Digital Maturity Assessment

Country Level Indonesia

DMI Team
February 2023
Outline
• Background
• Protocol of assessment
• Focus Group Discussion
• Assessment results
• Plan of actions
• Limitation
• Follow up
• Conclusion
Background
Health information systems and digital health

Collects Process Analyze Present Interpret Use

Electronic
Interoperability,
medical Artificial
data storage, Artificial
records, IoT, intelligence, big Data
data intelligence, Dashboard,
Mobile apps, data analytics, visualization,
warehouse, decision information
health Decision smart
database support sharing
applications, support dashboard
management systems
telemedicine, systems,
systems
blockchain
Digital health transformation
ICT Infrastructure and Information Systems

Data standard and interoperability

Regulation and policy

Governance
Purpose of the digital maturity assessment
• Determine the country digital health maturity level in Indonesia.
• Recommend actions/interventions to improve digital health maturity
level in Indonesia.
• Provide general feedback of digital maturity for the sub-national level
• Engage community and professional association for the individual
review mechanism of digital maturity of sub-national and hospital level.
Protocol and Method
Consideration of digital maturity assessment
• Supporting digital health
Digital health
transformation
transformation in Indonesia
• Self-assessment and immediate
results and feedback
Stakeholders
Previous
assessment
• Capability for continues improvement
engagement
of HIS
self-monitoring

Contribution of
sub-national level and
further utilization
Assessment protocol

Develop
Focus Group
self-assessment
••Include sub-national ••Socialization Discussion ••Reach additional
instrument
level ••Electronic format of DMA respondents
••Self-assessment model ••Literature review (SOCI ••Compilation and ••Digital transformation ••Determine the country’s
as the main reference) preliminary analysis effort level of digital maturity
••Develop the ••Challenges ••Including the
questionnaires ••Expected outcome recommendations
••Pilot testing and
refinement Develop
Agreed assessment National
self-assessment
protocol Consensus
instrument
Selecting sub-national level respondents
Target of Respondents
Group Category #Respondent #Districts
1 Sumatera 3 9
2 Jawa-Bali 3 12
3 Kalimantan 2 8
4 Sulawesi 3 10
5 Maluku-Maluku Utara-NTB-NTT 2 8
6 Papua 2 8
7 MoH Level 7
Total 22 56
Mapping of digital maturity parameters
Parameters HMN EDIT GDHI IMM IS4H SCORE SOCI Others
Human capacity; workforce V V V V V
Investments, funding and financial management V V
Information management (data source, integration, analysis,
V V V V V
visualization, dissemination)
Data quality and data use for policy and action V V V V V
ICT infrastructure V V V V V V V
Standards and interoperability V V V
Service and applications V V
Leadership and governance V V V V V V
Legislation, policy, and compliance V V V V
Review progress and performance (M&E) V
e-Government V
Advanced analytics V
 SOCI as the main instrument
1. Leadership and governance
HIS leadership and governance
2. Policy, Regulation and compliance
3. HIS Investment, funding and financial management
4. HIS workforce and human capacity
HIS Management and Workforce
5. Review progress and performance of HIS
6. ICT Infrastructure
7. Security
HIS ICT Infrastructure
8. Applications and services
9. HIS standard and interoperability
10. Health management information (data collection,
HIS Standard and Interoperability
integration, analysis, dissemination)
11. Data quality and data use
12. Advanced analytics
HIS Data Quality and Use
 5 scale digital maturity
Instrument Scale
Level 0 Level 1 Level 2 Level 3 Level 4 Level 5
Sustainable
EDIT No Capacity capacity
SCORE 1 2 3 4 5
IS4H 1 2 3 4 5
Institutionalize
IMM nascent Emerging Established d Optimized
GDHI 1 2 3 4 5
Not emerging/ ad
SOCI applicable hoc Repeatable Defined Managed Optimized
Instrument validation and refinement

•• DHIS2
•• Expert MoH, Province
Internal meeting Electronic platform
Pilot Test and District
Team •• Spreadsheet level Form •• Technical
support
Socialization and • Hybrid meeting
distribution • Inviting 78
Targeted
self-assessment
respondent
• Several health
office could not
attend
(Kalimantan,
Papua)
Data Analysis Strategy
Quantitative data Qualitative data

Grouping: Consensus, MoH

Group (directorate generals) Description of evidences
and Sub-national (main General analysis: from the DMI instruments
islands, provinces and
districts)
Response rate by group,
completeness,
participations rate by
FGD: MoH, sub-national,
Calculate average score gender professional association.
(1-5) from the total 42 Development partners and
questions Comparison DMI level with private sector
external data: Health Profile
score, completeness of
Descriptive: average score minimum service standard Consensus workshop:
by domain, sub-domain and indicators validation of evidence,
parameters within the 3
recommendation of actions
groups
Assessment Result
 Response rate

* 2 sub-national level not eligible (less than 80% completeness

Response rate by group (total 69%)
Participation rate of self-assessment
Digital maturity, Health profile, reporting rate
Health Profile Score Reporting Rate SPM
DMI Level DMI Level
Above Below Above Below

1 8 3 1 6 5
2 23 5 2 22 6
3 4 3 3 4 3
4 1 4 1
Grand Total 36 11 Grand Total 33 14
Digital maturity, Health profile, reporting rate
Level 1 Level 2 Level 3 Level 4 Total

Reporting Rate SPM

Above 6 (12.8) 22 (46.8) 4 (8.5) 1 (2.1) 33 (70.2)

Below 5 (10.6) 6 (12.8) 3 (6.4) (0) 14 (29.8)

Health Profile Score

Above 8 (17) 23 (48.9) 4 (8.5) 1 (2.1) 36 (76.6)

Below 3 (6.4) 5 (10.6) 3 (6.4) (0) 11 (23.4)

DMI Level and Health Profile Score

Kualitas data profil kesehatan

II III

I IV

Level DMI
STAGES OF CONTINUOUS HIS IMPROVEMENT - CONCENSUS

Emerging Repeatable Defined Managed Optimized

Leadership & Governance 2.33

ICT Infrastructure 2.8

Standards & Interoperability

Data Quality & Use 2.31

2.85
2.54
Management & Workforce 2.2
DMI Level in different group
Consensus vs average score of DMI Level
• all domains have gaps that need to be
improved

• Compare to sub-national average

score, the consensus and MoH group
result was slightly better for almost
all domain, especially ICT
Infrastructure, and standard and
interoperability.
Domain A: HIS leadership and governance
Consensus 2.3

Min Max
1.4 2.3

Papua Jawa-Bali

Note: there are several HIS documents and regulations available, digital health transformation blueprint, MoH
strategic planning, eHealth strategic planning, some sub-national level has HIS strategic planning

Propose actions: advocate national HIS documents, establish HIS unit at sub-national level, allocate budget
for HIS in the organization strategic planning (especially at sub-national level)
Sub-domain of HIS leadership and governance
Parameters of HIS leadership and governance
• Organization structure
and Leadership are
perceived most required
improvement at
sub-national level and
MoH Level.
Domain B : HIS Management & Workforce
Consensus 2.2

Min Max
1.2 2.2

Papua MOH

Notes: HIS capacity building and acknowledgement (career path). Small budget allocation for HIS at
sub-national level and inconsistency (depend on specific event and leadership)

Propose actions: HIS workforce acknowledgment, IT background part of the health workforce, regulation
standard HIS workforce and their competencies. Mapping of budget allocation for HIS (reference for
sub-national level). Advocate high level staff at sub-national level for HIS
Sub-domain of HIS Management & Workforce
Parameters of HIS Management & Workforce
• HIS competency, HR
capacity building and
policy were amongst the
weakness
Domain C : ICT Infrastructure
Consensus 2.8

Min Max
1.3 3.3

Papua MOH

Notes: Lack of infrastructure in sub-national level (quality and quantity). Requires budget for infrastructure
maintenance. Collaboration with District office of ICT (infrastructure, security, maintenance)

Propose actions: national budget allocation for infrastructure, develop tool to evaluate infrastructure
requirements at sub-national level. Develop SOP for ICT maintenance and BCP (for sub-national level) and
capacity building. Improve internet access remote area in collaboration with MoIC.
Sub-domain of ICT Infrastructure
Parameters of ICT Infrastructure
• Infrastructure ICT was
perceived better compare
to other domain of DMI
• MoH, Sumatera and
Jawa-Bali have higher DMI
Level compare to other
groups.
Domain D: Standard & Interoperability
Consensus 2.8

Min Max
1.3 2.4

Jawa-Bali
Papua
MOH

Notes: HIS guideline available (health program specific, data quality) with possible overlapping. MoH just recently develop
standard and interoperability, release new regulation. Information systems still fragmented (health program specific).
Master data under development
Propose actions: Advocate new regulation, increase sub-national level capacity to facilitate interoperability within their
area, elaborate number of HIS related guidelines to avoid duplication and confusion. Integration of aggregate data and
accessibility (OneHealthData). Certification for interoperable IS. Scaling up health data standard and unique ID (and
access for sub-national level)
Sub-domain of Standard & Interoperability
Parameters of Standard & Interoperability
• Data sets, master facility list,
individual data exchange, and
interoperability architecture have
been included in the regulations.
• Several activities were under
development (medical terminology,
integration and data sharing)
• The implementation of
interoperability was still limited
(scale and quantity), especially in the
sub-national level
Domain E: Data Quality and Use
Consensus 2.3

Min Max
1.4 2.4

Papua Sumatera

Notes: Routine data available but within each health program. Fragmentation of information access and use. Data quality
assessment is in place. New regulation of One Health Data

Propose actions: individual and aggregate data quality assessment as routine activity, improve access to routine data
(analysis on the fly), advocate and implement One Health data regulation (data integration, data analysis and access)
Sub-domain of Data Quality and Use
Parameters of Data Quality and Use
• Infrastructure ICT was
perceived better compare
to other domain of DMI
• MoH, Sumatera and
Jawa-Bali have higher DMI
Level compare to other
groups.
Limitation
• Operational definitions were perceived different amongst respondents
(differences in understanding): both narrative questions and the possible
answers
• Some questions mention “based on national standard“, it was confusing
since there is no concrete standard that is mentioned)
• Not relevant to the existing HIS situation in the organization (especially
for the sub-national level)
• Some questions were perceived repetitive (duplication)
Recommendation and follow up
• Dissemination results in form of seminar, publication
• Ensure priority action plans incorporated into national HIS activities and
digital health transformation in Indonesia
• Improve self-assessment instrument for sub-national level
• Individual feedback for sub-national level which has completed the
assessment
• Scaling up assessment for other sub-national level and re-evaluate the
DMI country level.
Conclussion
• The results of the digital maturity assessment show that there are still
gaps that require intervention
• Governance, leadership and regulation
• Management of health information systems and human resources,
• Information and communication technology infrastructure, especially at the
sub-national level,
• Application of standards and interoperability at the facility level. health services,
and
• Improving the quality of data and its use for strategic decision making at all levels
of the organization and users.
 THANK YOU

This presentation is made possible by the support of the American people through the United States Agency for
International Development (USAID). The contents are the sole responsibility of the Country Health Information
System and Data Use program and do not necessarily reflect the views of USAID or the United States
Government.