INTERVIEW

TELEMEDISIN DI
MASA NORMAL*
TELECONSULTATION
THERE IS A MISCONCEPTION THAT THE
MACHINE WILL REPLACE THE DOCTOR

BUDI SAMPURNA
HUMBERTO OLIVEIRA SERRA
President of Brazilian Telemedicine and
In an interview to the Visão Hospitalar, the
Brazilian Telemedicine and Telehealth Association’s
president (ABTms), Humberto Oliveira Serra, talks
about the telemedicine panorama in Brazil, the
teleconsultation incorporation to medical care and

Kompartemen Hukum Advokasi dan Mediasi

Telehealth Association - ABTms, coordinator
of the Telehealth Nucleus of Maranhão State
- Telehealth Brazil Network Program; and
Telehealth Unit chief (HU-UFMA) .
the controversy generated around the Resolution
nº 2.227/ 2018, issued by the Federal Medicine
Council (CFM), which tried to set rules for exercising
this technology in the country.

PERSI 2018-2021
In a few lines, Humberto defended the CFM
resolution, which was eventually repealed, and
condemned the lack of information that has
mediated the debates on the subject. For him,
in addition to the lack of information on the new
Information and Communication Technologies (ICTs),
the debate is bitter because of the misconception
that the machine can replace the doctor. Check out

* Setelah tidak ada lagi Kedaruratan Kesehatan Masyarakat the interview below.

38 |
Pengertian (WMA, 2018)
• Telemedicine is the practice of medicine over a distance, in which
interventions, diagnoses, therapeutic decisions, and subsequent
treatment recommendations are based on patient data, documents
and other information transmitted through telecommunication
systems.
• Telemedicine can take place between a physician and a patient or
between two or more physicians including other healthcare
professionals.
• Face-to-face consultation between physician and patient remains
the gold standard of clinical care
• Like all health care interventions, telemedicine must be tested for
its effectiveness, efficiency, safety, feasibility and cost-effectiveness
Pengertian Telemedicine 2
Tujuan
• Telemedicine provides patients with access to high- quality healthcare
services through advanced communication and information technology.
• Therefore, telemedicine can greatly improve the equity and efficiency of
health service delivery and increase the patients’ access to specialist
expertise that was unavailable or difficult to access before.

Cara pelayanan
• Pelaksanaannya: store and forward, remote monitoring dengan
wearable, real-time interactive service (video conferencing)
• Fasyankes – fasyankes, fasyankes - pasien
Pelaksanaan di masa Pandemi Covid-19
• Pasien Covid-19 pada periode tertentu dapat sangat banyak
sehingga rumah sakit tidak mampu menampung dan
melayaninya tepat waktu, oleh tepat pemberi pelayanan, tepat
sumber daya
• Pasien non Covid sepanjang masa pandemic Covid-19
“terpaksa” di nomor-dua kan aksesnya ke rumah sakit, sehingga
tidak terlayani
• Kedua keadaan tersebut merupakan dasar kebijakan pelayanan
telemedisin, meskipun terdapat keterbatasan
• Diatur dengan Permenkes 20/2019 (antar fasyankes), SE
Menkes No 303/2020 dilanjutkan dengan Kepmenkes No
4829/2021, serta Perkonsil No 74/2020.
Pedoman Telemedisin (Kepmenkes)

• Fasyankes dapat menggunakan aplikasi yang dikembangkan

sendiri atau dapat bekerjsama dengan penyedia aplikasi
pemerintah atau swasta
• Dokter dapat melakukan : anamnesis, pemeriksaan “fisik”
tertentu dengan alat audiovisual, anjuran/rujukan ke
pemeriksaan penunjang, merujuk ke fasyankes lain,
memberi resep (termasuk resep elektronik).
• Farmasis dapat memberikan telefarmasi, termasuk
pengantaran obat
Perkonsil
Do
• Buat rekam medis, ada informed consent
untuk telemedisin
• Boleh menerbitkan resep obat/alkes, kecuali
narkotika dan psikotropika

Dont:
• telekonsultasi antara tenaga medis dengan
pasien secara langsung tanpa melalui
Fasyankes;
• melakukan tindakan invasif melalui
telekonsultasi;
Pada masa Normal
• Tidak ada lagi status kedaruratan Kesehatan masyarakat
• Sistem Pelayanan Kesehatan dan aturan keprofesian diberlakukan
sebagaimana pada keadaan normal
• Masyarakat mungkin terbiasa dengan layanan telekonsultasi dan
teknologi kedokteran lain, meskipun mungkin belum evidence
based
• Layanan Telemedisin dapat dikembangkan untuk mengatasi
keterbatasan akses layanan, baik layanan primer maupun layanan
spesialistik
• Teknologi kedokteran mungkin akan cepat berkembang, sehingga
tersedia alat pemeriksaan yg berbentuk wearable atau tersedia di
pusat tele konsultasi yang dibangun di daerah remote
Isu Penting di masa normal
• Apakah layanan telemedisin dapat diberikan oleh Fasyankes atau
juga provider khusus platform telehealth? (wilayah utama JKN)
• Apakah pada dasarnya layanan telemedisin dilaksanakan di FKTP
sebagai gate keeper, agar tujuan utama memperluas akses dan
menjangkau pasien yang berada di tempat “jauh” tercapai.
• Apakah rumah sakit memberikan layanan telemedisin?
• Apakah rumah sakit memberikan layanan telemedisin:
• Langsung ke pasien untuk menjadi gate-keeper (primer) atau layanan
rujukan (sekunder – tertier)?
• Ataukah melalui FKTP (antar faskes) untuk memberi akses layanan
konsultasi spesialistik ?
Telemedisin di FKTP
• Telemedisin harus disediakan di layanan primer, terutama di
daerah yang memiliki wilayah tertinggal, terluar, dan tidak
terakses.
• Layanan telemedisin antar fasyankes akan memperkuat FKTP
dengan memberi peluang akses layanan spesialistik
• Di desa yang terpencil agar didirikan pusat telekonsultasi
sehingga memiliki peluang mengakses layanan Kesehatan
primer dan sekunder, meskipun terbatas
• Di Brazil (2009-2010): dilakukan di pelayanan primer, sebagai
gate keeper, ternyata dapat mencegah 80,8% perujukan, dan
mengurangi 45,5% biaya transfer (Alkmim MB et al. Bull of
WHO, 2012)
Telemedisin di rumah sakit
• Melayani FKTP untuk memperkuat layanan primer, sebagai
bagian dari domain public layanan rumah sakit (antar
fasyankes)
• Melayani store and forward, tele-monitoring, dan real-time
interactive consultation dengan tenaga Kesehatan di FKTP
INTERVIEW

• Melayani langsung pasien sebagai

pasien rujukan, termasuk tele-
monitoring (menggantikan program
rujuk balik?)
• Mengurangi waktu tunggu
layanan spesialistik, mengurangi
biaya transport,
 Kelebihan Telemedisin
• Mengurangi waktu untuk • Make health care accessible to people
perjalanan who live in rural or isolated communities
• Memberi peluang pengelolaan • Provide long distance clinical care.
awal kedaruratan medis
• Make services more readily available or
• Memfasilitasi pencari
pendapat/opinion convenient for people with limited
• Mengurangi kejadian cross- mobility, time or transportation options.
infection • Obtain expertise of specialists.
• Meningkatkan edukasi kedokteran • Improve communication and
• Kenneth Lyen, SMA News, Jan 2019 coordination of care among members of
a health care team and patient.
• Kurangi biaya, kurangi waktu • Provide support for self-management of
tunggu, efisiensi sumber daya health care.
• Quick and efficient medical evaluation
• Xiaoli Wang et al.
https://doi.org/10.1155/2019/7642176 and management.
ASPS, 2020

Masalah dan
Limitasi
• Underlying conditions (tanda
penyakit dapat saja tidak
dilaporkan karena pasien tidak
tahu)
• Overlooked diagnosis (tidak
dikeluhkan tidak berarti tidak
sakit)
• Clinical judgement
• Breaking bad news
• Medico-legal issues (who is to
blame if things go wrong?)
Kenneth Lyen, SMA News, Jan 2019
• Information transmitted may not be
sufficient (e.g. poor resolution of images)
to allow for appropriate medical decision
making by the physician and assistant(s);
• Delays in medical evaluation and treatment
could occur due to deficiencies or failures
of the equipment;
• Security protocols could fail, causing a
potential breach of privacy and/or
inadvertent disclosure of personal
identifying information and/or protected
health information;
• Lack of access to complete medical records
may result in adverse drug interactions,
allergic reactions or other judgment errors;
• Overuse of medical care;
• Unnecessary or overlapping care.
ASPS, 2020
Take Home Notes
• Telemedicine should be
appropriately adapted to local
regulatory frameworks, which may
include licencing of telemedicine
platforms in the best interest of
patients.
• Telemedicine should not be viewed
as equal to face-to-face health care
and should not be introduced solely
to cut costs or as a perverse
incentive to over-service and
increase earnings for physicians