained through anamnesis, certain physical examinations or supporting examinations; management (penatalaksanaan) and treatment of patients, which should be carried out based on the relevant diagnoses; provision of prescriptions for drugs and/or medical devices, which should be sent to patients based on their diagnoses; issuance of referral letters that address examinations or further actions to laboratories and/or other healthcare facilities in accordance with the results of patient management.
Supporting examinations	Supporting examinations are carried out via laboratory tests, which can be implemented using medical laboratory applications or other healthcare facilities that offer medical laboratory services.
Tele-pharmaceutical services	Tele-pharmaceutical services at pharmaceutical service facilities should be offered as follows:   electronic prescription services, which can be offered by pharmacists with reference to pharmaceutical service standards that are in line with the relevant laws and regulations; pharmacists can communicate with prescribing doctors in order to confirm or provide recommendations that may result in modifications being made to electronic prescriptions; pharmaceutical preparations, medical devices, medical consumables (barang medis habis pakai – “BMHP”) and/or health supplements that are prepared based on electronic prescriptions can be delivered to patients/patients’ families through pharmaceutical service facilities or through deliveries of pharmaceutical preparations, medical devices, BMHP and/or health supplements.

The self-isolating COVID-19 patients will be monitored with the following activities:

 

• at least twice a day daily monitoring through chats and video calls. The monitoring includes checking vital indicators such as blood pressure, temperature, pulse rate, respiratory rate and oxygen saturation;

• provision of COVID-19 education to patients, communities and families;

• electronic prescriptions of additional drugs if any new symptom emerges;

• temporary comorbidity treatments, if a patient has been diagnosed with comorbidity or if controlled comorbidity becomes uncontrollable when self-isolation is carried out;

• preparation of referral letters and coordination if the patient’s condition deteriorates; and

• issuing isolation completion certificates.
   

The overall flow of the online monitoring of self-isolating COVID-19 patients are as follows:
 

• any COVID-19 patient who will undergo self-isolation can choose one of the platforms from the platform data announced in the relevant government notification (via WhatsApp).

• after contacting the selected platform, the COVID-19 patient can consult with a doctor about their existing clinical symptoms. The doctor will then issue an electronic prescription in PDF form to the patient who should then submit it to a pharmaceutical service facility appointed by the MoH. This facility will then dispense the required medicine. If a patient has received medicine from a healthcare facility, they must inform the doctor during any consultation via telemedicine.

• electronic prescriptions can be used only to obtain pharmaceutical preparations.

• any pharmacist who works at relevant pharmaceutical service facilities appointed by the Ministry and receives notifications of electronic prescriptions from doctors must inform COVID-19 patients on the pharmaceutical preparations while the prescribed pharmaceutical preparations are being prepared for immediate delivery.

• the delivery of pharmaceutical preparations must follow provisions on the delivery of pharmaceutical preparations, medical devices, BMHP and/or health supplements through closed-loop electronic prescribing.
   

With the issuance of MoH Decree 4829/2021, it is expected that COVID-19 patients without any symptoms (asymptomatic) or with mild symptoms can utilise the health treatment via telemedicine services to minimise the spread of virus through face-to-face treatment and the availability of beds in the hospital can be reserved for COVID-19 patients with moderate to severe symptoms.
 

If you have any questions or require any additional information, please contact Jade Hwang and Andina Sitoresmi of Roosdiono & Partners (a member of ZICO Law).