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E-HEALTH : FORM OF PUBLIC SERVICE INNOVATION IN HEALTH

SECTOR (Case Studies in Indonesia)


Galih W. Pradana, Trenda Aktiva Oktariyanda
Departement of Public Administration, Faculty of Social and Law UNESA, Indonesia
Email : galihpradana@unesa.ac.id; trendaoktariyanda@unesa.ac.id
Abstract
Technological developments have already affected the human paradigm to meet the daily life needs higher. Service in the
field of health as an example becomes one of the essential needs of the people. Stakeholders including Governments all
over the world, compete to provides an innovative public service. The development of public service innovation nowadays
leads to a form of electronic-based government services. The implementation of e-government is scattered in various fields
and lines, including the field of health which is known as e-health. In Indonesia, the implementation of e-health can be
categorized at the stage of shoots and yet many people who figure it out, although its benefits are so big and influential
to the life of the community as well as for the improvement of public services more innovative, effective, and efficient.
The present paper describes the implementation of e-health in the public sector, especially its development in Indonesia. In
this study, we carried out a literature review, analyze a carefully selected sample of books, theses, and papers in this area.
Based on the type of data and technical analysis, this study used a qualitative approach. To achieve data communication,
information flows, and integrated medical record, then the information and communication technology in Indonesia needs
to be improved. These things need to be concern from the Government because of the information and communication
technology in Indonesia, according to the Global Information Technology Report for Asia and the Pacific has a score of
3.75 7 highest score and ranking 15th.
Keywords : public service innovation, e-government, e-health.
1.

Introduction
Based on Indonesian legislation, one of the main Governments obligation is to provide a good quality service to

the people. The public service itself is an activity or series of activities to fulfill the needs of service in accordance with
regulations for each citizen and resident of goods, services, and/or administrative services provided by the organizer of the
public service (read : Ministerial Regulation Number 31 2014). Then in Act Number 25 2009 about public service,
described that the community deserves a good quality service in accordance with the principle and purpose of the Ministry
(chapter 18).
If were talking about a good quality service, its means correlated with an innovative service. This is due to the
quality of service which is also determined by whether the service had the aspect of innovation regarding science and
technology or not. It is similar with Freeman (2004), which mentions the innovation as an attempt of the company
through the use of technology and information to develop, produce and market products that are new to the industry. In
other words, innovation is the modification or the invention ideas for improvement on an ongoing basis and development
to meet the needs of customers.
As advance in science and technology, especially information and communication technologies, conventional
service system that has been implemented in several government agencies shifted into innovation services with the
electronic-based service system. This is in line with presidential instruction Number 3 the year 2003 about policy and
strategy of the development of e-government. E-government has been introduced in Indonesia since 2001 through the
Presidential Instruction Number 6 the year 2001 on Telematics (Telecommunications, Media and Information Technology)
stating that Government officials should use telematics technology to support good governance and accelerate the process

of democracy. Then discharge instruction of the President of Republic of Indonesia Number 3 the year 2003 about policy
and National Strategy for the Development of e-Government is the proof that the government is serious to boost the quality
of public servants through e-government itself.
E-government is a form of public service based implementation of information and communication technologies,
as a medium of information and interactive means of communication between the Government with the other parties, either
community groups, business circles as well as between fellow government agencies. The implementation of e-government
in its application forms starting from a simple service, such as the provision of information and computer-based data about
the implementation of the governance and organization development as a form of manifestation of openness (transparency)
in public service. From the other services, it can be utilized as a means of internal communication among the units of the
device work area and interactive communication with public through e-mail, chat, of teleconferences.
In the health field, the implementation of electronic-based health care system has become the main program in all
countries, as revealed by Mong-Yuan Chang (2014) that every health institution in the world has prioritized in order to
reduce the workload of staff and improving efficiency and service quality by leveraging information technology. Even
since 1997, the WHO (World Health Organization) had been planning the use of information technology for health care
and medical purposes, until in 2005 on e-Health Resolution Number 58.28. In 2003 at the World Summit held in Geneva,
its declared the utilization of

potential information and communication technologies to support the Millennium

Declaration, the purpose is to improve health services. In that resolution, the WHO encourages each country to:
a)

Draw up a long-term strategic plan for developing e-health services in various areas of health, both for the
administration of the health, legal and regulatory frameworks, infrastructure and public and private partnership
mechanisms;

b)

Developing ICT infrastructures for e-health;

c)

Build collaborations with the private sector and non-profit institutions to support e-health;

d)

Developing e-health to reach the people, especially vulnerable to health problems and in accordance with their needs;

e)

Mobilizing cross-sector cooperation in adopting norms and standards in e-health, evaluation, principles, costeffectiveness in e-health to guarantee quality, ethics, and security with upholding the confidentially, privacy, equity
and equality;

f)

Developing a center of excellence and networking e-health, developed a model of a community health information
system for surveillance, response and civil defense emergency.
While in Indonesia the use of information technology for health sector has been regulated by Act No. 36 of 2009

about health, to efforts and organize an effective and efficient health care, required health information through information
systems and through cross-sector. The application of e-health in Indonesia has started to be implemented, with the
cooperation between government agencies, hospitals, universities, private sector, and telecommunications service
providers. A few government hospitals have started to apply the information systems of hospitals, though it is still used for
the internal purposes of the hospital institution. Starting in 2011 the Government of Indonesia has implemented the e-ID
CARD (electronic Card Sign Inhabitants), the technology can be used to support e-health, by means of storing the data the
health Brief e-ID CARD holders.
2.

Methodology
In this study, we carried out a literature review, analyze a carefully selected sample of books, theses, and papers in

this area. Based on the type of data and technical analysis, this study used a qualitative approach. This approach directs the
researcher to elaborate, categorizing and connecting the variables studied in a narrative way without going through a
statistical procedure (Strauss and Corbin, 2009: 4). As for the data analysis, this study uses interactive data analysis model.
This study does not separate data collection and data analysis (Bungin, 2012: 69). The temporary results of data analysis
the researchers used as the basis for next data collection.

3.

The Importance Of Innovation In Public Services


For the Government or a public service provider agencies, innovation is a form of transparency, accountability, and

good governance principles that aim to create a public organization with better performance. In addition, there are a few
points which become the background of the importance of innovation in Government sector, among other things:
(Suwarno, 2008:26)

a) The number of management techniques that focus on just-in-time, supply chain management, outsourcing, and total
quality or business process re-engineering that is used by a variety of medium and large companies to survive and
compete with one another. But only a few who dare to come out of the mainstream and creating new breakthroughs;

b) Traditional management techniques above also led the Organization in a pattern of rigidly and not flexible;
c) The impact of innovation can be felt and seen on the performance and profits of the Organization at the bottom line
level.
The best innovation is an innovation which is the output of the creation and implementation of processes,
products, and services or new service methods up to date, and also the results of the application of real efficiency,
effectiveness, which bore into the quality of the results. It can be proved that innovation has evolved from an initial
understanding, which includes the only innovation in terms of products and processes. Innovation product or service comes
from a change in the shape and design of the products or temporary services, innovation process originates from
sustainable quality renewal movement and resulted in the harmonization of the changes in organization, procedures, and
policies.
As for some typology of innovation in public service are divided into:
1.

The method of service innovation. Method service innovation is new changes in terms of interacting with
customers or provide services in new ways;

2.

Strategy or policy innovation. Strategy or policy innovation refers to the vision, mission, goals, and strategies
along with a new reason for departing from the existing reality;

3.

Innovation in interaction system that includes changes in governance (Muluk, 2008:44).

According to Mulgan and Albury, innovation, innovation has a range of levels, they are incremental, radical, and
transformative (Muluk, 2008:46).
1.

Incremental innovation means innovation happens to bring slight changes to a process or service. In general,
most of the innovation is at this level and rarely brings changes to organizational structure and organizational
relationships.

2.

Radical innovation is a fundamental change in public service or the introduction of the ways an entirely new
organizational and service in process.

3.

The transformative innovation or systematically bring changes in the structure of the labor force and
organizational and transform all sectors and organizational change dramatically. This type of innovation
requires a longer time to get the desired results and a fundamental change in the composition of social,
cultural and organizational.

In terms of process, innovation can be divided into two types, namely: (Muluk, 2008:48)
a.

Sustaining innovation, innovation is a process that brings new changes but still based on the conditions of
service and the running system or existing products.

b.

Discontinues innovation, innovation is the process that brings a change that completely new and no longer
based on pre-existing conditions.

4.

e-Government Overview
At first glance, the definition of e-Government seems clear and unequivocal, but when compared with other

investigation fields of Information Systems and Information Technologies, it reveals a terminological and conceptual
multiplicity. It is thus necessary to clarify and unify fundamental concepts (S, Rocha, & Cota, 2016). E-government refers
to the delivery of national or local government information and services via the internet or other digital means to citizen or

businesses or other governmental agencies. E-government is a one-stop Internet gateway to major government services. Egovernment facilities provision of relevant government information in electronic form to the citizens in a timely manner;
better service delivery to citizens; empowerment of the people through access to information without the bureaucracy;
improved productivity and cost savings in doing business with suppliers and customers of government; and participation in
public policy decision-making E-Governance refers to how managers and supervisors utilize IT and the Internet to execute
their functions of supervising, planning, organizing, coordinating, and staffing effectively (Palvia & Sharma, n.d.).
In the e-Government domain, Al-Jaghoub et al (2010) mention the following types of activities and relationships:
Government-to-Citizens or Government-to-Clients, Government-to-Businesses/Companies, Government-to-Employees,
Government-to-Government, and Citizen-to-Citizen. Zaidi and Qteishat (2012) define only three: Government-to-Citizen,
Government-to-Businesses/Companies, and Government-to-Government. Unlike so-called traditional services provided by
the government, the provision of e-Government services in non-hierarchical, in both directions, and should be available
twenty-four seven (Jinmei, 2011).
5.

The Concept Of e-Health And Its Implementation


In a simple terminology, e-health is composed of e (electronic) which means electronic, and health which

means health, later termed in the context of public service into public health in General. Based on empirical observation
and experience of the author, the term e-health began appearing in the late 19 th century and early 20th century. It is also
reinforced by Kristianto in his article e-Health in Indonesia which mentions that the telecommunications technology that
is used in the beginning was analog, a technology that is used for communication between patients and doctors, hospital
service, and data exchange electrograms. During this time, the technology was then known as the telemedicine (kristianto,
2013:168).
According to Pagliari (2005), E-Health is the use of information networks of telecommunications technology
especially the internet to improve the quality of health services. E-Health is useful for providing health information, either
in the form of prescription medication, as well as information related to the types of the disease. E-Health is the application
of communication technology and information that covers the entire functions that affect the health sector. E-Health
involves a lot of parties ranging from the community up to the pharmacy. E-Health Service consists of connectivity,
content, commerce, community, and clinical care.
E-health application and implication research have gained popularity over the last few years. Based on Hage et al.s
(2013) systematic literature review on e-health service adoption in rural communities we can summarize the findings (in
Table 1) for the following types of e-health services researched and their application contexts (Miah, Hasan, & Gammack,
2016).
Table 1
E-health service categories and their applications.
Type of e-health

Application context

the internet and social media

Social contact; economic development; access to information; empowerment; health;


bridging the digital divide; education; reducing cost/time

Video conferencing and telehealth

Health; bridging the digital divide; reducing cost/time; access to information; social
contact

Telecommunications (mobile)

Access to information; education; bridging the digital divide; reducing cost/time;


health; quality of life; social contact; economic development

Community Networks

Access to information; education; bridging the digital divide; reducing cost/time;


quality of life; social contact; economic development

Web portals

Access to information; bridging the digital divide; health;

Computer labs

Education

In a general sense, e-health is a form of services using information and Communication Technology applications
linked with the overall functional elements supporting the health sector. Developments to date include the term electronic
health records, telemedicine, consumer health informatic, health knowledge management, virtual healthcare team, mobilehealth, Healthcare Information Systems (Kristianto, 2013:168).
The function of e-Health is describing the unique abilities of the internet that enable the delivery of health services.
As a result, e-Health cause health care become more efficient, making the patient and other health parties can conduct
consultation and interaction without having to meet face-to-face (Pagliari, 2005).
In a various studies of literature all around the world discovered that the reason for e-Health emergence is to
simplify transactions data processing (especially in medical records) from one place to another (Vittaca, 2009; Clarke et al.,
2005; Salud, 2003 Pyper et al, 2003; Glass, 1998 in the paradise and Zakiyyah, 2011:175). The problem is not yet fully
resolved and is one barrier to the process of the implementation of e-health, especially in non-European countries and
America is about the protection of patient data confidentiality itself (McClanahan, 2008; Wilson, 2001 in paradise and
Zakiyyah, 2011:175). Some researchers previously have explained the integrated health information system. This means
not only connecting the internal side of the hospital but also a relationship with all the stakeholders who are directly related
(Wangler et.al, 2003; Wen et al., 2001; Kim et al., 1990, paradise and Zakiyyah, 2011:175).
In connection with the previous discussion, stakeholders also have further ideas, trying to integrate all the data and
health information across member countries of ASEAN. Things aspects influenced the high number of patients in various
countries (such as Singapore, Indonesia, and Malaysia) are also experienced by other countries is the development of ehealth are still in the order of integration, data communication and flow of information, and not to discuss the factors
restricting implementation of processes and supporting.
Talk a little bit about the development of e-health in Indonesia, which has been marked by the existence of
regulations related to e-health. Legal basis for the Organization of the e-health as an amplifier of its existence are as
follows:
1.

Health Development Policy Towards Healthy Indonesia 2010, in accordance with the decision of the Minister

2.

The emergence and growth of information and communication technology, touch many layers of life. This is

of health of the Republic of Indonesia No. 574/Ministry of Health/SK/IV/2000;


reflected in the Millennium Development Goals (MDGS), especially in the target 18: In cooperation with the
private sector, make available the benefits of new technologies, especially information and communications ";
3.

E-Health for All in the year 2012 (3rd European Ministerial e-Health Conference, Tromsoe, Norway), is a
target of for WHO;

4.

Who's been years working on activities with the use of information technology for health care and medical
purposes? For example, the international conferences held by the WHO (December 1997) give input on
"Telematics" are included in the policy of WHO;

5.

Member States WHO are currently drawing up a strategy for developing e-Health and other organizations are
already preparing strategies for information and communication technology. E-Health is one of the topics
discussed at a meeting of the World Summit of the information society in Geneva, December 2003
(Supriyatno, 2006).

In addition from regulation terms, according to the author empirical view, the implementation of e-health in
Indonesia have been initiated with system information application in hospital and clinics in Central Government and
regions although its not yet fully integrated. The most common incidence happen when the patient is moved then the
repetition of hospital laboratory checks and medical record data is repeated by the patient themselves. Through medical
record integration, these problems should not occur.
To achieve data communication, information flows, and integrated medical record, then the information and
communication technology in Indonesia needs to be improved. These things need to be concern from the Government
because of the information and communication technology in Indonesia, according to the Global Information Technology
Report for Asia and the Pacific has a score of 3.75 7 highest score and ranking 15th. This is because Indonesia is an

archipelago country. For mobile phone ownership from World Bank data is 98 of 100 people while the number of internet
users subscribers in Indonesia is 55 million people, or 22% of the total population of Indonesia (Kristianto, 2013:170).
Tracing on the data above, the opportunities for implementing e-health in Indonesia is very wide open: with
technology m-health and telemedicine. Basic service for mobile phones must be used for voice and SMS (Short Message
Service), as well as the internet access data to log on to the web and applications. With two such services, health care
information, even medical record data can be distributed evenly and tightly integrated.
It can be realized with the cooperation of the partnership within the Government, between the Ministry of health
and Ministry of education as a provider of health information sources including the holder of a medical record data from
the patient, and the Ministry of communications and informatics infrastructure responsible for telecommunications and
information technology to be used. If connected with the Ministry of the population and the civil registry then the facilities
of e-ID CARD can also be used to store the data of medical record for each resident.
In addition to the internal governance partnership, as well as much needed partnership with relevant stakeholders,
such as STATE-OWNED ENTERPRISES and private parties. Private parties, in this case, includes the private from the
health sector (private hospitals, polyclinics) as well as the private sector telecommunications. So health care using e-health
will be realized with a good and thorough.
6.

Conclusion
Looking at the development of SCIENCE and TECHNOLOGY and the demands of the times that so high, then an

innovation, especially in the public service, has become the necessity and urgency of the Government. The public service
innovations development nowadays, as in different countries lead to electronic-based forms of government services, or
commonly also called e-Government. The application of e-Government is a concern in various lines of the public health
field, including termed e-Health.
In Indonesia, the implementation of e-Health can categorize as a "shoots" and yet many people who knew it. In
addition, some problem such as e-health systems, infrastructure, and superstructure as well as partnerships between related
stakeholders also remains as the Government's task to be completed.
In terms of its prospects, Indonesia has a huge potential to implement e-health. Although there are still many
obstacles that have not been resolved, but the benefits derived will far bigger and feels for the people as well as for the
improvement of public services more innovative, effective, and efficient.
Acknowledgement
The authors would like to thank Badrudin Kurniawan for his careful review and suggestions which helped to improve this
editorial.
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