Healthcare has always been one of the driving pillars of the need for technological advancements. In the last decade alone, the medical world has seen breakthroughs encapsulating treatments such as genomic editing and regenerative medicine. Whereas from an educational perspective, the digital era has catapulted medical training through the implementation of augmented and virtual realities for surgical and diagnostic practices. These technological advancements, however, have remained scarce since their availability is not as widespread as traditional approaches to medicine – especially in countries still trailing behind in terms of technological capability.
The declaration of the Covid-19 pandemic has not only pushed the need to have easily accessible healthcare, but also the normalization of advanced medical care to minimize physical interactions between patients and medical workers. The approach to seeing the aforementioned statement into fruition has been two-pronged; first is through the introduction of telemedicine, and the second approach has been through the implementation of Artificial Intelligence or AI.
Indonesia was in the early stages of developing the regulatory infrastructure for telemedicine before the pandemic, with digital applications such as Halodoc and Alodokter quickly leading the digital healthcare revolution. Prior to any specific telemedicine-related legislation enacted by the government, the Ministry of Health (“MoH”) had implemented an inter-healthcare facility telemedicine practice on 7 August 2019 through MoH Regulation No. 20 of 2019 regarding the Organization of Telemedicine Services through Health Services Facility. The main driver for this was to provide the means for healthcare facilities to consult with one another for the purposes of upholding diagnoses, therapy recommendations, and/or plans for the prevention of diseases with one another. The overall goal was to standardize Indonesian healthcare to be on par with one another and better serve patients on a national level.
Following the declaration of Covid-19 as a worldwide pandemic, there was a sudden urgency for the government to further regulate the implementation and parameters that telemedicine can cater to. This was due to the strictly enforced lockdown policy at the time preventing physical healthcare access for those with non-covid related illnesses and conditions, while telemedicine, which was expected to overcome this problem has limited coverage in terms of consulting services, examination coverage, and drug administration. This has resulted in the non-optimal handling of non-covid diseases in the pandemic era.
With the world slowly getting back to normal post Covid-19, the government has ramped up the need for technological based healthcare with efforts now turning to build a new telehealth infrastructure. As several of the regulations for telemedicine were enacted under the premise of the pandemic, most of them have been revoked as per the winding down of restrictions surrounding Covid-19. This has led to the current gap in the regulatory framework involving telemedicine in anticipation of the telehealth legislation that is said to be currently in the works.
The MoH, in multiple times, has expressed the urgency for such legislation as well as the push for Indonesia to quickly catch up with our western counterparts in building a technological base for healthcare. A glimpse of this first step to telehealth can be seen with the enactment of MoH Regulation No. 24 of 2022 regarding Medical Records on 31 August 2022, wherein healthcare facilities are now required to utilize electronic medical records especially those providing telemedicine services.
Aside from the move to building a telehealth infrastructure as described above, the government may need to further consider how AI now plays a significant role in healthcare. The current AI landscape has taken over in the sense that we can easily come across AI in our everyday lives. The use of AI in healthcare is becoming more and more probable with several countries already adopting its use as a diagnostic, patient care, or training tool. The utilization of AI in healthcare can be seen through the implementation of health regulation and maintenance, early detection of illnesses such as cancer or degenerative diseases, more accurate diagnoses, faster and accurate decision-making, optimized treatment plans, and its use in end-of-life care[1].
An example of this can be seen in China, as one of the world’s greatest superpowers, recently stepped-up investments in healthcare and life sciences with AI[2]. One of the hopes for such an investment is for China to increase patient care in order to provide a more reliable and accurate diagnostic outcomes and clinical decisions. Other countries such as the United States of America as well as the United Kingdom among others have also started to adopt AI in the provision of healthcare. However, most of the implementations of AI as seen above has mainly be used as an internal tool to aid doctors and researchers in their provision of healthcare services as well as in their medical research.
A further way in which AI can be used as a patient facing tool in addition to aiding healthcare professionals and researchers behind the scenes can be seen through the digital app Babylon Health UK[3], which is an AI-powered personal healthcare assistant and telemedicine platform. The Babylon app’s AI is built around a doctor’s brain and uses existing medical knowledge and health data to form a digital medical encyclopedia to easily identify illnesses, symptoms, and drugs as well as how it all correlates with one another[4]. As a result of this, patients can now access the chatbot feature of Babylon as triage by allowing patients to enter symptoms and responding with the most likely causes and treatments based on its medical database known to it. It further allows for patients to request to seek specialist advice following the initial AI consultation. Although Babylon is said to be widely accurate and saves doctors and practitioners time therefore enabling them to allocate more of their time to treating more serious diseases, there are many skeptics to this form of patient care.
From an Indonesian legal perspective, in anticipation for the launch of a telehealth era, it would be no surprise if apps such as Babylon start to come to market in the near future. The developing telehealth regulation infrastructure should be able to answer the question of which regulatory authority should have the power to control and supervise the medical advice generated from AI, especially to what extent service providers or related professionals should be held liable for such misdiagnosis or inaccurate medical advice.
As it currently stands, Indonesia is still in the efforts to keep up with the development of technology and regulatory infrastructure related to telemedicine, in which the main regulators for a telemedicine app are the Ministry of Communications and Informatics (“MCI”) and the MoH. Wherein the former regulates the app from a business activity and licensing point of view, and the former regulates the implementation of the services provided within the app. However, bearing in mind that AI will increasingly enter the health services industry, it is necessary to reconsider the effectiveness of the role of the two agencies in the telehealth world, including how the two regulators can maximize their role in the development of an increasingly technology-intensive healthcare industry.
In conclusion, Indonesia is in a push towards building a telehealth ecosystem that combines medicine and technology to build a better healthcare infrastructure for the nation. The pandemic has certainly emphasized the urgency of how technology needs to be integrated into our healthcare system in order to provide efficient and accurate diagnoses and care to patients. To what extent the new telehealth regulation reaches and whether it will include provisions regarding AI is still yet to be confirmed. However, milestones such as the implementation of electronic medical records seem to signal that the government is taking small steps in the right direction in digitizing Indonesia’s healthcare system. Said telehealth regulation is said to already be in the works with drafts of the regulation hopefully shared to the public by the end of 2023.
The information provided in this article is not intended as legal advice. All information, content, and materials contained herein are for general knowledge purposes only.
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[1] https://www.babylonhealth.com/en-gb
[2] https://www.babylonhealth.com/en-us/ai/guide-in-healthcare#
[3] https://www.pwc.com/gx/en/industries/healthcare/publications/ai-robotics-new-health/transforming-healthcare.html
[4] https://www.mckinsey.com/capabilities/quantumblack/our-insights/the-next-frontier-for-ai-in-china-could-add-600-billion-to-its-economy