Utilization of Health Technology in Managing Primary Health Services and Programs of Private Sector

This article was written because I was invited as a speaker at the 2022 Indonesian HIV Research Network National Meeting (Pertemuan Nasional Jaringan Penelitian HIV Indonesia 2022) this December. I really enjoyed being a speaker about Health Technology (HT), even though I’m not an expert. I dared myself to accept the invitation with the consideration that my opinion as a user/beneficiary of health technology could be useful for other friends working in health services and programs, especially in the private sector. I hope so.

This opportunity helped me to reflect the meaning of HT, both in my daily life personally and as a professional clinician and manager of a private organization in the health sector.

In order to avoid rambling, I refer to HT’s understanding according to several sources.

  • Health technology is defined by the World Health Organization as the “application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives”.
  • Indonesian Law on Health (Law No.36/2009) in chapter 42 stated that
    • Technology and health technology products are held to be researched, distributed and developed and utilized for public health.
    • Health technology as referred to in paragraph (1) includes all methods and those used to prevent disease, detect disease, alleviate suffering from illness, cure, minimize complications and restore health after illness.

Based on the understanding above and personal experience in enjoying technological advances, convinced me that the development and use of technology is beneficial to fulfill the needs of my daily life and making activities easier, faster, and more precise. Moreover, the development of digital technology is so rapid.

The benefits of technological advances can be felt by the world of health—the field of profession that I am involved in as a doctor, clinician, and manager of organizations engaged in basic health business social enterprises. Evaluation over the past few days resulted in the view that progress in HT is indeed beneficial, as well as challenging. The challenges vary depending on the needs and conditions/situation when deciding to choose and access the right health technology.

HT does not stand alone. It is connected to other types of technology, especially technology in the fields of information, communication and education. Examples of information and communication technology: websites, television, radio, e-mail, mobile phones, instant messaging and social media applications, meeting applications such as Zoom, Google Meet, and educational technology such as online learning.

I illustrate that the rapid development of HT today is like a busy shopping mall filled with diverse choices of models with attractive and intense offers, and boisterous visitors who want to buy/use. Buyers even fight to get it according to the variations in the challenges of each individual in terms of needs/goals, abilities, and situations/settings. In more detail, the variations are as follows:

  • The difference between the need of technology and their goals. This applies to the public, private, and/or government sectors.
  • Availability of funds. Whether or not you can afford it, independent funds or funds from other people/organizations or regions/countries/grants.
  • Not ready to access. It’s just the display stage because the technology is still in the research/testing stage, or it’s a new model/prototype, or it has to pivot because it still has to be imported, or it can’t be accessed yet because there are certain regulations that must be complied with.
  • Confused to choose. Is it for clinical needs such as screening, diagnostics, treatment, or prevention, or for a combination of these? Do we choose simply to follow our desires or is there a pure need? Do we vote based on personal interests, or for organizational, regional, and national needs?
  • Forced to choose a certain technology for reasons the majority are already using it, so we inevitably follow it to make it easier and cheaper.
  • Unconsciously, we just follow the trend to look advanced.
  • There is no more space to choose, because it is immediately available and it is mandatory to use it even if there is a possibility that the technology is not suitable.
  • Consider security and data privacy systems. Don’t let the collected data and someone’s personal data are accessible without permission, even to be traded by people who don’t have access.
  • The use of technology for public health or individual health purposes?
  • Considering the limited amount of money to save lives it would seem inhumane. If a HT is needed by someone we love, we will definitely try hard to get it, whatever the cost or wherever the tool is, even if the technology does not yet have scientific evidence.

Specifically, the biggest challenge for me working in the private sector is how to adapt and choose the most appropriate with the availability of funds, resources, and organizational infrastructure. Angsamerah cares about the secured data and privacy of patient and company, considering that our services are closely related to areas that are full of stigma: sexual health, sexually transmitted infections and HIV, and mental health.

If the selection is not right, instead of helping, the opposite could happen. The HT we choose and use will make it complicated. It’s expensive, and not effective! It is very different if we understand the purpose of investing in the application of this technology. Even if you spend a lot of money, it’s not a problem as long as there is a cost-benefit analysis calculation, namely the process of comparing/analysing the estimated costs and benefits associated with a business/product/service purchasing decision.

Let me share my experience in selecting the utilization of TK implementation from Angsamerah’s perspective. This means that I, as a private organization, apply a social entrepreneurial approach in providing differentiated models of primary health services that are needed by the community, particularly in relation to sexual and mental health services and other related diseases. Most of the health services in Angsamerah are related to government program public health, both routine programs with government funds, as well as initiation/temporary programs sourced from grants through ministries, or directly to private organizations. Angsamerah Foundation has received grants from several international organizations, such as the USAID, ASHM, and currently ongoing programs from the AIDS Healthcare Foundation.

There are several models of independent investment health services and programs created and managed by the Angsamerah organization: clinics, online consultations, independent physician practices, pharmacies, Angsamerah POS (Health Check Point) mobile clinics, Kacapikir educational program and the Angsamerah blog which currently contains more from 800 articles and our own Angsamerah management application design. We use a variety of technologies, according to the goals of each model unit and the needs of Angsamerah’s organizational management as a limited company and foundation. These technological variations are interconnected.

How do we choose the right HT?

There are 3 stages that my team and I did:

First stage. In general, we refer to the ideal HT expectations, as follows:

  • Proven to provide the highest accuracy and quality.
  • Zero side effects and non-invasive.
  • Not complicated but practical to operate, fast results, low maintenance, easy and responsive.
  • Affordable, even accessible for free or available as open source.
  • Easily accessible anywhere.
  • Safe for the environment.

Even so, I’m also realistic that perfect technology is just an illusion. The ideal technology is relative. Why? Human needs are very complex, unlimited following changes in human health that constantly evolve with environmental and socio-cultural changes, while the process of producing “ideal” technology is very limited and is influenced by factors such as the development of knowledge and skills, time, effort, and costs.

Second stage. Analyze sharply and thoroughly:

  • Purpose of technology needs: clinical, nonclinical, or for management purposes.
  • Why a particular technology is needed. Also learn the differences and correlation between existing/old and new technologies.
  • Identify our seller/provider partners and those who assist us in designing or operating the technology.

This stage helps the process of selecting the technology we need to be systematic and brief, and the selected technology is able to integrate with the technology we already have.

Third stage. We filter the results of the technology choice in the second stage using 5 filter elements that we routinely discuss, namely:

  • Quality

We will continue to strive to select the technology with the best accuracy. Whether for screening, diagnostic, treatment or other purposes. Also, consider safety: there is or how much risk the technology poses to patients/clients/users, our staff and the environment.

  • Client base-oriented.

Ensuring the selected technology prioritizes benefits based on client/patient needs.

    • For screening, diagnostic and treatment needs: non-invasive/painless, no harmful side effects, quick results, or can the patient do it himself.
    • For customer care: making it easier for clients to access information and services, for example: bookings, fast response, no need to wait long, and convenient.
    • Fees that do not burden the client/patient. It would be even better if we could allow clients/patients access at no charge.
  • Service/program provider. Paying attention to technology that’s easy to operate for the technical team, both health and non-medical personnel, to carry out their duties. Usually new technology is difficult at first because we are not used to it. With early training, the technology is easy to learn and operate with zero human error.

 

I will give an example of the use of information and communication technology, related to service data management using the Angsamerah application. Starting from medical and non-medical staff who are in charge of booking appointments to input the patient/client’s data, then paramedics complete the data, doctors fill in diagnoses and examination results, laboratory technicians complete the results, pharmacists carry out the drug/vaccine logistics, cashiers and financial management settle the payments, all business units carry out monitoring and evaluation, all connected.

Technology should be easy for the team to operate. There is also a team that is always ready to provide assistance in solving problems that arise in operations.

  • Management
    • Ensure that the variations of technology to be used are integrated with other devices, thus minimizing repetition in all processes between divisions/units/individuals. Example: from the time of patient booking, visit, and follow-up, then data collection, financial and accounting systems, including customer satisfaction surveys, are all integrated.
    • Facilitate communication and coordination between the team and external parties, ease of accessing subunit team data while still paying attention to and maintaining data security and privacy.
    • The technology is not easily damaged, maintenance is easy, consumable supporting materials are easy to obtain and are sure to be supplied on time/not on and off, and are affordable. It is also important to pay attention to the availability of a team that is responsible and responsive in overcoming problems that arise suddenly.
    • Easy monitoring, supervision, and evaluation of usage.
    • Paying attention to the calculation of the cost-benefit analysis of the use of technology.
    • Integrated data management technology utilization with security and privacy issues.
  • Marketing
    • Technology supports our social marketing approach. This means that HT is able to combine promotion, marketing and educational messages through technology platforms that are currently developing rapidly such as websites (articles – blogs) connected to social media (Instagram, Facebook, Twitter, LinkedIn).

These three stages of the screening process helped me and my team to deal with a rapidly evolving range of technologies. We were not in a hurry; we were able to minimize/anticipate the commotion. We are also able to control the costs of using technology. When newer technologies emerge, we don’t have to overhaul existing systems and start from scratch again. Old technology and newest technology can be integrated, or old technology can be upgraded.

That’s the description of my brief reflection on the use of HT from the user’s point of view. Hopefully useful for you!

At the end, as a reminder for all of us:

“… Perfect technology is an illusion or even ideal technology is relative, human is the driver in developing and utilizing technology as much as possible for humanity purposes.”
“…be specific, stay focused and do it step by step. Start with what we can do at no cost, or adjust to your abilities. Don’t forget to be observant to take advantage of what is already there.”

Let’s enjoy the work, friends!

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