COVID-19 has changed the way people interact as they reduce the frequency of physical interaction in order to slow down and hopefully stop the spread of the virus. As a result, the demand for the use of technology in daily interaction has been rapidly growing during the pandemic to ease communication while maintaining physical distance. The President of Indonesia, Joko Widodo, has encouraged people to start getting treatment online through the existing medical applications in Indonesia, be it for regular health checks or to detect COVID-19 exposure. This can be particularly challenging for those in the healthcare sector, where physical examination is an important element for health workers in performing their duties.
As a measure to keep healthcare services accessible during the pandemic, the Government of Indonesia has issued several new regulations on telemedicine.
Below, we elaborate the prevailing law and regulations on the utilization of telemedicine in Indonesia, especially during the COVID-19 pandemic.
Telemedicine in Indonesia
Telemedicine is briefly mentioned in Minister of Health Regulation No. 90 of 2015 concerning the Organization of Health Service Facilities in Remote Areas and Very Remote Areas (“MoH Reg 90/2015”) to support health services in remote areas, with the purpose of increasing the accuracy of and accelerate the process of providing medical diagnoses and consultations and other health service facilities in areas which lack health workers with specific qualifications.
For further implementation of MoH Reg 90/2015, particularly telemedicine services, the Minister of Health (“MoH”) issued MoH Regulation No. 20 of 2019 concerning the Organization of Telemedicine Services between Health Service Facilities (“MoH Reg 20/2019”) to specifically regulate the organization of telemedicine.
MoH Reg 20/2019 defines telemedicine as the provision of long-distance health services by health professionals utilizing information and communication technology, consisting of information exchange on diagnosis, medication, disease and injury prevention, research and evaluation, and sustainable education of health service providers in order to improve individual and public health. Meanwhile, Telemedicine Services through Health Service Facilities is defined as Telemedicine which is implemented between one health services facility and other health services facilities in the form of consultancy to confirm diagnoses, therapy, and/or prevention of diseases (“Telemedicine Services”). As the title of MoH Reg 20/2019 suggests, the regulation only covers Telemedicine Services between one health services facility and other health services facilities. In this matter, health services facility is defined as a device and/or place which is utilized by the central government, regional government and/or public to provide promotive, preventive, curative or rehabilitative health services (“Health Service Facilities”)
Telemedicine services in this sense are divided into tele-radiology, tele-electrocardiography, tele-ultrasonography, teleconsultation clinic services, and other Telemedicine consultation services in accordance with the development of science and technology.
A health worker performing Telemedicine Services has to hold a license to practise in the relevant Health Service Facilities. For this purpose, Health Service Facilities are divided into:
- consultancy-providing Health Service Facilities, meaning the Health Service Facilities that provide Telemedicine services. The Consultancy-Providing Health Service Facilities are hospitals which are owned by the Central Government or Regional Government or the Private Sector and which fulfill the requirements (“Consultancy-Providing Health Service Facilities”); and
- consultancy-requesting Health Service Facilities, meaning the Health Service Facilities that request the telemedicine services. The Consultancy-Requesting Health Service Facilities are hospitals, first level Health Service Facilities and other Health Service Facilities (“Consultancy-Requesting Health Service Facilities”).
Both the Consultancy-Providing Health Service Facilities and Consultancy-Requesting Health Service Facilities must fulfill the following requirements in order to implement Telemedicine Services: (1) human resources; (2) facilities, infrastructure, device; and (3) application.
The application which is one of the requirements may be provided by the MoH or may be self-developed, but a self-developed application must be registered with the Ministry of Health.
Both Consultancy-Providing Health Service Facilities and/or Consultancy-Requesting Health Service Facilities must register themselves as implementing Health Service Facilities with the MoH through the Directorate General under the Ministry of Health whose duties and responsibilities are concerned with the health services sector.
In addition, guidance and supervision on the implementation of Telemedicine Services will be provided by the MoH, provincial health agencies, and regency/district-level health agencies according to their respective competencies under the prevailing law and regulations.
The Utilization of Telemedicine during the COVID-19 Pandemic
Considering that the MoH Reg 20/2019 only specifically regulates the implementation of Telemedicine Services between Health Service Facilities in Indonesia, the pandemic prompted the MoH to issue Circular Letter No. HK.02.01/MENKES/303/2020 concerning the Organization of Health Services through the Utilization of Information and Communication Technology to Prevent the Spreading of Corona Virus 2019 Disease (COVID-19) (“SL 303/2020”) to allow doctors and dentists to provide certain treatment through telemedicine.
Following the MoH, the Indonesian Medical Council (Konsil Kedokteran Indonesia (“KKI”)) as an autonomous, independent, non-structural body, consisting of a medical council and a dental council whose role is to provide guidance on the implementation of medical practices by the relevant institutions in accordance with their respective functions in Indonesia, issued KKI Regulation No. 74 of 2020 concerning the Clinical Authority and Medical Practice through Telemedicine during the of Corona Virus 2019 (COVID-19) Pandemic in Indonesia (“KKI Reg 74/2020”).
Both SL 303/2020 and KKI 74/2020 are the responses from the Government to reduce physical interactions between health workers and patients while keeping healthcare accessible during the COVID-19 pandemic through the use of information and communication technology in the form of telemedicine in order to prevent the virus from spreading. These regulations grant doctors, dentists, specialist doctors, and sub-specialist doctors the clinical authority to provide medical services to patients by means of through application/electronic systems in the form of telemedicine as well as face to face consultations during the COVID-19’s emergency.
Doctors or dentists who are performing medical practices through telemedicine must have a registration certificate (surat tanda registrasi) and a license to practise (izin praktik) in the Health Service Facilities where the telemedicine is implemented in accordance with the prevailing law and regulations.
According to SL 303/2020, doctors have the authority to perform the following services through telemedicine:
a. History taking, which covers presenting complaints, accompanying complaints, history of the current illness, other disease or risk factors, family information and other relevant information that doctors ask patients/families to provide via online means;
b. Physical examination by audio visual means;
c. Providing advice and suggestions based on the result of the supporting examination and/or certain physical examinations. Supporting examinations may be carried out by the patient using the patient’s own resources or based on the recommendation from the previous supporting examination on the doctor’s instructions. Recommendations may be in the form of further medical examinations at health service facilities;
e. Treatment of patients;
f. Prescribing medication and/or medical equipment for the patient in accordance with the diagnosis. The doctor or dentist may issue the prescription electronically in accordance with the prevailing regulations except in the case of any type of narcotics and psychotropics; and
g. Issuing a reference letter for further examination or action at a laboratory and/or Health Services Facility depending on the treatment of the patient.
In addition to the above, according to KKI Reg 74/2020, doctors or dentists who perform medical practice through telemedicine must perform an assessment of the patient based on their competency and authority. Further, the regulation provides that if the assessment does not show any emergency for the patient, then doctors or dentists must continue to carry out treatment through telemedicine. However, if the assessment does show an emergency for the patient which requires diagnostic action and/or therapy, the doctors or dentists must immediately transfer the patient to a Health Service Facility for direct treatment.
It is important to note that any medical practice conducted through telemedicine must be recorded in a medical record by the practicing doctor or dentist, as stipulated in both SL 303/2020 and KKI Reg 74/2020. The medical record can be made manually in writing or electronically in the form of a transcript for each patient to be archived in the Health Service Facilities where the telemedicine is being performed. Additionally, keeping medical records confidential is the responsibility of the doctor or dentist.
During the performance of telemedicine, doctors and dentists are prohibited from:
a. performing teleconsultations between health workers and patients directly without the mediation of any Health Service Facilities;
b. providing inadequate information to patients;
c. performing diagnosis beyond the doctor’s or dentist’s competency;
d. requesting irrelevant supporting examinations;
e. committing any disgraceful, intimidating or violent acts towards patients during medical practice;
f. committing any invasive acts through teleconsultation;
g. charging fees other than or higher than those determined by the health service facility; and
h. issuing health certificates.
Lastly, the provisions of SL 303/2020 and KKI Reg 74/2020 will expire when the Government of Indonesia declares the public health emergency due to COVID-19 is over.
This publication is not intended to be a comprehensive review of all developments in the law and practice, or to cover all aspects of those referred to. Readers should take legal advice before applying the information contained in this publication to specific issues or transactions or matters.
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