Jakarta, Indonesia – AeHIN, in partnership with FIND and in collaboration with the Ministry of Health (MoH), conducted two consultative workshops to confirm and triangulate the findings from the interviews and field observations on One Health antimicrobial resistance (AMR) surveillance and data systems in Indonesia. The goal is to establish a playbook for AMR and Antimicrobial Use/Consumption (AMU/C) within the SATUSEHAT system to support the development of an interoperability framework. The workshops included presentations on the findings, challenges, and opportunities in AMR surveillance, followed by group discussions focused on data and technology, regulation and policy, and practitioners and service facilities. The first workshop consisted of three sessions, and the second workshop consisted of four sessions; both took place in Jakarta and were held in a hybrid format (online and offline). The invited stakeholders from government sectors, professional associations, international development partners, hospitals, and relevant private sectors were identified through the stakeholder mapping process, alongside those who partook in the interviews and observations.

Participants from the government sector, professional associations, international development partners, and relevant private sectors joined the first consultative workshop for the ‘Development of Interoperability Data Standards (IDS) for FHIR-based Antimicrobial Resistance One Health Surveillance (FAMROHS)’ project

The first workshop was conducted on 12 September 2024 at the Royal Kuningan Hotel. The workshop served as a critical step in developing interoperable data standards for AMR reporting, identifying challenges, and proposing collaborative solutions. Key discussions during the workshop centered around the need for standardized data collection and reporting practices to ensure consistency across health facilities. For instance, the Directorate of Health Service Quality at the MoH highlighted the importance of linking healthcare-associated infections (HAIs) with AMR surveillance and stressed the need for improved feedback mechanisms within healthcare facilities to enhance infection control practices. This sentiment was supported by another participant who emphasized the importance of systematically managing culture results and antibiotic usage to provide clearer insights into AMR trends. The Ministry of Agriculture also brought attention to the critical need to integrate veterinary and environmental data, particularly regarding antibiotic use in livestock, to ensure a unified approach to AMR control.

The discussions also highlighted significant barriers to the effective implementation of these recommendations. These included fragmented reporting systems, limited resources, and the slow pace of policy implementation. The current state of AMR reporting is fragmented, with more advanced surveillance in human and animal health compared to the environmental health sector. Existing reporting systems, such as SIMONA and SIRS Online, have yet to fully integrate data across these sectors, thereby hindering effective AMR monitoring. Stakeholders pointed out that the labor-intensive process of data collection, especially in coordinating national surveillance efforts, leads to data overlaps and inefficiencies. Furthermore, they emphasized the importance of improving data collection systems to include outpatient and community-level data, which are currently underrepresented in AMR surveillance, leaving significant gaps in the overall understanding of AMR dynamics.

Participants from the government sector, professional associations, international development partners, and relevant private sectors joined the second consultative workshop for the ‘Development of Interoperability Data Standards (IDS) for FHIR-based Antimicrobial Resistance One Health Surveillance (FAMROHS)’ project

The second workshop, conducted on 4 October 2024 at the Royal Kuningan Hotel, built on the discussions from the first workshop by focusing on tangible progress in AMR surveillance systems and data interoperability as identified in the landscape findings. While the first workshop emphasized the challenges of fragmented reporting systems and the need for standardized data collection, the second workshop showcased advancements, such as discussions on integrating AMR into national hospital accreditation and expanding the AMR Information System (SIRS Online). Based on WHO guidelines, these efforts align with the AMR National Strategy (Stranas), which focuses on four key pillars and 13 interventions to help AMR surveillance. One major initiative is the mandatory AMR reporting via SIRS Online, with new additions like PPRA (AMR Control Program) reporting. Notably, the second workshop introduced the plan to integrate electronic medical records (EMR) into national platforms like SATUSEHAT to streamline data collection, offering real-time monitoring and simplifying reporting.

Additionally, this workshop highlighted the importance of broader stakeholder involvement, including engaging the private sector through public-private partnerships and incorporating a wider range of clinical specialties in the AMR monitoring framework. Participants were divided into three groups, each group explored key areas in their expertise through focus group discussions (FGD) aimed at developing an AMR surveillance data standards and interoperability framework. This session outlined a clear path forward, focusing on defining data elements, ensuring interoperability, and using digital tools for real-time access, marking a significant step toward implementing a cohesive AMR surveillance strategy. FIND and the WHO also shared their insight on AMR interoperability experience at the global level, emphasizing the necessity of not solely data exchange, but also a mutual understanding of that data across various sectors. Effective AMR management requires aggregating data from human health, animal health, agriculture, and the environment, and using digital tools to facilitate this integration.

Following the landscape analysis and consultative workshops, the next step was to design efficient standards that enhance data collection and analysis in line with the digitalization of medical records without burdening healthcare professionals. To support this effort, the standard was developed using HL7-FHIR for the SATUSEHAT ecosystem. The Indonesian Ministry of Health has developed a playbook to implement HL7-FHIR for health facilities. For the purpose of enhancing surveillance, the AMR and AMU/C playbook was developed and disseminated. Among the recommendations that was delivered to the Ministry of Health, it is important to pilot the playbook in hospitals.

Hendri Kurniawan Prakosa presenting the project findings at MedInfo 2025

On August 12, 2025, at the MedInfo 2025 conference in Taipei, Taiwan, Hendri Kurniawan Prakosa, researcher from Universitas Gajah Mada (UGM), presented the paper titled “A Preliminary Result: Is Implementing WHO SMART Guidelines for AMR and AMU/C Surveillance in Indonesia Feasible?” The paper outlines the development of an interoperability playbook for antimicrobial resistance (AMR) and antimicrobial use/consumption (AMU/C) surveillance. It highlights the alignment of electronic prescription and culture testing data with HL7-FHIR standards and global health terminologies such as SNOMED CT, LOINC, and ICD-10. The initial findings indicate promising technical readiness for adopting the WHO SMART guidelines through Indonesia’s SATUSEHAT platform, marking a key step toward strengthening the national AMR surveillance system.

For more information about this project, please reach out to:

AeHIN at | secretariat.indonesia@aehin.net | secretariat.indonesia2@aehin.net 

UGM at | anis.fuad@gmail.com 

FIND Digital Health at | Joseph.Njunge@finddx.org | santi.maulintania@finddx.org